bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison between Xpert MTB/RIF threshold cycle value and smear microscopy of bronchial lavage for diagnosis of pulmonary tuberculosis in bronchoscoped patients
Authors: Khalil Magdy M. , AbdelHalim Hesham A. , Salem Gehad Y.
Published: May 2023

Context

GeneXpert MTB/RIF (GX) has an important role in the diagnosis and treatment of pulmonary tuberculosis (TB) and predicts the infectiousness of the patient through the threshold cycle (Ct) value.

Aims

To compare the performance of the Xpert MTB/RIF Ct-generated values with microscopy on bronchoalveolar lavage (BAL) fluid to determine the added value of GX Ct for TB diagnosis.

Settings and design

This was a prospective cohort study that was conducted in Kafr Elsheikh Chest Hospital from September 1, 2018 to December 31, 2019.

Patients and methods

The study was conducted on 111 BAL samples of highly suspected patients of MTB clinically (+\-) radiologically, who cannot give sputum or with hemoptysis. These samples were examined by direct microscopy, solid culture media, and GX, and the results were compared. An optimum Ct value was identified to determine infectious patients.

Results

Negative GX was 78 (69.3%) and the positive GX was 33 (29.7%). Culture-positive cases were 30 (27.0%). Smear result showed only seven positive cases. The correlation between smear grade and Ct value yielded a converse relation (r=−0.61). Ct cutoff value for ruling in smear-positive patients was established at 22.3 cycles (sensitivity was 90.4% and specificity of 63.2%).

Conclusions

The study confirmed that GX examination of BAL provides a good diagnostic rapid test that is superior to smear microscopy in detection of TB. Ct values demonstrate quantifying mycobacterial load and so can predict the infectiousness of the patients. Ct value less than 22.3 provides a good diagnostic test for smear-positive status.
Role of complement activation product C4d as a predictor biomarker in lung cancer diagnosis
Authors: El-Maboud Suliman Lucy A. , Moawad Amr A. , Elshahawy Heba , Abdalla Dina A.
Published: May 2023

Background

Molecular biomarkers such as complement C4d in bronchoalveolar lavage (BAL) may interfere with lung cancer diagnosis. However, limited studies have been conducted. The authors aimed to study the role of complement C4d as a predictive marker for lung cancer diagnosis.

Participants and methods

This case–control study included 45 participants: 30 were diagnosed as patients with lung cancer, comprising 16 with non-small cell lung cancer (NSCLC) and 14 with small cell lung cancer (SCLC), and 15 apparently healthy individuals as a control group. All patients (group I) were subjected to chest radiography, chest computed tomography, and flexible bronchoscopy. Forceps biopsies and BAL were taken for histopathological and cytological examination and measurement of C4d levels. For all participants, sputum and blood samples were collected for C4d measurement.

Results

There were statistically significant higher complement C4d levels in serum (P=0.006) and sputum of patients with lung cancer versus control group (P<0.001). There was no statistically significant difference in complement C4d level between NSCLC and SCLC in the three samples (P=0.315 for BAL, 0.7 for serum, and 0.744 for sputum). Complement C4d has a high sensitivity and specificity in serum and BAL for lung cancer prediction.

Conclusion

Complement activation product C4d biomarker could be used as a predictor of lung cancer diagnosis; however, it cannot differentiate between its two major subtypes: NSCLC and NSCLC.
Safety of osimertinib in adult patients with metastatic epidermal growth factor receptor T790M mutation-positive non-small cell lung cancer
Authors: Malik Prabhat S. , Noronha Vanita , Dabkara Deepak , Maddu Vamshi K. , Rajappa Senthil , Limaye Sewanti , Batra Ullas
Published: May 2023

Background:

A Phase IV, single-arm study was conducted to assess the safety of osimertinib in Indian patients with epidermal growth factor receptor (EGFR) T790M mutation-positive stage IV non-small cell lung cancer (NSCLC).

Methods:

Enrolled patients received 80 mg osimertinib for six cycles or until disease progression or unacceptable toxicity or withdrawal. Primary safety variables included treatment-emergent adverse events (TEAEs), serious adverse events (SAEs), and adverse events (AEs) leading to discontinuation/interruption/change (D/I/C) of drug dose, and AEs of special interest (AESIs). AEs were summarized by the percentage of patients experiencing at least one occurrence of each event.

Results:

Of the 60 enrolled patients (median age 58 [range: 34–81] years; 51.7% women) at eight sites, nine patients were discontinued prematurely due to disease progression (n = 7) and death (n = 2); median (range) duration of treatment was 126 (1–134) days. Median age of patients was 58 (34–81) years; 51.7% (n = 31) were women; 86.7% (n = 52) were nonsmokers; and most of them (98.3%) had adenocarcinoma. About 75% (n = 45) of patients experienced any of the TEAEs, with the most frequent being fatigue and creatine phosphokinase (CPK) increase (n = 6, 10% each). TEAEs in 11 (18.3%) patients were judged as study treatment related, with CPK increase being the most common (n = 4, 6.7%). TEAEs led to D/I/C of drug dose in eight (13.3%) patients, with one being study treatment related. Nine (15%) patients had AESIs of dyspnea (n = 6), chest pain (n = 2), and cardiorespiratory arrest (n = 1); two of them had a fatal outcome. One AESI (mild dyspnea) was considered study drug related. TEAEs of grade ≥3 were reported in seven (11.7%) patients, including dyspnea in two (3.3%), followed by diarrhea, mucosal inflammation, cardiorespiratory arrest, and others (n = 1, 1.7% each). None of the SAEs and fatal events were considered as study treatment related. Seven (11.7%) patients had abnormal electrocardiogram (ECG; not clinically significant) at the end of the study.

Conclusion:

Our study confirms the favorable safety profile of osimertinib without any new safety concerns in Indian patients with EGFR T790M mutation-positive stage IV NSCLC.

ClinicalTrials.gov Identifier:

NCT03853551

CTRI registration no. CTRI/2018/10/015941

-
A review of clinical evidence to assess differences in efficacy and safety of luteinizing hormone–releasing hormone (LHRH) agonist (goserelin) and LHRH antagonist (degarelix)
Authors: Bahl Ankur , Rajappa Senthil , Rawal Sudhir , Bakshi Ganesh , Murthy Vedang , Patil Ketaki
Published: May 2023

Luteinizing hormone–releasing hormone agonist (LHRH-A), goserelin, and antagonist, degarelix, are both indicated for the treatment of advanced prostate cancer (PCa); however, large comparative trials evaluating their efficacy and safety are lacking. In this review, we assessed the available evidence for both the drugs. Although degarelix achieves an early rapid decline in testosterone (T) and prostate-specific antigen (PSA) levels, median T and PSA levels, in addition to prostate volume and International Prostate Symptom Scores, become comparable with goserelin over the remaining treatment period. Degarelix causes no initial flare, therefore it is recommended in patients with spinal metastases or ureteric obstruction. Goserelin achieves lower PSA, improved time to progression, and better survival outcomes when administered adjunctively to radiotherapy compared with radiotherapy alone, with significant results even over long-term follow-up. The evidence supporting adjuvant degarelix use is limited. Goserelin has better injection site safety, single-step delivery, and an efficient administration schedule compared with degarelix, which has significantly higher injection site reactions and less efficient administration mechanism. There is conflicting evidence about the risk of cardiovascular disease (CVD), and caution is required when using LHRH-A in patients with preexisting CVD. There is considerable long-term evidence for goserelin in patients with advanced PCa, with degarelix being a more recent option. The available comparative evidence of goserelin versus degarelix has several inherent limitations related to study design, sample size, conduct, and statistical analyses, and hence warrants robust prospective trials and long-term follow-up.
CONCORDANCE
Authors: Prabhash Kumar , Biswas Bivas , Khurana Sachin , Batra Ullas , Biswas Ghanashyam , Advani Suresh Hariram , Mohapatra Prabrajya N. , Rajappa Senthil , Sharma Ajay , Patil Shekhar , Dattatreya Palanki Satya , Roy Rakesh , Almel Sachin , Goyal Gautam , Warrier Narayanankutty
Published: May 2023

Background:

Molecular tissue testing in non-small cell lung cancer (NSCLC) is done for the assessment of epidermal growth factor receptor (EGFR) mutation. EGFR mutation status is the basis for deciding the targeted treatment option for patients with metastatic NSCLC. The nonavailability of tissue samples and contraindications for biopsy pose a significant challenge. Hence, circulating tumor DNA (ctDNA) by liquid biopsy can be a viable alternative for NSCLC patients.

Methods:

This study was conducted at 15 sites across India. EGFR mutation testing from plasma was done as part of the study at the central laboratory by the next-generation sequencing (NGS) method, and EGFR mutation test results from tissue samples (done as part of routine practice) were recorded for all the patients.

Results:

Out of the total patients enrolled (N = 245), the majority (64.5%, n = 158) were men. The median age of patients was 58.0 (range: 26–84) years. The concordance between plasma and tissue testing was found to be 82.9% (95% confidence interval [CI]: 77.55, 87.45). The sensitivity and specificity of NGS were 68.4% (95% CI: 56.92, 78.37) and 90.1% [95% CI: 84.36, 94.21), respectively. Plasma testing detected 1.2% (n = 3) and tissue sample testing detected 2.4% (n = 6) positive status of exon 20 T790M EGFR mutation. Out of the total number of patients enrolled, 25 were tissue positive and plasma negative, while 16 were plasma positive and tissue negative.

Conclusions:

This real-world study in Indian patients suggests that plasma testing for EGFR mutation analysis is a viable diagnostic option in newly diagnosed advanced/metastatic NSCLC patients. The noninvasive plasma procedure in patients without available/evaluable tumor sample may enable more patients to receive appropriate targeted therapies by providing clinicians with valuable insights into the patient's tumor mutation status.

ClinicalTrials.gov Identifier:

NCT03562819
Relevance of multi-disciplinary team approach in diagnosis and management of Stage III NSCLC
Authors: Batra Ullas , Munshi Anusheel , Kabra Vedant , Momi Gagandeep
Published: May 2023

Lung cancer is reported as the leading cause of cancer-related mortality worldwide. Non-small cell lung cancer (NSCLC) constitutes 80%–85% of all lung cancers. Diagnosis of NSCLC is a complex multistep process. The prognosis of NSCLC is poor as most of the patients are presented at the metastatic stage. The management of these patients needs the expertise of different specialists. A multidisciplinary team (MDT) comprising specialists from different disciplines has a substantial role in improving outcomes in these patients. This is feasible through extensive discussions, accurate evaluation of patients, reviewing medical records, implementing ideal treatment strategies, and merging local treatments with systemic treatment concepts. Therefore, the MDT approach for stage III NSCLC management can enable early treatment initiation, optimal treatment modalities, and reduce healthcare expenditure. Studies have shown that MDT can provide multimodality care facilitating the diagnosis and treatment of stage III NSCLC, resulting in survival benefit of these patients. Thus, it is imperative to collate scientific evidence to get an insight into the MDT approach in advanced NSCLC treatment. This review aims to summarize the impact of MDT on treatment rates, survival outcome, treatment guideline adherence, and quality of life (QoL) of stage III NSCLC patients.
Evolving trends in lung cancer
Authors: Deshpand Ramakant , Chandra Manish , Rauthan Amit
Published: May 2023

Lung cancer is one of the deadliest cancers globally and accounts for most of the cancer-related deaths in India. Comprehensive data on lung cancer in India are lacking. This review aimed to discuss the epidemiological trends of lung cancers and driver mutations as well as the recent advancements in molecular diagnostics and therapeutic options primarily in non–small cell lung cancer (NSCLC) in India. Electronic databases, such as PubMed and Google Scholar, were searched to retrieve the relevant literature published in the past 5 years. As per the GLOBOCAN 2018 report, lung cancer was ranked the fourth leading cause of cancer (5.9% cases) in India, in all ages and sexes. Furthermore, 63,475 of all cancer-related deaths (8.1%) were attributed to lung cancer (cumulative risk 0.60), making it the third leading cause of cancer-related mortality. The common targets for treatment in lung cancer patients mainly include EGFR mutation, ALK and ROS1 rearrangements and PDL1 expression. In India, EGFR and ALK re-arrangement are commonly reported, but there is limited data of PD-L1 expression. Molecular testing has gained importance as several biomarkers are being targeted to treat lung cancer patients. Surgery, radiotherapy, systemic chemotherapy, and personalized molecular-targeted therapy prolong the overall survival (OS) in patients with NSCLC. Although chemotherapy and molecular-targeted therapies have greatly improved the clinical outcomes, prolonged disease control could not be attained in most NSCLC patients. In this situation, immunotherapy seems to be potentially beneficial to obtain long-lasting disease control with minimal adverse events.
Mental Health and Related issues During COVID-19
Authors: Dewangan Roshan Lal
Published: May 2023

Coronavirus outbreak in Hubei Province, China, has now spread all over the world. People are witnessing the loss of thousands of lives across the world every day. On the one hand, where most of the government advisory aimed at facilitating physical health, the need for mental health promotion was also recognized. The aim of the paper is to review the findings and commentaries of researches during COVID-19. Coming data suggest that COVID-19 pandemic can cause several psychological distresses during and after this pandemic. Stigma, violence, and other social factors can give extra challenges to mental health professionals. Among these challenges, one serious factor is the risk of suicide. Older individuals, females, and health workers have been identified as most prone to the mental health crisis. E-platform has been identified as the best service delivery system; however, service delivery can be compromised by some hurdles. Few suggestions have been made on the basis of available findings for readiness and mental health promotion.
Personification of Stress, Depression, Anxiety, and Quality of Life, among Parents of Attention Deficit Hyperkinetic Disorder Children
Authors: Kumar Krishan , Sharma Rajni , Saini Lokesh , Shah Ruchita , Sharma Akhilesh , Mehra Aseem
Published: May 2023

Introduction:

Attention deficit hyperkinetic disorder (ADHD) is a common pediatric condition which contributes to poor quality of life (QoL) among parents of children diagnosed with the same. These parents go through anxiety, stress, depression, and other psychological trauma; face a lot of social taboos and stigma. These entire psychosocial variables affect their day-to-day life functioning, productivity, and psychological health. Thus contribute to poor perceived QoL among these parents.

Aim:

The study's main objective is, therefore, to see the effect on an ADHD child's parent of their perceived QoL in relation to their psychological wellbeing as measured by their level of stress, anxiety, and depression.

Materials and Methodology:

A total of 30 parents of children with ADHD were selected as samples from the outpatient section of the PGIMER, Department of Psychiatry, using a purposive and convenient sampling method. Among these parents, QoL was assessed using the WHO QoL (BREF); whereas stress, depression, and anxiety levels were assessed using Depression Anxiety Stress Scale II.

Results:

Our research findings suggest the mean age of the parents to be 32 years (with the age range of 28–45), with the mean age of the child as 9 years (with the age range of 4–13). Where parents <35 years of age (86.7%); have registered better physical QoL than those over the age of 35. Nonetheless, most parents (73.3%) reported poor perception of QoL. Our research findings also showed that most parents suffer from severe depression (66.7%), stress was also perceived as high among these parents, and parents aged >35 years showed higher anxiety than compared to other age groups. The overall QoL was also found to be negatively correlated with anxiety, stress, and social relationships. The mentioned findings have been discussed further.

Conclusion:

The overall results of this study showed clearly that most of the parents had perceived serious burden and poor QoL in all areas. The research also indicates that these parents are more distressed, stressful, and depressed. Our research finding indicated that for these parents to keep their lifestyles healthy, they can make a difference by recognizing and embracing the fact that ADHD is more inevitable than the one caused by environmental and/or personal errors. Parents should share their workload, increase their need for assistance and encourage one another to take some time out of the care of the child to have a shift and enhance their QoL.
Accessing Mental Health Care among People with Schizophrenia
Authors: Lukose Ammu , Venkatesh Rahul K. , Cherian Anish V. , Bhat Shrinivasa Undaru , Prabhu Santosh , Arahanthabailu Praveen , Kumar Shishir , Bhat Aneesh , Shetty Naveen Chandra
Published: May 2023

Background:

“Duration of untreated psychosis” (DUP) remains a major predictor of poor outcome among people with schizophrenia (SCZ). Reducing DUP remains a challenging public health concern. Studies from various low- to middle-income countries demonstrate that many patients with SCZ remain untreated for long, especially in rural communities. However, there is paucity of data from rural India on DUP and pathways to care.

Methodology:

We consecutively recruited 106 patients registered at a rural psychiatric center in South India who met the International Classification of Disorders-10 criteria for SCZ. The delay from the onset of psychotic symptoms to seeking psychiatric help was measured and the pathways to care were assessed.

Results:

The patients were nearly equally distributed across the genders and were predominantly <40 years of age from rural and low- to middle-income backgrounds. The mean and median DUP were 3.15 ± 5.61 years and 1 year (interquartile range = 2.79), respectively. Although the longest time to contact was 28.5 years, 80% had DUP shorter than 5 years. Three major gateways to care were identified, with native/faith healers being the most popular (73.58%).

Conclusion:

In rural India, patients with SCZ tend to take longer to seek psychiatric help after their first psychotic episode compared to urban counterparts. Our results emphasize the necessity of developing early identification, improving mental health literacy, and providing community-based interventions for people with SCZ.
Naturalistic Study of “Adherence to Follow-Up” in the Initial 1st Year Cohort of Patients Utilizing a Tertiary Hospital-based Geriatric Mental Health-Care Service using the “Service Evaluation Framework”
Authors: Gupta Nitin , Das Subhash , Kaur Tanupreet
Published: May 2023

Background:

There are very few specialised hospital with quality assurance services catering to the needs of the elderly with mental illness. The concept of 'Appointment adherence' has received little attention in the field of geriatric mental health from India. There is a need to study the pattern of 'drop-out' amongst geriatric patients.

Method:

An initial cohort of first 105 cases presenting to the clinic were followed up to explore their socio-demographic and clinical variables, overall functioning and satisfaction with the services. Adopting a 'naturalistic approach,' and using the 'service evaluation framework', at the assessment period of about 36 months, tools like socio-clinical profile, Hindi Mental State Examination (HMSE), Everyday Abilities Scale for India (EASI), Global Assessment of Function (GAF) scale, WHOQOL-BREF-Hindi version, Patient Satisfaction Scale (PAT-SAT) and 'Service Evaluation (SSS-16 and SSS-10 Practitioner Versions)' were administered.

Result:

68 cases were available for assessment of functional outcome and satisfaction parameters were assessed for 78 of the cases. 75% had functional disorders and medical morbidity was present in more than 50% of cases. The mean score for WHOQOL-BREF and GAF were 44.4 (poor quality of life) and 72.91 (slight impairment in socio-occupational functioning) respectively. PAT-SAT score in all the sub-categories were above average. 'Organic' diagnosis patients had lower QoL on certain domains compared to 'functional' patients. Only 30.47% patients were coming for follow-up with 25.71% having died. Of the 32/68 (34.29%) cases who had dropped out, 50% were adherent to treatment in different ways. Additionally, GAF scores were lower in 'drop-out' group.

Conclusions:

There is a relatively high rate of 'drop-out' over a 3-year period. However, if patients keep coming for follow-up (i.e. do not 'drop-out'), they are more likely to show improvement in their level of social and occupational functioning.
Profile of Inhalant Users Seeking Treatment at a De-addiction Center in Kashmir
Authors: Ismail Haamid , Hussain Arshad , Ismail Nadia , Zargar Waris Ahmad , Kour Sanjeet
Published: May 2023

Background:

As substances of abuse, inhalants are chemicals whose vapors can be intentionally inhaled to produce psychoactive effects. Serious mental health and substance use problems commonly co-occur with inhalant-use disorders (IUDs).

Methods:

It was a cross-sectional study. All patients attending the outpatient service and inpatient department of the de-addiction center of the institute-seeking treatment for inhalant use were approached for the study. Diagnosis of IUD was made as per the Diagnostic and Statistical Manual-5 criteria by the consultant psychiatrist. A semi-structured questionnaire was used to record the sociodemographic status. A phenomenology checklist was used to assess the phenomenology.

Results:

A total of 92 patients were included in our study. Nearly 98.9% of participants were males and 70.5% were of urban background. About 59.8% of participants were educated up to middle classes. The mean age of the study group was 18.38 years. Two-third of our study group were in the age group of 10–19 years. Adhesives were the most predominant inhalant used by 100% of cases. Bagging was the predominant mode of intake of inhalants (83.7%), followed by sniffing (16.3%). Feeling of relaxation (100%) followed by euphoria (73.9%) was the common hedonic experiences, whereas nausea was the most common aversive experience reported by 73.9% of cases. All patients reported high levels of craving.

Conclusion:

Our results showed that inhalant users were mostly urban male students who were using adhesives as the predominant inhalant. Bagging was the most common mode of intake of inhalants. Policymakers need to develop strategies regarding inhalant-use problem, especially in schools.
Assessment of Mental Health in Indian Medical Students during the Coronavirus Disease-2019 Pandemic
Authors: Mangalesh Sridhar , Dudani Sharmila , Dave Neeru D
Published: May 2023

Context:

Medical students are more anxious and depressed than their peers, and the prevalence of various mental health problems is on the rise. The coronavirus disease-2019 (COVID-19) pandemic has had far-reaching psychosocial consequences on the Indian population.

Aim:

The aim of this study is to assess the mental health status of Indian medical students during the COVID-19 pandemic and lockdown.

Settings and Design:

A questionnaire-based, cross-sectional study of medical students from across India.

Methodology:

The general health questionnaire with 28 items (GHQ-28) was adapted to GoogleForms® and circulated extensively to medical students in various colleges across India among the nationwide lockdown that began from March 22, 2020. A total of 1000 responses were collected for a period of 1 month from May 12 to June 11. Other questions included uncertainty due to the pandemic about one's career as a medical student, satisfaction with the field of medicine, the year of training, and how long the student believed the effects of the pandemic would last.

Statistical Analysis Used:

A Chi-square test was applied to compare the proportions, and Mann-Whitney U or Kruskal–Wallis test was used to compare the continuous variables between the groups.

Results:

A total of 60.3% (57.2–63.2) of students had GHQ-28 scores above the cutoff of >23 and had mental health problems. Female sex, smoking, alcohol, dissatisfaction with medicine, and uncertainty due to the pandemic were associated with mental distress. GHQ-28 scores increased uniformly with the year of training of the student, except in the case of IInd year, where scores were the least. Similar trends existed for the somatic, anxiety, social-dysfunction, and depression score components of the GHQ-28.

Conclusions:

Mental health issues are very common among medical students, particularly now during the COVID-19 pandemic. Early identification along with guidance and counselling is essential for all-round development of medical professionals.
Mental Health Impact of the COVID-19 Pandemic on Reverse Migrant Workers in Uttarakhand
Authors: Verma Kanupriya , Mujawar Zeeshan , Mujawar Swaleha , Banerjee Amiya
Published: May 2023

Introduction:

The announcement of a nationwide lockdown in India in March 2020 in response to the CoVID-19 pandemic led an exodus of migrant workers back to their homes. The significant adverse impact of this event in its early phase on these reverse migrants has been well documented. With the passage of several months, these reverse migrants eventually reached their homes and re-entered their own communities. This study was conducted amongst a rural community on the interior regions of Almora in hill state of Uttarakhand.

Aim:

It aims to assess the impact of the later phase of the CoVID-19 pandemic and lockdown on the reverse migrants, and compare this impact with the residents, who have never migrated. Methodology: Door-to-door survey was conducted in the study population, 5-9 months after the lockdown was announced. The participants were matched and grouped into residents and reverse migrants and were evaluated on PHQ-9, GAD-7, IES, and BRIEF-COPE to assess the impact on the participants.

Results:

No significant depression or anxiety was found in the reverse migrants group, even though the impact of the pandemic and lockdown was felt more by them as compared to the residents group. In addition, there was no significant difference between the two groups for depression or anxiety.

Conclusion:

These findings can be attributed to factors such as social support from the community members, engagement in work and the use of approach based coping mechanisms.
Psychological Impact and Coping Strategies in Health-Care Workers during the Coronavirus Disease 2019 Pandemic at a Dedicated Coronavirus Disease 2019 Hospital
Authors: Panse Smita Nikhil , Parikh Disha Devang , Santre Manjeet S. , Wadgaonkar Gaurav P. , Gholap Shwetali D. , Raidurg Kalyani A. , More Jyoti B. , Karad Arvind V. , Meshram Nimish S. , Sikchi Rachit S.
Published: May 2023

Background:

Health-care workers (HCWs) are on the frontline dealing with the Coronavirus Disease 2019 (COVID-19) pandemic all over the world. Several hospitals in India are now functioning as Dedicated COVID-19 Hospitals (DCH). This study has been designed to understand the psychological impact of the pandemic in HCWs at a DCH.

Objectives:

the objective of the study was to assess psychological impact and coping strategies in HCWs during the COVID-19 pandemic at DCH.

Subjects and Methods:

This is a cross-sectional observational study conducted at a DCH. The study used a semi structured questionnaire for demographic details and the tools-Depression Anxiety Stress Scale (DASS-21) and Brief COPE for assessing psychological impact and coping strategies, respectively, in HCWs willing to participate. Chi-square test was applied to establish an association between the demographic variables and psychological symptoms and Spearman's correlation coefficient was used to assess correlation between coping strategies and psychological symptoms.

Results:

Out of 136 participants, 43.4% (n = 59) had at least one of the symptoms among stress, anxiety, or depression on the DASS-21 scale. Resident doctors and nurses had a higher incidence of psychological symptoms (P = 0.009, χ2 = 13.58, df = 5). The presence of chronic illness was significantly associated with psychological symptoms (P = 0.036, χ2 = 4.38, df = 1). Higher values on the anxiety (ρ = 0.216, P < 0.05) and depression (ρ = 0.226, P < 0.05) subscales correlated with the increased use of avoidant coping strategies.

Conclusions:

There is significant psychological impact of the COVID-19 pandemic on HCWs. Regular assessment and mental health interventions must be part of the pandemic management. Building positive approach coping strategies can reduce stress and other psychological symptoms.
Public Health Challenges and Initiatives in Problematic Internet Use
Authors: Kathiresan Preethy , Bhargava Rachna
Published: May 2023

With the increase in Internet use across the world, there has also been an increase in the prevalence of problematic Internet use. There are various challenges in addressing the same – the addictive nature of Internet, lack of standard or uniform definition making its measurement or comparability across studies difficult, lack of national epidemiological studies that can help to direct resources based on the need, lack of awareness among the general public, challenges in restricting access of Internet to children and adolescents, and the commercial interests of gaming and gambling industries. The various initiatives to address problematic Internet use can be divided into supply reduction measures, demand reduction measures, and harm reduction measures, similar to that in the case of substance use disorders. Supply reduction measures focus on reduction in the availability or accessibility of Internet for children and adolescents. Harm reduction measures focus on regulating the age appropriateness of content of gaming or other Internet-related material provided to children, as well as restriction on the information that can be obtained from children. Demand reduction measures include promoting responsible use or healthy use of Internet as part of education for schoolchildren, and establishment of treatment centers for treatment of patients with problematic Internet use. India still has a long way to go in all these three arms of public health initiatives to curb the problem of Internet addiction.
Phototherapy versus pregabalin in treatment of chronic kidney disease associated pruritus
Authors: El Mulla Khaled F. , Khalifa Doaa E. , Gawish Rasha I. , Eldeeb Marwa E.
Published: May 2023

Background

Chronic kidney disease-associated pruritus (CKD-AP) is a challenging disorder with unsatisfactory treatment response. The exact pathophysiology is unknown. Phototherapy and pregabalin are commonly used treatment options. Narrow band-ultraviolet B (NB-UVB) acts by inhibition of Langerhans cells, modulation of interleukin production, and induction of apoptosis of mast cells. Pregabalin acts by suppressing presynaptic glutamate release through inhibition of calcium currents via high-voltage active channels, leading to reduced neurotransmitter release and attenuation of postsynaptic excitability.

Objective

To compare the safety and efficacy of NB-UVB versus pregabalin in the treatment of refractory CKD-AP.

Patients and methods

A prospective randomized controlled study included 40 patients on maintenance hemodialysis with refractory pruritus. Patients were randomized into two groups: group A (20 patients) received two sessions of NB-UVB per week for a period of 2 months, and group B (20 patients) received pregabalin (50 mg after each dialysis session) for 2 months. The results of the present study were assessed by total 5-D itch score (after 4, 8, and 12 weeks).

Results

Both groups showed significant reduction in itching severity by the end of treatment (week 8) but recurrence of symptoms during follow-up (week 12) was observed, with no significant difference between both groups. However, fewer adverse effects, earlier onset of response, and less tendency of recurrence were observed in the NB-UVB group.

Conclusion

NB-UVB and pregabalin are both effective options in controlling refractory CKD-AP. Rapid control and delayed recurrence of symptoms favor NB-UVB.
Prevalence, clinical criteria, and risk factors of skin tags
Authors: Abdel-Rahman Amal T. , Elsaied Seham A. , Mohammed Sahar S.
Published: May 2023

Background

Skin tags are benign condition; however, their appearance may be associated with some risk factors. There are no studies correlating clinical criteria of skin tags with the associated comorbidities whether isolated or mixed.

Objective

To evaluate prevalence, clinical criteria of skin tags, and risk factors that may be associated with skin tags.

Patients and methods

This study included 1000 participants, who were screened for the presence of skin tags and examined to detect clinical criteria. Patients with skin tags were screened for the presence of comorbidities (obesity, hypertension, diabetes mellitus, and dyslipidemia) and were classified into patients without associated comorbidities and those with isolated or mixed comorbidities.

Results

Overall, 30% of patients presented with skin tags. Most skin tags were brown (72%), small (50.8%), sessile (81.6%), and located on neck (56.6%). Comorbidities were reported in 95% of patients with skin tags, with predominance of mixed comorbidities (65.96%). In comparison with patients without associated comorbidities, skin tags with isolated comorbidities were more sessile (P=0.043) and medium sized (P=0.002). However, skin tags with mixed comorbidities were more sessile (P=0.011), more numerous (P≤0.001), and with older age of onset (P<0.001) compared with those without comorbidities. On comparing the two groups of comorbidities, skin tags with mixed comorbidities were more black (P≤0.001), large (P≤0.011), more numerous (P≤0.001), and older age of onset (P≤0.001). There was a significant correlation between lesion duration and numbers and age, BMI, random blood sugar, hemoglobin A1c, and dyslipidemia.

Conclusion

Skin tags are very common and considered as cutaneous markers for risk factors such as age, BMI, random blood sugar, hemoglobin A1c, cholesterol, and low-density lipoproteins. Presence of mixed comorbidities can increase the liability of skin tags to be more numerous, larger, and with late age of onset compared with presence of isolated comorbidity or even absence of comorbidity.
Evaluation of serum interleukin-33 as an activity serum marker for nonsegmental vitiligo
Authors: Khafagy Naziha H. , Magdeldin Amany M. , Ibrahim Mona Abdel-Halim
Published: May 2023

Background

Vitiligo is a chronic acquired disorder resulting from the destruction of epidermal melanocytes owing to multifactorial causes. Various cytokines play a central role in its pathogenesis. Interleukin (IL)-33 has an essential role in different autoimmune diseases; however, scarce data are available about its role in vitiligo as an activity marker.

Objective

To evaluate serum IL-33 levels in patients with active and stable vitiligo.

Patients and methods

A case–control study was conducted on 75 participants: 25 patients with active nonsegmental vitiligo (NSV), 25 with stable NSV, and 25 age-matched and sex-matched controls. The disease characteristics of vitiligo were reported regarding activity, duration, type, and extent. The vitiligo disease activity (VIDA) score was used to evaluate the disease activity. The serum level of IL-33 was measured by enzyme-linked immunosorbent assay in all groups.

Results

The serum IL-33 levels showed no significant difference (P=0.996) between active cases (mean=1378±1102.66 ng/l) and stable NSV cases (mean=1397±948.97 ng/l); however, a highly significant difference (P<0.001) was found between active/stable cases and controls (mean=230.00±55.90 ng/l). No relation was found between IL-33 levels and the patient's age (P=0.288), duration of vitiligo (P=0.67), duration of last activity (P=0.149), VIDA score (P=0.377), vitiligo extent (P=0.377), sex (P=0.217), or vitiligo types (P=0.383).

Conclusion

IL-33 may have a pivotal role in the immune dysregulation of NSV vitiligo. However, it cannot be used as a discriminating serum marker between active and stable cases.
Basal cell carcinoma mimicking noma
Authors: Srivastava Prachi , Saxena Animesh , Kanchan Shivansh , Chauhan Prateek , Chaturvedi Mohini
Published: May 2023

Basal cell carcinoma (BCC) is one of the commonest cutaneous malignancies and usually presents as a nodular or ulcerative lesion on the face and neck region. A rare subtype of BCC known as horrifying BCC, which is a locally destructive and invasive subtype of BCC, was seen in our patient, who had presented with a very large and grotesque-looking lesion covering the entire left half of the face, leading us to suspect noma or cancrum oris as the first differential diagnosis. However, on histopathology, it was confirmed as a case of BCC, thereby reinforcing the fact that as clinical presentations may be variable, histopathology should always be the gold standard for diagnosis. BCC has long since been known as a mimicker, with BCC mimicking lesions being a separate entity, but to the best of our knowledge, noma as a BCC mimicker has never been reported earlier. We are therefore presenting this case for its rarity.
Oral hygiene awareness and practice in orthodontic patients in Makkah city: A cross sectional study
Authors: Mahjoub Dalal Tariq , AlJabri Rahaf K. , Bifari Nidaa E. , Najjar Rahaf S.
Published: May 2023

OBJECTIVES:

To evaluate the level of oral hygiene awareness and practice among orthodontic patients that have fixed appliances and investigate the differences in awareness as per age, gender, and education qualification.

MATERIALS AND METHODS:

A cross-sectional study with 250 patients was included. A questionnaire was used to collect information regarding the patient's oral hygiene.

RESULTS:

The level of awareness and oral hygiene practice was significantly higher among females, with a consistent stepwise increase toward older ages. Also, increased with higher education level, longer duration since getting the appliance, and receiving instructions from the orthodontist.

CONCLUSIONS:

Oral hygiene instructions received by the orthodontist play an important role in the patient's awareness level. Also, many predictors have a significant effect on the patient's cooperation in practicing oral hygiene measures.
Effect of COVID-19 on orthodontic treatment/practice- A systematic review and meta-analysis
Authors: Alam Mohammad Khursheed , Abutayyem Huda , Kanwal Bushra , Alswairki Haytham Jamil
Published: May 2023

Coronavirus disease of 2019 (COVID-19), which has affected almost all medical professions, has had a significant negative influence on dental care. Additionally, non-urgent dental procedures were stopped during the epidemic in a number of countries. The purpose of this systematic review was to examine the impact of COVID-19 on individuals who had undergone or are currently having orthodontic treatment in any capacity during/after the pandemic's occurrence. After a thorough search of the online journals, a total of 634 documents were found, and 416 of the papers were initially chosen. The removal of 362 similar or duplicate publications that followed led to the initial availability of 54 separate papers. The final selection consisted of 23 documents, mostly in vitro investigations, cross-sectional studies, and comparative evaluations, which satisfied the necessary inclusion and exclusion criteria. COVID-19 had a significant impact on nearly every sphere of the patients' lives who were undergoing orthodontic treatment. However, people who are currently availing of various orthodontic treatment modalities did not experience the same issues as the ones faced by patients earlier. Teleorthodontics emerged as a viable option to access treatment during the lockdown period caused due to the pandemic. COVID-19 also had an overall negative impact on the psyche and morale of orthodontists around the world.

PROSPERO Registration Number:

CRD42022380823
Assessment and comparison of cranial base morphology in individuals with long face and short face
Authors: Rai Shivprasad , Saidath K , Mathew Karishma A. , Shetty Suhani S.
Published: May 2023

OBJECTIVES:

The objectives of the study was to assess and compare the cranial base morphology in long face and short face.

METHODOLOGY:

The study comprises 64 individuals (32 in each group). Group I consists of individual's with long face and group II comprises individuals with short face. Individuals were classified into groups with the help of lateral cephalometric parameters like Gonial Angle, Anterior facial height, Posterior facial height, Jarabak's Ratio, and Y-axis. Linear and angular measurement in the cranial base was taken.

RESULT:

The results showed statistically significant difference in Sella-Nasion, Sella-Basion and Nasion-Sella-Basion between the two groups. Sella-Spinoethmoidal suture, Nasion-Spinoethmoidal suture, Spinoethmoidal suture-Sella-Basion, Frankfurt Horizontal-Sella-Nasion, Frankfurt horizontal-Sella-Basion, Frankfurt horizontal-Sella-Spinoethmoidal suture showed no statistically significant difference among the groups.

CONCLUSION:

The study concluded that individuals with long face have a greater Sella-Nasion, Sella-Basion, Nasion-Sella-Basion compared to individuals with short face.
Digital evaluation and correlation of facial growth patterns assessed on lateral CEPH and orthopantomogram through ONECEPH mobile application
Authors: Goyal Diksha , Kumar Piush , Jain Shubhangi
Published: May 2023

OBJECTIVES:

This study aimed to investigate the correlation of gonial angle and three linear measurements on OPG and lateral cephalograms and their effects on the different facial patterns using the OneCeph android app.

METHOD:

About 90 pre-treatment digital lateral cephalograms and OPGs of 90 patients were selected and divided into 3 categories, based on their growth patterns. The OPGs and lateral cephalograms were uploaded on the OneCeph android app. After calibrating using One linear measurement i.e. length of extracted premolar for OPG and ruler in radiograph for lateral cephalogram, Gonial angle (Ar- Go-Me), ANS-Me (LAFH), U1-NF, L1-MP were measured. The data were collected, tabulated, and subjected to statistical analysis using the SPSS software (version 20.0). The level of significance was kept at 5%.

RESULTS:

Values for parameters were highest in the vertical growth pattern followed by average and horizontal in both cephalogram and OPG. Upon comparison of lateral cephalogram and OPG, no significant difference was observed in gonial angle and a significant difference in LAFH and L1-MP in all three growth patterns with OPG scores greater than cephalometric tracing. The interclass coefficient test indicated almost perfect agreement for the gonial angle between the two methods. A substantial agreement was seen for U1-NF on lateral cephalogram and OPG in the vertical group. Also, a fair agreement in the vertical and horizontal group was observed in Lower anterior mandibular height.

CONCLUSION:

Vertical parameters such as gonial angle and maxillary anterior dental height can be accurately determined on an OPG by the OneCeph application.
Primary Rhabdomyosarcoma of the Breast in an Adult: A Role of Volumetric Modulated Arc Technique Radiotherapy
Authors: Sarkar Sujata , Bashir Irfan , Yotham Roopesh Reddy , Sharma Ritesh
Published: May 2023

ABSTRACT

Rhabdomyosarcoma (RMS) is the most common soft tissue tumor in children and is rarely seen in adults. It is slightly more common in females. It constitutes <1% of all breast malignancies. Radiologically, it is difficult to differentiate RMS from other breast benign or malignant tumors. Hence, it is often diagnosed late. Immunohistochemistry staining with actin, desmin, myogenin, and myoD1 confirms the diagnosis. There is no standard treatment due to rarity of cases. Role of radiotherapy is still controversial, but many studies have shown the benefit of radiotherapy in large tumors of more than 5 cm. RMSs are usually aggressive tumors with survival ranging from 3 months to 7 years. Here, we report a case of primary RMS of the breast in a 49-year-old female, describing radiological and pathological features and treatment with volumetric modulated arc technique radiotherapy.
Modular orbits on the representation spaces of compact abelian Lie groups
Authors: Bouilly Yohann , Faraco Gianluca
Published: May 2023

Let

S

be a closed surface of genus

g

greater than zero. In the present paper, we study the topological-dynamical action of the mapping class group on the

\mathbb T^n

-character variety giving necessary and sufficient conditions for

\mathrm{Mod}(S)

-orbits to be dense. As an application, such a characterisation provides a dynamical proof of the Kronecker's theorem concerning inhomogeneous Diophantine approximation.
Steel, Hotwork Tool, Bars, and Forgings and Forging Stock 5.25Cr - 1.5Mo - 1.0V (0.35-0.45C) (H-13) Electroslag Remelted (ESR) or Consumable Electrode Vacuum Arc Remelted (VAR) Annealed
Authors:   AMS E Carbon and Low Alloy Steels Committee
Published: May 2023

This specification covers a premium aircraft-quality, low-alloy steel in the form of bars and forgings 25 square inches (161 cm2) and under, and forging stock of any size.
Sealing Techniques for Missile Applications
Authors:   A-6C2 Seals Committee
Published: May 2023

The purpose of this recommended practice is to provide the missile hydraulic and pneumatic component designer with information learned, tested, and substantiated in the correction of problems and failures experienced with seals that are subject to the unique requirements of missile static storage and subsequent dynamic operational conditions.
Compatibility of Turbine Lubricating Oils
Authors:   E-34 Propulsion Lubricants Committee
Published: May 2023

This method is used for determining the compatibility of a candidate lubricant with specific reference lubricants. The reference lubricants to be used will typically be mandated by the owner of the product specification against which the candidate lubricant is being compared. This method is split into two procedures (Procedure A and Procedure B) with a summary of each procedure contained in Section 4.
An (un)common remedy to Indigenous communities’ subsistence: revisiting Traditional Knowledge Commons
Authors: Zois Christos , Pergantis Vassilis
Published: May 2023

Indigenous Traditional Knowledge (ITK) has been at the centre of heated debates about patent and intellectual protection for a long time. Efforts to normatively regulate the protection of ITK are imbued by a property-based logic associated most prominently with intellectual property regimes, which focus primarily on its economic value. However, such an approach collides with the spiritual, cultural and sacred character of Indigenous Traditional Knowledge. This article aims to provide an alternative for ITK protection through the revamping of the Traditional Knowledge Commons (TKC) concept. It elucidates those TKC traits beneficial to Indigenous communities and identifies potential challenges associated with TKC implementation. The article highlights instances of successfully enacted TKC as evidence of the economic and social capacity of such communitarian schemes, which can further empower Indigenous communities. Lastly, the article explores the viability of establishing a commons-alike ITK management regime on a global scale given the divergent views and aspirations both of communities providing ITK and potential ITK users.