bluuebunny/crossref_metadata_2025 huggingface dataset:
Community Preparedness towards Dam Disaster: Disaster Risk Reduction (DRR) Program in Cameron Highlands
Authors:   TNB Research, Malaysia, Muda Rahsidi Sabri , Hussain Mohd Ramzi Mohd , Tukiman zawati , Abdullah Fatin Shahira
Published: July 2021

Dam disaster occurrences are an unexpected event that occurs suddenly without warning. It has become very alarming, resulting in a catastrophic break followed by a flood wave at high speed with considerable loss of life and catastrophic damages to infrastructure and the environment. Given these circumstances, the community preparedness for disaster risk reduction (DRR) is important to strengthen disaster response strategies. It helps the community to understand the situations to face disaster and interact with present conditions with efficient manners. The research aims to investigate the community awareness and preparedness and the effectiveness of the DRR program toward dam-related disaster. In this research, two dams in Cameron Highland have been selected as sites study: Sultan Abu Bakar (SAB) Hydroelectric Scheme and its vicinity in Lembah Bertam; and Susu Dam and its vicinity in Pos Telanok. The research utilised questionnaire surveys as a data collection method, where Statistical Package Software SPSS Version 25 was used to analyse data. The finding indicates that an integrated community-based program is an effective approach to increase people's preparedness for the disaster. The result can assist local agencies and dam owners in formulating strategies for future DRR programs. Identifying these pertinent factors enables a greater understanding of the community's preparedness for disaster risk reduction (DRR) in both dams of Cameron Highlands.
Two Decades of Research in e-Learning: A Deep Bibliometric Analysis
Authors:   REMIT, Universidade Portucalense, Portugal, Sobral Sónia Rolland
Published: July 2021

E-learning is the electronic version of distance learning: a planned teaching that presupposes a physical separation between the teacher and the student. The distance is either geographic or temporal, and communication can be asynchronous or synchronous, respectively. E-learning has been a target of high-quality research for the last two decades. The purpose of this paper is to analyze the scientific production on e-learning in journals indexed on Elsevier’s Scopus. The sample was composed by 25330 articles from 2000 to 2019. The results obtained by bibliometric analysis showed that rates publication continue to increase. A report was made on the journals, languages, authors, keywords, organizations and countries that publish in the field. This analysis was done for all articles as well as for the most cited articles. The bibliometric analysis was done for a total of 20 years, as well as for four 5-year periods. This article provides information from the past, but mostly clues about research on e-learning in the future.
Involving Students in the Instructional Design Process to Improve Their Satisfaction with Their Learning in the COVID-19 Era
Authors:   the School of Information Sciences, Morocco, Imane Ryane
Published: July 2021

Like most university students worldwide, the engineering students at the School of Information Sciences (ESI) have to deal with their school closure and the new paradigm of distance learning. Despite efforts made by the administration and the teachers to accompany students, an internal survey conducted by the end of October 2021 revealed that almost all students, especially first-year ones, did not accept distance learning. This paper describes our experience to improve students’ satisfaction with distance learning by involving them in their courses’ design process. Four courses were concerned by the experience and were designed following the ADDIE method. Last-year students participated in the ADDIE analysis step, while the first-year students participated in the last step by evaluating the co-created courses. Courses were co-created with students as most of them got involved in the ADDIE development step and enriched courses by realizing extras activities. Results showed that students were highly satisfied with courses taught in the context of this study.
Filipino Physical Education Teachers‘ Technological Pedagogical Content Knowledge on Remote Digital Teaching
Authors:   the Cebu Normal University, Philippines, Tanucan Jem Cloyd M. , Hernani Ma. Rosita A. , Diano Jr. Felix
Published: July 2021

This study examined the Filipino physical education (PE) teachers’ technological pedagogical content knowledge (TPACK) on remote digital teaching approach. More specifically, it looked into their preparedness on remote digital teaching using the TPACK model, the relationship between their demographics, and the seven dimensions of knowledge of TPACK model and its interrelationship using a descriptive correlational research design. The sample was composed of 1,402 PE teachers across the three major islands of the Philippines who, using online survey, answered a 19-item questionnaire with a five-point Likert scale about their TPACK on remote digital teaching. Using the Pearson Product Moment Correlation and Chi-Square test of Independence, the study yielded four major results: 1) PE teachers have an average level of preparedness to conduct remote digital teaching in all domains of knowledge of TPACK; 2) The preparedness level of the PE teachers to conduct remote digital teaching in all domains of knowledge of TPACK is dependent to their age, sex and teaching experience, except technological knowledge, as it is independent to their highest educational attainment; and 3). There is a significant interrelationship on the PE teachers’ preparedness to conduct remote digital teaching among all domains of knowledge of TPACK. Hence, in order to successfully navigate a paradigm in education that accentuates the utilization of technology and other digital platforms, teachers have to be equipped with the tri-relationship of knowledge – content, pedagogy, and technology – through capability-building activities that consider their demographics and background.
Distance Learning during Lockdown: Satisfaction Assessment among Moroccan Trainee Teachers
Authors:   Laboratory of Informatics Systems and Optimization, Faculty of Science, Ibn Tofail University, Kénitra, Morocco, Boumaaize Zineb , Madhi Youssef El , Soulaymani Abdelmajid , Wahbi Bouazza El , Faylali Hanan El
Published: July 2021

Like everywhere in the world, the sudden onset of the coronavirus pandemic and the consequent closure of schools has imposed distance education as a compulsory alternative. Therefore, teachers have switched to distance education; students have been invited to join the platforms set up. Similarly, Regional Center for Education and Training (CRMEF) has been mobilized to ensure the continuity of the pre-service training for future teachers. This research aims to assess the distance education satisfaction of future teachers during confinement. A descriptive study was conducted by using the Google Forms tool. No less than 360 trainee teachers from the Rabat-Salé-Kenitra Regional Center (CRMEF) participated in the study. A qualitative approach was carried out to develop the construct. After validation of the questionnaire by the research committee, the questionnaire was self-administered. The reliability of the questionnaire was determined. A total of 360 responses were received (30% men and 70% women). Cronbach's alpha of the questionnaire turns out to be 0.8. On the whole, 58.33% of the confined trainees were dissatisfied about distance learning. 60% of the participants did not have computer equipment, while 73.33% reported that they have connection and network problems. Switching to distance learning was not a choice. Remains the best solution to complete the modules of the qualifying training of trainee teachers before their assignment. Empirical research findings and recommendations need to be taken into consideration to practice this approach in the post-pandemic period.
A prospective study of prevalence of anti-microbial susceptibility of bacterial isolates in lower respiratory tract infections
Authors: Husaain Ajaz , Sultana Qursheed , Ansari M. Abdur Rab
Published: July 2021

Background: Lower respiratory tract infections (LRTIs) is one of the most common causes of mortality and morbidity across all age groups. In recent years, antibiotic resistance is constantly increasing. Thus, there is a need to monitor the bacteriological profile of pathogenic organisms. The present study aims to identify bacterial pathogens and their antibiotic susceptibility pattern.Methods: A prospective, observational, single centered study was conducted at tertiary care hospital for a period of 1 year i.e. from March 2016 to March 2017. A total of 733 sputum samples were collected and analyzed in microbiology lab. The samples went subjected to microscopy testing, culture and antibiotic sensitivity using suitable bacteriological methods.Results: From 733 sputum samples, about 51.34% were males and 48.56% were females. Approximately 49.65% of total samples were growth positive. Klebsiella was found to be the predominant microorganism followed by Methicillin sensitive Staphylococcus aureus (MSSA) and streptococcus. The gram-negative bacteria showed highest sensitivity for piperacillin/tazobactam, imipenem and ciprofloxacin. The gram-positive bacteria were found to be more susceptible for vancomycin, teicoplanin and amikacin.Conclusions: LRTIs are contagious form of disease and can rapidly disseminate among community. The irrational use of antibiotics complicates the management due to the antibiotic resistance. Local trend of antibiotic susceptibility pattern should be known as it helps in increasing the appropriate use of the antibiotics, decreasing the mortality and morbidity and reduces the anti-microbial resistance.
A comparative study of efficacy and safety of anti-oxidants as an add-on therapy to metformin on glycemic parameters in newly diagnosed type 2 diabetes mellitus patients at a tertiary care hospital
Authors: P. Yashaswini , A. Geetha , K. Ravi
Published: July 2021

Background: Oxidative stress plays major role in diabetes mellitus (DM), abnormal high free radicals decline antioxidant defence mechanism can lead to damage of cellular organelles and enzymes, increased lipid peroxidation and insulin resistance leads to development of complications. Supplementation of antioxidants protects free radical induced damage and further complications. The objective was to evaluate the efficacy and safety of metformin versus metformin with vitamin C and E on glycaemic parameters in newly diagnosed type 2 diabetes mellitus (T2DM).Methods: 60 newly diagnosed T2DM patients were randomized into two groups of 30 in each to receive metformin (500 mg BD) alone in group A versus metformin (500 mg BD)+vitamin C (500 mg OD)+vitamin E (400 mg OD) in group B for 12 weeks. Efficacy was measured by improvement in glycaemic (FBS fasting blood sugar, PPBS postprandial blood sugar and HbA1c glycosylated haemoglobin) parameters at week 4, 8 and 12 from baseline. Safety was assessed by monitoring treatment emergent adverse effects.Results: The baseline characteristics were comparable between the two groups. There was a significant reduction of glycaemic parameters seen in both the groups from baseline to week 12 (p<0.001) but the difference was not statistically significant between the two groups (p>0.05). No significant adverse effects were noted.Conclusions: Both the groups are effective in improving glycaemic indices and supplementation of vitamins along with metformin as compared to metformin alone with no significant adverse effect. Hence, daily consumption of vitamins may be beneficial in decreasing blood glucose in patients with T2DM and thus reducing the risk of complications.
A prospective, open label, randomized-controlled study to evaluate the efficacy and safety of MyVir tablets in mildly symptomatic COVID-19 patients
Authors: Jayanthi C. R. , S. Shankar A. , Shankar M. Ravi , S. P. T. Lakshmana Perumal , L. Manjunath Reddy , K. Renish T.
Published: July 2021

Background: Coronavirus can cause pneumonia, respiratory failure and death. The emergence of novel coronavirus has posed a challenging situation that warrants urgent global attention. Currently there was no effective therapy available for COVID-19 and hence antiviral and immune modulators are most sought after medicines to manage complications of COVID-19.Methods: In this study involving mild COVID-19 we randomized 42 patients to receive a MyVir tablets twice daily along with standard of care (SOC) or SOC alone in 1:1 ratio for 14 days. We evaluated the benefits of MyVir tablets by assessing clinical outcomes and improvement in immune markers (LDH, CRP, D-dimer, TLC).Results: At the end of the study the immune markers in MyVir group improved significantly compared to control group. In patients who received MyVir, CRP decreased from 3.3 mg/l to 1.7 mg/l (p=0.0171). D-dimer decreased from 0.589 on day 0 to 0.368 on day 14 (p=0.03) and LDH decreased from 224 U/l on day 0 to 158 U/l on day 14 in test group (p=0.05). TLC showed favorable improvement in study group compared to control group. Early recovery from COVID-19 symptoms was observed in patients on MyVir treated group. Patients treated with MyVir tablets reduced the duration of hospitalization when given along with standard of care.Conclusions: MyVir accelerated recovery of COVID-19 patients by early improvement in clinical symptoms and immune markers in this study and results clearly indicates that MyVir tablets has antiviral, immune booster activity. Hence this study provides evidence that MyVir has definitive role in the management of mild COVID-19 patients along with standard of care (funded by Mi Lab Life Sciences(P) Ltd. CTRI no. CTRI/2020/05/024967).
A pharmacoeconomic study of different brands of commonly prescribed antihypertensive drugs
Authors: Upasani Pooja C. , Barve Rohidas M. , Hiray Rajesh S.
Published: July 2021

Background: The hypertension is the most common chronic disease, therefore treatment should be affordable. The antihypertensive drugs of same strength are available in market at different costs. This study was undertaken to create awareness among health care workers and patients, about cost difference among different brands of same antihypertensive drug. So that whenever possible, a cheaper effective brand can be prescribed to ensure better patient adherence.Methods: Maximum retail price (MRP) of various antihypertensive drugs of same strength, manufactured by different pharmaceutical companies was obtained from various offline and online sources. The minimum and maximum cost of 10 tablets/capsules noted. The cost ratio and percentage cost variation was calculated for single drug and fixed dose combinations. The ceiling price (as per DPCO) of essential antihypertensives (as per national list of essential medicines) was compared with their maximum cost.Results: The formulations of single antihypertensive drugs (41) and fixed dose combinations of two drugs (19) and three drugs (9) were included in the study. Among the single antihypertensives analyzed the highest cost difference was of eplerenone (50 mg) and high cost ratio and cost variation percentage was of amlodipine (5 mg). Among fixed dose combination of two drugs analyzed highest cost difference was found that of hydrochlorothazide (12.5 mg)+olmesartan (40 mg) combination and highest cost ratio and percentage cost variation was of amlodipine (5 mg)+telmisartan (40 mg).Conclusions: There was a huge price variation among the antihypertensive drugs manufactured by various companies. Some measures must be taken by the government to bring the uniformity in the price that will help to reduce the economic burden on the patients.
Risperidone induced pancytopenia: a case report
Authors: Alrahili Nader M.
Published: July 2021

There are several case reports on hematological side effects after using antipsychotics in the literature. This case report could be the first case report of pancytopenia where laboratory work showed thrombocytopenia, lymphocytopenia, and neutropenia after using risperidone. It is about 14-year-old female presented with irritable mood and aggression started on Risperidone 0.75 mg every night. A few weeks later she developed frequent and recurrent urinary tract infections and heavy vaginal bleeding that lasted for 5 days and reoccurred twice in the same month. Patient was admitted to internal medicine ward to investigate the cause of bleeding. No signs of splenomegaly, hepatomegaly, or lymph node enlargement were observed. All immunological workup results were negative. Bone morrow showed normal cellularity with granulocytic hyperplasia, suggesting a peripheral cause that was most likely a drug-induced effect. A provisional diagnosis of drug-induced pancytopenia was established. These hematological side effects may make physician to be more careful while prescribing risperidone and to follow the guideline of regular lab work especially CBC.
Determinants of contraceptive methods use after voluntary induced abortion at the Yaounde Central Hospital, Cameroon
Authors: Fouelifack Florent Y. , Mba Cadette C. N. , Ofeh Anyimbi M. , Tebeu Pierre M.
Published: July 2021

Background: Abortion is the termination of pregnancy with expulsion of the product of conception before the age of fetal viability- 28 weeks. In Africa, 96% of abortions are unsafe and there is an estimated 1 death for 150 abortions. Few data are available in Cameroon on the determinants of contraception after a voluntary termination of pregnancy. The objective of this study to investigate the determinants of the use of contraceptive methods after a voluntary termination of pregnancy.Methods: The study was descriptive cross-sectional lasting 09 months in the gynecology and obstetrics unit of the Yaounde Central Hospital. We included women admitted to this unit who have already had at least one abortion. All women who did not give their consent were excluded. The data were entered and analyzed using the Epi-info software version 7.2.2.6. The tools used to express our results were the Student's and Whitney's test, the Wald test and the Odd ratios (OR) with their 95% confidence interval. The significance level was 5%.Results: Out of 139 participants, 86 (61.87%) had already used a modern contraceptive method after voluntary termination of pregnancy. The mean age was 27.13±6.16 years with extremes of 16 and 42 years. Being single and having unwanted pregnancies independently increased contraceptive method use after abortions.Conclusions: An intensification of campaigns for behaviour change and men's involvement would further improve the use of contraceptive methods after abortion.
An analytical study of abnormal uterine bleeding in women of child bearing age group
Authors: Shah Jayneel V. , Pandya Munjal J. , Prajapati Prakash B. , Senta Dharmik B. , Patel Meet K.
Published: July 2021

Background: AUB (abnormal uterine bleeding) is defined as any variation from the normal menstrual cycle including alteration in its frequency, regularity of menses, duration of flow and amount of blood loss. In India, the reported prevalence of AUB is 17.9%. It can occur any time between menarche to menopause. A good clinician tries to recognize and identify the causative factors responsible for the disease, reverse the abnormality and induce or restore the cyclic predictable menses which should have normal volume and duration.Methods: 200 cases of AUB fitting the selection criteria were taken from OPD and gynecology ward between September 2020 to June 2021.Results: AUB was more common in the age group 41-45 years, that is, perimenopausal age group, more in multiparous women and women with previous surgeries on uterus and adnexa. Heavy menstrual bleeding was the most common complaint. Endometrial hyperplasia was the most common finding on ultrasound examination. Medical therapy was beneficial in some patients, rest had to undergo surgical intervention later.Conclusions: Transvaginal sonography is very accurate in assessing the endometrium as well as uterus and adnexa and diagnosing their abnormalities. Medical therapy is the first line of management in most cases. Dilatation and curettage should be used along with hysteroscopy for better results. LNG-IUS gives very good result in suitable cases. Hysterectomy is the final measure if everything else fails. Vaginal hysterectomy is preferred wherever possible.
Maternal mortality-a three-year retrospective study in a rural medical college of India
Authors: Hansda Jayasree , Roy Debobroto , Das Krishnapada , Sarkar Manojit , Das Rumpa , Pramanik Arpita
Published: July 2021

Background: Maternal mortality is a tragic event as family revolves around a mother. The deadly obstetrical triad of hemorrhage, preeclampsia and infection has accounted for a third of all deaths. This study was conducted to assess maternal mortality ratio, demographic profile and causes of maternal death.Methods: This retrospective longitudinal study was conducted in the department of obstetrics and gynecology for a period of three years from 1st January 2018-31st December, 2020. Total no of death during this period was 134.Records of deaths and demographic profiles were retrieved from the medical record library of aforesaid hospital.Results: There were 134 maternal deaths amongst 56815 live births with MMR 235.85. The majority of deaths were in 20-29 year of age group and most of the deaths seen in multigravida. The 91.79% death was observed within the 24 hours and after 72 hours. Eclampsia, preeclampsia and hemorrhage were leading cause of maternal death seen in the study.Conclusions: Maternal mortality is higher than national MMR. Majority of maternal death were preventable by proper antenatal care, early detection of high-risk pregnancies and their timely referral to tertiary care centre.
Occupational COVID-19 exposure among health care workers in obstetric unit in a Central Government Hospital in India: initial experience
Authors: Tondon Neha Pruthi , Malik Renuka , Kumari Kanika , Singh Anjali
Published: July 2021

Background: Health care workers (HCW) are the frontline warriors who are at a high risk of acquiring the COVID-19. HCW in obstetrical department are at high-risk due to their close proximity with the patient for examination, giving treatment and in delivery. The objectives of this study were to evaluate the positivity rate of COVID-19 in the initial 3 months of pandemic in health care personnel working in obstetric unit in a tertiary care hospital.Methods: Prospective cohort study was conducted in department of obstetrics and gynecology at tertiary care hospital in Delhi from 10 April to 10 June 2020. Predesigned questionnaire was used to record data of HCWs exposed to COVID-19 patients.Results: In a period of 3 months (April-June 2020), 152 health care workers were exposed to 30 COVID-19 patients.  Out of this, 10 HCW were found to be positive on testing, showing a positivity rate of 6.58%. Positivity ratio was 6:3:1 among nurses, auxiliary workers and doctors respectively. Labor room was area of high infection as 80% of HCW were infected in the labor room .80% HCW acquired infection during patient care in hospital and 20% were infected in contact with asymptomatic COVID-19 positive HCW.Conclusions: Positivity rate in obstetric department is comparable to that of general population. Appropriate infection prevention measures like use of PPE, handwashing and maintain safe distance from the patient is the key to prevention of infection. Gloves and N95 masks have been shown to provide superior protection as compared to triple layer masks. Nursing staff and auxiliary workers should be reinforced the importance of use of PPE, hand hygiene and physical distancing.
Retrospective analysis of maternal mortality: a paradigm shift from 2010 to 2020
Authors: Kempaiah Sujani , . Urvashi , . Mamatha , Fernandes Jessica Celina , Sivasambu Gayatri Devi , Azmathulla Shaziya , Shivashankar Shruthi
Published: July 2021

Background: Maternal mortality is attributed usually to complications that generally occur during or around labour and these are mostly preventable through proper understanding, diagnosis and management of labour complications. The quality of health services women receive during pregnancy, intranatal and postnatal periods are crucial for the survival and well-being of the mother and her newborn baby. The objective was to analyse the changing trends in maternal mortality occurring over a decade, to assess factors associated with maternal mortality and propose effective interventions in preventing such mortality.Methods: It was a retrospective study to analyse maternal mortality between January 2010 and January 2020 in Ramaiah medical college hospital. Data was collected the institutional medical and delivery records and patient details regarding obstetric history, pre-existing comorbidities, cause of death, interventions done was noted and review of maternal mortality was done.Results: The maternal mortality in the present study was 432.73/1 lakh live births. There were 57 maternal deaths in the study period. Most deaths occurred in the 20-25 age group. 42.10% of deaths occurred ninety six hours after admission. Sepsis (42.1%), hypertensive disorders (12.30%) and haemorrhage (10.5%) are the most common direct causes of maternal death. Post-operative and post abortal sepsis, ARDS, cardiogenic shock, pulmonary embolism and AFLP are the other direct causes. Hypertensive disorders (9.64%) and haemorrhage (19.5) is the two leading indirect causes of maternal deaths.Conclusions: Maternal health services should move beyond the focus on emergency obstetric care, to a broader approach that encompasses preventive and early interventions and integration with existing services. Most of the maternal deaths can be prevented if the high risk antenatal women are identified earlier and referred to the tertiary centre earlier for diagnosis and management.
Laparoscopic management of adnexal masses in admitted patients at tertiary care centre, Bhilai, Chhattisgarh, India
Authors: Naik Meena , Singh Pooja , Ratnani Rekha
Published: July 2021

Background: Laparoscopy is most widely accepted procedure in gynaecological cases both for diagnostic and operative purposes. It is associated with early recovery, shorter hospital stay and significant patient satisfaction. This study has been conducted to evaluate the effectiveness and safety of laparoscopy in the management of adnexal masses. Our Primary aim was to find out indications, intraoperative findings and different interventions to deal with adnexal mass. The objective of the study was to determine laparoscopic management of adnexal mass in all women attending Obstetrics and Gynaecology department, Shanakaracharya Institute of Medical Science, Bhilai, Chhattisgarh.Methods: This is a retrospective record-based observational study conducted over a period of one year from March 2020 to March 2021 after getting approval from the institutional ethical committee. Patients diagnosed with adnexal mass were evaluated and data was collected and analyzed.Results: Of the 130 cases of adnexal mass admitted in the hospital during the period under review, 43 cases (33%) were diagnosed as ovarian cyst among which simple cystic ovarian cyst was found to be most common etiology followed by ectopic pregnancy (41 cases). Majority of cases were managed laparoscopically with a good success rate, better outcome and short hospital stay. Conversion rate to laparotomy was 3.8% mainly seen in cases with complex ovarian mass or dense adhesions.Conclusions: Diagnosis of adnexal mass is important and it may affect females of any age group. Laparoscopy is a better approach to deal with adnexal masses (except malignancy) as it has better paronamic vision with less complications, less post-operative pain, shorter hospital stay. Careful patient selection should also be taken into account. Current study is an overview in favor of laparoscopic management of adnexal mass.
Pap smear screening in antenatal women: an opportunistic way to save life
Authors: Siddiqui Sana , Rehman Suhailur , Bano Imam , Arif Sayeedul H.
Published: July 2021

Background: Cancer cervix is the most common genital tract malignancy encountered in developing countries. In India, first visit to the gynaecologist for most women is during pregnancy and it may be the only visit. Hence, prenatal care offers an excellent opportunity to implement cervical screening in patients of young age, especially in women who do not seek routine health care. Therefore, this study was conducted to know the prevalence of abnormal Pap smear among the ante-natal women and to evaluate the result in relation to various risk factors.Methods: Cross sectional observational study conducted on 425 ante-natal women attending the antenatal clinic using questioner addressing various socio-demographic variables. Measures of central tendency calculated and result was tabulated by using chi-square test.Results: Maximum number of cases in our study was NILM i.e.314 (74%) followed by 68 cases of Candida (16%), 30 cases of Bacterial vaginosis (7.1%) and 10 cases of Trichomonas vaginalis (2.4%). Only 3 cases of abnormal Pap smear was reported i.e. 2 of ASCUS and 1 of LSIL. Thus, prevalence of abnormal Pap smear was 0.7%.Conclusions: In country like India where organised screening programme are not available, as well as the awareness and uptake of available services by the target population is also poor; screening in pregnancy is worthwhile and may be a viable option to reduce the burden of cervical carcinoma.
Fetomaternal outcome and effect of ursodeoxycholic acid in patients of obstetric cholestasis
Authors: Laul Poonam , Kumari Soma , Miglani Urvashi , Laul Anish , Gandhi Shalini , Miglani Sanjeev
Published: July 2021

Background: The objective of this study was to determine fetomaternal outcome and effect of ursodeoxycholic acid in patients of obstetric cholestasis.Methods: This study was prospective observational descriptive study of 130 women, which was conducted in the department of obstetrics and gynaecology, Deen Dayal Upadhayay Hospital, New Delhi. Statistical analysis was performed using the z test when appropriate. A p value of <0.05 will be considered statistically significant.Results: Spontaneous onset of labour was present in 48.5% of patients, induction was done in 31.5% of patients and in rest 20% of patients LSCS was indicated. Normal vaginal delivery occurred in 97 of 130 patients while emergency LSCS done 33 of 130 patients. Emergency LSCS was done in 16 of 33 patients due to foetal distress. Pre-term delivery and PROM occurred in 8.5% and 9.2% of patients respectively while PPH occurred in 12.3% of patients. Among the 130 cases included in present study 34 patients (27.2%) had fetal distress, 41 patients (31.5%) had MSL and 40 neonates (32.0%) required NICU. 16 neonates out of 130 (12.8%) had birth weight below 2.5 kg. Apgar score was <7 after 5 min in 31 neonates.Conclusions: Ursodeoxycholic acid (UDCA) is useful in relieving symptoms and decreasing the biochemical markers.
Vesico-cervical fistula following normal vaginal delivery: case report and management overview
Authors: Koothan Vijaya
Published: July 2021

Vesico-uterine fistula is an uncommon pathological communication developing between the uterus or cervix and the urinary bladder especially in traumatic caesarean sections. We presented a case of vesico-cervical fistula who presented after 18 years of occurrence of fistula and successful repair. Clinical diagnosis may be delayed due to varied presentations and evaluation may require more than one modality of investigation. The choice of treatment surgical or conservative management depends on the location size and number of the fistula. Surgical outcomes of open laparotomy, laparoscopic and robotic surgery have been successful. Obstetric outcomes of post repair patients have had successful pregnancies.
Newer modalities for treatment of severe COVID-19 infection and their use in pregnancy-boon or bane?
Authors: Anand Shivani , Sarkar Avir
Published: July 2021

We are into the second year of the COVID-19 pandemic which is caused by an RNA virus, belonging to the severe acute respiratory syndrome (SARS) family. Though the mainstay of COVID management continues to be mainly symptomatic, many new management options are coming up. Due to ethical reasons, pregnant and lactating women are never included in the clinical trials used to test drug safety and efficacy, but COVID-19 is here to stay and we should begin to analyse the effects of the various proposed drugs in its management in pregnant population.
Determination of maintenance Jarlsberg® cheese dose to keep the obtained serum osteocalcin level; a response surface pathway designed de-escalation dose study with individual starting values
Authors: Lundberg Helge Einar , Holo Helge , Holand Trond , Fagertun Hans E. , Larsen Stig
Published: July 2021

Background: Daily maximum effective dose (MED) of Jarlsberg® increased the serum osteocalcin (tOC) level, vitamin K2 and affected the lipid pattern positively. The aim of the study was to estimate and verify a daily maintenance dose.

Methods: 12 healthy female volunteers (HV) were included in a de-escalation study after a six week run-in period on the daily MED of 57 g Jarlsberg® cheese. A 3-level within-patient response surface pathway (RSP) design with individual starting values was developed. Another 12 HVs were included in a new study with a six week run-in period on MED followed with six weeks on the estimated maintenance dose. All HVs were premenopausal female between 20 and 52 years of age. The main variable in the studies was the tOC level.

Results: tOC, cOC and the vitamin K2 variants increases significantly (p<0.01) during the run-in period on daily MED of Jarlsberg® in both studies. The maintenance daily dose was estimated to 45 g (95% CI: 38-52 g/day) and used in the new study. The tOC level was reduced from 19.8 ng/ml (95% CI: 12.0-27.6) obtained in the run-in period to 18.5 ng/ml (95% CI: 11.7-25.3) during the maintenance part. This represents a reduction of 6.6%. The sum of vitamin K2 variants changed from 0.58 ng/ml on MED of Jarlsberg® to 0.59 ng/ml (95% CI: 0.37-0.82) during the maintenance period.

Conclusions: Daily MED of Jarlsberg® cheese increases tOC, cOC and the vitamin K2 level. The maintenance Jarlsberg® dose was estimated to 45 g/day and verified as sufficient.
Rationale, study design and methodology of the hypertension registry: a Pan-India, prospective, longitudinal study to assess management and real-world outcomes of high-risk essential hypertension
Authors: Abdullakutty Jabir , Shah Jay , Oomman Abraham , Ezhilan J. , Krishnamani N. C. , Navasundi Girish , Khan Mohammed Y. , Gaurav Kumar , Pandit Sucheta , Mane Amey
Published: July 2021

Background: India contributes significantly towards a large part of the worldwide epidemic of hypertension (HTN) and its associated complications. As, there are limited longitudinal studies available in India to understand its occurrence over time, this Pan-India longitudinal study will aid to assess the real world outcomes of HTN across the country.

Methods: This was a prospective, multi-centered, longitudinal, observational study investigating a large COHORT of people with HTN across India over a period of one year. The primary objective of this study was to evaluate blood pressure (BP) control and clinical outcomes in high-risk hypertensive patients distributed over 5 visits (including baseline visit). The secondary objective is to assess the co-morbidities/risk factors in different clinical settings across India. Participants (4,000) with HTN will be included from 200 centres across India and data will be recorded for the use of anti-hypertensives, demographics, socio-economic status, anthropometric measurements, family history, personal history, risk factors, co-morbid conditions and physician treatment preferences. Overall, clinical practice patterns were assessed for their relationship with clinical outcomes.

Conclusions: This study is expected to reveal the trends in complications associated with HTN, treatment strategies used by physicians, and correlation among treatment, control and complications of HTN within the Indian context. The outcome of this study will help to identify the burden of HTN, along with pin-pointing the emergence of early-onset complications and dose titration patterns. This will eventually help to develop person-centred care and facilitate public health agencies to invest appropriate resources in the management of high-risk HTN across India.

Trial registration: Since this is a real world evidence study no trial registration was needed as per Indian regulations.
A comparison of regulatory approval of clinical trial protocol with different countries
Authors: Amaresh K. , Salimath Geetanjali , Ganachari M. S. , Devarinti Revana S. , Kumar Uday
Published: July 2021

In present scenario, different countries must follow different regulatory requirements for protocol approval process of new drug application. Present study, we studied the regulatory requirements, timelines of approval and guidelines according to central drug standard control organization (CDSCO), therapeutic goods administration (TGA), food and drug administration (FDA) and European medical agency (EMA). The objective was to compare the regulatory approval of clinical trial protocol process. A comparative observational study was undertaken among the clinical trials and regulatory bodies of India (CDSCO), Australia (TGA), US (USFDA), Europe (EMA). The study specified various regulatory guidelines and safety requirements for conduct and inspection of clinical trial. Clinical trial protocol guidelines the essential documents are determined, and various timelines are being identified. And compared with the fees with other countries. Indian payments were compared with other countries. Timelines with safety reporting were compared with other 3 countries (Europe, Australia and US). The regulatory guidelines in the clinical trial different between countries. There is different timelines and requirements of clinical trial application approval process for each regulatory body. This study methodology has enabled comparisons to be made both within agencies and between different authorities and has identified differences in the timelines that applications spend in different stages of the review.

 
Clinico-pathological profile of scrub typhus in children: a cross sectional study from Eastern India
Authors: Dasgupta Rayan , Basu Sumita , Mukherjee Asha
Published: July 2021

Background: Scrub typhus is a vector-borne zoonosis, endemic in Asia and it may present as an undifferentiated fever or with multisystem involvement. This study was carried out to understand the varied presentation of scrub typhus in children and the response to treatment in a tertiary care hospital in Eastern India.Methods: All children between 1 month and 12 year of age admitted with fever for more than 5 days and positive IgM ELISA for scrub typhus were included in the study and their course in hospital was documented. They were randomly divided into 2 groups of 41 patients each, into doxycycline and azithromycin group and were then evaluated for therapeutic response.Results: In this study, pallor (89%) was the commonest finding followed by hepato-splenomegaly (73.2%), pneumonia (65.9%) and rash was found in 43.9%. Eschar was found in 32.9% whereas serious complications like shock and meningoencephalitis was found in 9.8%.  Pericardial effusion was detected in 23.2% cases, coronary artery dilatation in 11% cases and both effusion as well as coronary artery dilation was found in 2.4%. In azithromycin group, 73.2% patients had drug response whereas in doxycycline group, 92.7% patients had drug response and this association was statistically significant (p=0.0188). Two patients who presented late with shock expired but all others responded to treatment and were doing well on follow up.Conclusions: Scrub typhus may present with multisystem involvement including cardiac manifestation which needs to be identified early by echocardiography. Doxyclycine is still the best modality of treatment and if used early, outcome is favourable.
Study the role of c-reactive protein and thrombocytopenia in diagnosing early neonatal sepsis
Authors: Babu N. Aravind
Published: July 2021

Background: In clinical practice, early detection of neonatal sepsis remains difficult. Neonatal sepsis diagnosis is a challenge because of its non-specific presentation and the low sensitivity of the time-consuming bacterial cultures. So, many sepsis markers, like C-reactive protein (CRP) and platelet count, are emerging to improve its diagnosis. The aim of the study was to evaluate the role of CRP and platelet count in early neonatal sepsisMethods: This study was conducted in the department of SNCU in Virudhunagar Government Headquarters hospital, 50 neonates with culture-confirmed sepsis were included. Before antibiotic treatment, neonates CRP and platelet count, and other inflammatory markers were assessed.Results: In 50 newborns, culture was positive in 22 cases, CRP was positive in 24 cases, and thrombocytopenia in 18 cases. In 22 culture-positive cases, 19 cases are CRP positive, and 17 cases had thrombocytopenia. In 17 culture-positive thrombocytopenia cases, 16 cases are Gram-negative stain, 1 case is Gram-positive stain.Conclusions: CRP and Platelet can be helpful in the future diagnosis of neonatal sepsis, despite being promising and convenient markers for neonatal sepsis.
Evaluation of fatty liver disease using ultrasound in a semi-urban population in Jos, North Central Nigeria
Authors: Gabkwet Anthony E. , Igoh Emmanuel O. , Gwom Pam M. , Taiwo Folake Y. , Salaam Abdul J. , Danjem Samuel M. , Pam Stephen D.
Published: July 2021

Background: Fat liver is one of the most common abnormalities of the liver depicted on ultrasound and whose impact has not been fully evaluated in Nigeria. Ultrasound scan is an imaging modality that is cheap and readily available and comes in handy in evaluating this disease. Aim of the current study was to determine the relationship of Fatty liver with age, gender, alcohol consumption and body habitus.Methods: This is a hospital-based cross-sectional study involving 316 subjects diagnosed with fatty liver on ultrasound scan. A structured questionnaire was administered to each subject to ascertain their age, sex, and alcohol intake. The weight and height of all subjects were also measured and the body mass index (BMI) was calculated.Results: The study comprises 151 (47.8%) males and 165 (52.2%) females respectively. A good number of the participants 232 (73.4%) were between the age of 30-59 years. The majority of the participants had of 30 kg/m2 and above. Majority of the participants 225 (71.2%) do not consume alcohol. The study showed a positive but weak correlation between increasing BMI and fatty liver span. The study revealed that most participants with liver span <15.9 cm (57.1%) or ≥16 cm (75.5%) have BMI ≥30 kg/m2.Conclusions: This study showed fatty liver is common in all ages and gender but commoner in the middle age groups with strong relationship between increasing body weight and fatty liver, but a weak relationship with regards to the span of the liver.
Prevalence of asthma chronic obstructive pulmonary disease overlap in patients attending a tertiary health care centre
Authors: Chandravanshi Suresh , Sharma Mahesh Kumar , Lakra D. P. , Khande Manisha , Panda R. K.
Published: July 2021

Background: The study aimed to assess the magnitude of asthma chronic obstructive pulmonary disease asthma chronic obstructive (ACO) in patients with chronic airway disease.Methods: The study was conducted as cross-sectional study on patients with chronic airway disease presenting at our institute during the study period of 1 year. Global initiative for asthma management and prevention (GINA) syndromic approach table was used to diagnose patients with chronic airways disease. Syndromic and confirmatory diagnosis of ACO was made based upon clinical features and spirometry respectively.Results: About 73.6% were diagnosed as chronic obstructive pulmonary disease (COPD) and 26.4% cases were diagnosed as asthma. Overall ACO was present in 20% cases. ACO was significantly associated with advancing age, male gender, and longer duration of smoking (p<0.05) in asthma patients whereas in COPD patients ACO was associated with advancing age (p<0.05).Conclusions: Overall one fifth of the patients with chronic airway disease have asthma COPD overlap. The ACO is observed in almost equal proportions in asthma and COPD. ACO prevalence was found to increase with age in patients with asthma and COPD.
Parents’ psychological adjustment after gamete donation: a systematic review
Authors: Sarantaki Antigoni , Vogiatzoglou Maria Eleni , Barbounaki Stavroula
Published: July 2021

The age factor plays a key role to the successful rates of ARTs protocols. The practical answer to this problem would be the acceptance of an egg, donated by a younger woman, who wants to undergo ovary stimulation, thus offering her cell to a female recipient. This review aims to investigate the psychological adjustment of parents who have used gamete donation, as well as its effect on the psychological adjustment of children in case of disclosing the children’s donor origin. The PubMed and Google Scholar databases were searched for peer reviewed papers, focusing on parents’ psychological adjustment after gamete donation. Key search inclusion criteria included all papers published in English (between 2005 and 2019) relating to investigate the psychological adjustment of parents after gamete donation, as well as its effect on the psychological adjustment of children in case of disclosing the children’s donor origin. These families are possibly expected to be affected by the circumstances of the birth, especially in case of gamete donation or surrogacy, in terms of parents’ thoughts, feelings and behavior towards the child.
Pontine hemorrhage presenting as Foville’s syndrome
Authors: Stephen Mary , . Jayasri , P. J. Harigaravelu , . Baranitharan
Published: July 2021

Foville’s syndrome, also known as inferior medial pontine syndrome is one of the rare brainstem stroke syndromes with only few cases reported worldwide occurring due to involvement of the infero-medial aspect of pons. Condition is characterised by various cluster of neurological features as a result of defect in multiple vital areas like cortico spinal tract, medial lemniscus, middle cerebral peduncle, facial nerve and abducens nerve involvement. We reported one such rare case of a patient with no known systemic co-morbidity, who presented with sudden onset diplopia, lagophthalmos and contralateral weakness of limbs. On evaluation with computed tomography imaging, hemorrhage at the level of inferior pons was found. Patient subsequently treated and commenced on physiotherapy for rehabilitation.