bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison between Local Infiltration Analgesia and Ultrasound Guided Single Shot Adductor Canal Block Post Total Knee Replacement Surgery - A Randomized Controlled Trial
Authors: Narayan Priti , Sahitya Vijay A. , Chandrashekaraiah Mahesh M. , Butt Ahsan J. , Johnston Keith A. , Skowronski Sharon
Published: August 2021

Context:

Good quality analgesia posttotal knee arthroplasty (TKA) contributes majorly to early mobilization and shorter hospital stay.

Aim:

To compare adductor canal block (ACB) versus local infiltration analgesia (LIA) for postoperative pain relief in patients undergoing TKA.

Settings and Design:

This prospective, single-blind, randomized controlled trial was undertaken at a tertiary care university hospital.

Materials and Methods:

Sixty patients of American Society of Anesthesiologists physical status Classes I, II, and III, who received spinal anesthesia for TKA were randomly allocated to two groups. Group A patients had LIA of the knee joint using a mixture of 50 mL of 0.25% bupivacaine, 10 mg morphine (1 mL) and 99 mL of normal saline. Group B patients received ACB using 25 mL of 0.5% bupivacaine under ultrasound guidance. All patients received multimodal analgesia comprising of paracetamol, diclofenac, and patient controlled analgesia with morphine in the first 24 h' postoperative period. The primary outcome measures were first 24 h' morphine consumption and pain scores at 4, 6, 8, 12, and 24 h. The secondary outcome measures were nausea/vomiting, sedation, and patient satisfaction scores.

Statistical Analysis:

Statistical analysis was performed using the Student's t-test, Mann–Whitney test, and Chi-square test.

Results:

The 24 h morphine consumption was 11.97 ± 7.97 and 10.83 ± 6.41 mg in the LIA group and ACB group, respectively (P = 0.54). No significant differences were noted either in the pain scores at rest and flexion or secondary outcome measures between both groups in the first 24 h.

Conclusion:

Single-shot ACB is equally effective as LIA as postoperative analgesia for TKA.
Role of Dexamethasone on Oxygen Requirement, Mortality, and Survival Incidence among COVID-19 Patients
Authors: Mahajan Lakshmi , Singh Arvinder Pal , Singla Akshita , Singh Gifty
Published: August 2021

Background:

Patients diagnosed with coronavirus disease 2019 (COVID-19) are often prone to developing systemic inflammation which eventually causes damage to the lungs and other important organs. Randomized open-label control trials carried out in the different parts of the world have highlighted the importance of corticosteroids for treating such patients.

Materials and Methods:

The current quasi-experimental study was based on COVID-19-infected patients with oxygen saturation <92% and evidence of pneumonia confirmed through radiological examination. Study participants in Group A received standard care, while those in Group B received standard care along with 6 mg intravenous dexamethasone for 10 days (or until discharge, if earlier). The clinical status of the study participants was assessed on day 7 and day 14 on a 6-point ordinal scale.

Results:

It was observed from the study that there was reduction in the intensive care unit (ICU) stay and mortality among the study participants requiring high-flow oxygen or noninvasive ventilation in Group B as compared to Group A. After 7 days of treatment, 50% of the study participants in Group B got discharged as compared to 15% of the study participants in Group A. The number of study participants requiring mechanical ventilation remained 1 in Group B as compared to 5 in Group A. After the completion of treatment schedule, 91% study participants were discharged. There was 1 case of mortality reported in Group B as compared to 6 cases of mortality in Group A.

Conclusions:

The current study highlighted that fewer number of COVID-19-positive study participants in Group B required high-flow oxygen supplementation and noninvasive positive pressure ventilation as compared to those included in Group A. The corticosteroid treatment also reduced the number of ICU transfer and mortality.
Comparison of Airway Ultrasound Indices and Clinical Assessment for the Prediction of Difficult Laryngoscopy in Elective Surgical Patients
Authors: Kasinath M. Pranav Rohit , Rastogi Amit , Priya Vansh , Singh Tapas Kumar , Mishra Prabhaker , Pant K. C.
Published: August 2021

Background:

Ultrasound is evolving as a probable tool in airway assessment. The upper airway is a superficial structure and has sonographically identifiable structures which makes it ideal for evaluation with the ultrasound.

Aims:

The aim of this study was to evaluate the role of skin to hyoid and skin to thyrohyoid membrane distance in prediction of difficult laryngoscopy.

Settings and Design:

This is a prospective observational study included 150 patients aged 18–60 years of American Society of Anesthesiologists Physical Status I and II scheduled to undergo surgery under general anesthesia requiring laryngoscopy and endotracheal intubation.

Materials and Methods:

The modified Mallampati score, mouth opening, mentohyoid distance, thyromental distance were noted. Skin to hyoid bone distance and skin to thyrohyoid membrane distance were measured by ultrasound. Patients were clubbed retrospectively into easy and difficult laryngoscopy groups on the basis of Cormack Lehane grading, and the characteristics of both groups were compared.

Statistical Analysis:

Statistical Package for the Social Sciences, Version 23 was used for statistical analysis. Independent samples t-test was used to compare the means between difficult and easy laryngoscopy patients. Diagnostic accuracy of the significant (P < 0.05) variables between difficult and easy laryngoscopy patients was calculated using receiver operating characteristics curve in terms of their area under curve. Appropriate cutoff values (with corresponding sensitivity, specificity, and overall accuracy) were also identified.

Results:

Out of 150 patients, 13 (8.7%) were identified as difficult laryngoscopy whereas 137 patients (91.3%) were identified as easy laryngoscopy. The demographics of both groups were comparable. Mentohyoid distance, skin to hyoid bone distance, and skin to thyrohyoid distance were statistically different between easy and difficult laryngoscopy patients, with lower mentohyoid distance and higher skin to hyoid bone distance and skin to thyrohyoid distance in difficult laryngoscopy patients. Diagnostic accuracy of the mentohyoid distance (70.3%) was slightly superior to skin to hyoid bone distance (67.1%) and skin to thyrohyoid distance (68.1%).

Conclusion:

Ultrasound measurements of skin to hyoid bone and skin to thyrohyoid membrane distance fail to eclipse clinical parameters in accurately predicting a difficult laryngoscopy.
Comparative Study of the Analgesic Efficacy of Intrathecal Fentanyl with Ultrasound-Guided Transversus Abdominis Plane Block after Lower Segment Cesarean Section
Authors: Nayak Nagalakshmi S. , Kalpana K , Dhanpal Radhika , Tudu Lal Chand , Prakash Jay
Published: August 2021

Background:

This study was conducted to compare the analgesic efficacy of intrathecal fentanyl with ultrasound-guided transversus abdominis plane (TAP) block after lower segment cesarean section. The objectives of the study were to compare the effects of subarachnoid fentanyl versus TAP block with respect to duration of postoperative analgesia, time for first analgesic request, total analgesic consumption in 24 h, time to first breastfeed and Apgar score at 1 and 5 min.

Materials and Methods:

Sixty-two patients undergoing elective or emergency cesarean delivery were recruited for the study in a prospective, randomized, single-blind manner. The patients were randomly allocated to either intrathecal fentanyl group (Group F) or TAP block group (Group T) after determining the eligibility criteria. Group F patients received subarachnoid block with 10 mg of 0.5% bupivacaine heavy with 25 mcg of fentanyl. Group T patients received subarachnoid block with 10 mg of 0.5% bupivacaine heavy prior to surgery and at the end of surgery, they received TAP block with 0.25% bupivacaine 20 mL on each side.

Results:

Group T had significantly longer time for the first analgesic request (7.65 ± 1.23 h) than group F (4.10 ± 0.32 h). The total analgesic consumption in 24 h was significantly less in Group T (1.0 ± 0) than Group F (2.13 ± 0.34). The Visual Analogue Scale scores at rest and on movement were significantly less in Group T than Group F at all-time points. The Apgar score at 1 and 5 min and time to first breast feed were comparable between the two groups. The incidence of side effects was less in Group T.

Conclusion:

This study indicated that ultrasound-guided TAP block has a better analgesic as well as safety profile compared to intrathecal fentanyl for cesarean delivery.
Peripartum Management of Gitelman Syndrome for Vaginal Delivery
Authors: Micha Georgia , Kalopita Konstantina , Theodorou Spyridoula , Stroumpoulis Konstantinos
Published: August 2021

We describe the anesthetic management of a spontaneous vaginal delivery at 38 weeks' gestation in a 36-year-old patient with Gitelman syndrome (GS). GS is a rare autosomal recessive renal tubulopathy characterized by hypomagnesemia, hypocalciuria, and secondary aldosteronism, which results in hypokalemia and metabolic alkalosis. To minimize any increase in catecholamine levels and consequent risk of ventricular arrhythmias, a labor epidural analgesia was administered using ropivacaine and fentanyl, along with intravenous magnesium and potassium supplementation. Ropivacaine was substituted for routine bupivacaine to decrease the risk of drug-induced cardiotoxicity. In the event of a cesarean section, the anesthetic plan was to continue with top-up epidural anesthesia and in case of failure, to convert to general anesthesia using propofol and rocuronium for induction. Delivery outcome was successful and uneventful.
Fentanyl-Induced Respiratory Depression
Authors: Udayakumar Prabha , Udayakumar Srisruthi
Published: August 2021

Opioid-related respiratory depression is a serious clinical problem as it can cause multiple deaths and anoxic brain injury. Genetic variations influence the safety and clinical efficacy of fentanyl. Pharmacogenetic studies help in identifying single-nucleotide polymorphisms (SNPs) associated with fentanyl causing respiratory depression and aid clinician in personalized pain medicine. This narrative review gives an insight of the common SNPs associated with fentanyl.
Rescue Strategies in Anterior Circulation Stroke with Failed Mechanical Thrombectomy—A Retrospective Observational Study (RAFT)
Authors: Bhatti Amit Ashok , Mahajan Niranjan P. , Vyas Devashish Dhiren , Shah Mudasir Mushtaq , Huded Vikram
Published: August 2021

Context:

Recanalization failure rate in mechanical thrombectomy (MT) for large vessel occlusions is up to 30%. Outcome greatly depends on recanalization success and, thus, there is an urgent need to adopt new strategies to improve recanalization.

Aims:

To report on the feasibility, safety, and outcome of rescue strategies (stenting and/or angioplasty) in cases of failed MT for acute ischemic stroke (AIS) in anterior circulation.

Materials and Methods:

It was a retrospective observational study where patients undergoing MT were divided into two groups. The first group (MT-only) was of patients who had undergone only MT with the standard tools (stentriever and/or aspiration). The second group (MT-plus) consisted of patients who underwent a rescue procedure after failure of the standard MT. The two groups were compared based on the demographics, risk factors, stroke severity, and the extent of infarct on imaging. The angiographic findings, procedural details, periprocedural care, and angiographic and clinical outcome were also compared.

Results:

Out of 181 cases, 142 were in MT-only while 39 were included in MT-plus group. The two groups had comparable baseline stroke severity, extent of infarct on imaging and door to puncture time. The MT-plus patients had significantly longer time of onset and puncture to recanalization time. The clinical outcome was favorable in both groups with 57.7% and 59% patients achieving mRS 0–2 in MT-only and MT-plus groups, respectively. Successful recanalization was achieved in 80.3% and 89.7% in MT-only and MT-plus groups, respectively. There was no significant increase in symptomatic intracranial hemorrhage and mortality after rescue procedures.

Conclusions:

Rescue stenting and/or angioplasty after failed MT is a safe and effective recanalization method for AIS in anterior circulation without increasing mortality or morbidity.
Successful Endovascular Reconstruction of Acute Lower Limb Ischemia Secondary to Embolic Aortoiliac Occlusion Using Endologix AFX Unibody Stent Graft
Authors: Wang Yunyi , Singla Animesh , Puttaswamy Vikram
Published: August 2021

Embolic aortoiliac occlusion presenting with acute lower limb ischemia is uncommon and represents a challenge for appropriate management. Several techniques for reconstruction are available, taking into account patient's demographics, surgical risk, and aortoiliac anatomy. Several endovascular and open surgical options exist. We present a novel management strategy, with the use of an endovascular aneurysm stent graft for the reconstruction of native aortoiliac system in a middle-aged female. This allowed for successful revascularization of her lower limb ischemia, while maintaining options for future intervention. Long-term data on this option for the management of acute aorto-iliac occlusion are limited.
Running Out of Vascular Access in Chronic Kidney Disease Patients - A Case Report On Translumbar Dialysis Catheter
Authors: Agrawal Nishant , Munde Yadav Waghaji , Shah Jignesh Navinchandra , Lanjewar Prajakta Sunil , Jawale Sunil
Published: August 2021

Vascular access is the key in patients with end-stage renal disease requiring hemodialysis. After some years, failure of conventional access is a major cause of morbidity and mortality in patients on chronic hemodialysis. Translumbar tunneled dialysis catheter may be a salvage option in such cases for long-term hemodialysis, thereby improving survival and acting as a bridge for renal transplantation.
Endovascular Management and Outcomes of Aortoiliac Occlusive Disease
Authors: Kumar Madhur , Choudhury Apratim Roy , Garg Puneet , Gupta Anubhav , Agarwal Yatish
Published: August 2021

Introduction:

Aorto-iliac Occlusive Disease (AIOD) involves the infra-renal aorta and the iliac arteries. Recent studies advocate endovascular management in TASC C and D lesions also. It involves balloon angioplasty with or without stent deployment.5 The aim of this retrospective study is to evaluate the results of endovascular balloon angioplasty and primary stenting in patients of AIOD.

Methods:

Twenty-five patients with Aorto-iliac occlusion disease who met the inclusion criteria during 1-year study period were included. Patients with acute thrombosis, abdominal aorta or iliac artery aneurysm and additional common femoral artery occlusion were excluded. The TASC II classification was used to define the characteristics of the lesions. The baseline data, procedural details and follow-up results were analysed.

Results:

Amongst 25 patients studied, age ranged from 40-75 years. Self-expanding metallic stent was employed in all patients. Technical success following primary stenting was achieved in all patients. Procedural times for TASC-II A, B, C and D lesions were 90+ 30, 110+ 40, 135+35 and 155+ 45 minutes, respectively. During follow-up, the cumulative primary patency rates at 1 month and 6 months were 100%. Cumulative primary patency rates at 1 year were 91.67%.

Conclusion:

Short- term outcomes of balloon angioplasty and stenting for Aorto-iliac artery occlusions in terms of primary patency rates were excellent.
Our Approach and Review of Current Concepts of Catheter Directed Procedures in Acute Limb Ischemia
Authors: Patkar Amrita , Gadhavi Rishabh , Kalwadia Neha , Sekhar R
Published: August 2021

Acute lower limb ischemia (ALI) is defined as sudden reduction of limb perfusion, leading to a threat to viability of the extremity. With better access to technology and better training in endovascular management in peripheral arterial disease, catheter-directed procedures are an attractive and feasible option in ALI patients. This article deals with our approach to ALI, the basic guidelines and clinical pathway adopted for its management, the hardware and drugs used, and also intraoperative and postprocedural care. It also briefly delves into our experience in using this protocol as also the recent modifications to standard techniques that have been employed, keeping in mind drawbacks such as bleeding and failure of recanalization when employing standard procedures. All patients who presented with ALI from the period of June 2016 to May 2021 with a short history of symptoms <14 days, Class 1, 2a, 2b ALI, and those that were fit and adequately consented for the procedure were studied. Those with age over 80 years, history of gastrointestinal bleed, and history of central nervous system bleed in the last 30 days were automatically excluded from undergoing these procedures. During this period, we saw 112 ALIs in our department, of which 74 cases were primarily deemed suitable for catheter-directed procedures, 60 for catheter-directed thrombolysis, 6 for AngioJet™, and 8 using the CAT6 Penumbra™ catheter. 6 (8.1%) cases subsequently failed the procedure and were converted to open surgery, of which only 2 of 6 had limb/s salvaged, meaning that 4 of 6 converted cases had major amputations. The high amputation rates (25 out of 112, i.e. 22.32%) were clearly attributable on audit, to a delayed referral to a tertiary care center, leading to a large number of Class 3 cases. In our part of the world, open surgical embolectomy is still the mainstay of treatment for ALI. However, an endovascular approach is an option that may be used in selected cases. The structural, personal, and technical conditions of each department must be considered before advocating this modality for therapy in patients.
Robert's Uterus-Rare Cause of Intractable Dysmenorrhea and Chronic Pelvic Pain
Authors: Nigam Aruna , Basanti Namoijam , Sharma Sumedha , Gupta Neha , Jain Abhinav
Published: August 2021

Robert's uterus is a rare type of congenital uterine anomaly where septum divides the uterine cavity asymmetrically resulting in the formation of a noncommunicating hemiuterus. Patients may present with recurrent pain, dysmenorrhea, recurrent abortions, and infertility. They are often misdiagnosed as unicornuate uterus with a noncommunicating horn. Thirty-year nulliparous female with history of severe dysmenorrhea since her menarche for which she had been operated thrice with no relief, presented with severe abdominal pain. Magnetic resonance imaging findings were suggestive of possibility of accessory horn with left hematosalpinx and hemorrhagic fluid in pelvis. Intraoperatively, it was found to be thick uterine septum completely dividing the uterine cavity asymmetrically with no communication with cervix indicative of Robert's uterus.
Analysis of related factors to internal derangement in temporomandibular joint dysfunction patients using magnetic resonance imaging
Authors: Mizuhashi Fumi , Ogura Ichiro , Sugawara Yoshihiro , Oohashi Makoto , Mizuhashi Ryo , Saegusa Hisato
Published: August 2021

Background/Aim:

The aim of this study was to investigate the related factors to internal derangement in the temporomandibular joint (TMJ) dysfunction patients using magnetic resonance imaging (MRI).

Methods:

We reviewed the MRI of 60 TMJs that were examined MRI and diagnosed with internal derangement. Characteristics of the patients with internal derangement such as gender, age, TMJ pain, disturbance of mouth opening, and joint effusion were examined. Statistical analyses of each characteristic such as gender, TMJ pain, disturbance of mouth opening, and joint effusion were performed by cross-tabulation. The age difference was analyzed using Mann–Whitney test. The relationships between internal derangement and gender, age, TMJ pain, disturbance of mouth opening, and joint effusion were also analyzed by logistic multivariate regression analysis.

Results:

The occurrence of internal derangement was different by gender (P = 0.021), and the number was larger on women. The presence of disturbance of mouth opening was significantly larger on disc displacement without reduction compared to that on disc displacement with reduction (P = 0.027). Age, TMJ pain, and joint effusion were not different between disc displacement with reduction and disc displacement without reduction. The result of logistic multivariate regression analysis showed that gender and disturbance of mouth opening were related to the higher risk of internal derangement (P < 0.05).

Conclusions:

These results suggested that internal derangement would be easier to occur on women, and the disturbance of mouth opening was occurring easily on disc displacement without reduction.
Evaluation of olfactory fossa depth using computed tomography in South Indian population
Authors: Patil Divya Teja , Ullas L. Yashas , Chaithanya A. , Dhanvarsha S , Sai Nikhilendra Reddy Aluru Venkata , Srinivasa Harshadeepa
Published: August 2021

Context:

Anatomical variations are very important in planning a paranasal sinus (PNS) surgery. Currently, there are limited data on olfactory depth in the South Indian subpopulation.

Aim:

The aim of this study was to determine the olfactory fossa (OF) depth using Computed Tomography (CT) in the South Indian population.

Settings and Design:

This retrospective study was conducted in radiology, Sri Devaraj URS Medical College, Tamaka, Kolar.

Materials and Methods:

A single radiologist analyzed computed tomography (CT) and medical records of 287 patients from October 2020 to March 2021. OF depth (Keros classification) was considered the primary outcome variable.

Statistical Analysis Used:

Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency, and proportion for categorical variables. P < 0.05 was considered statistically significant. Data were analyzed using coGuide_V.1.0.

Results:

The mean age was 44.2 years in the study population. Among the study population, 183 (63.76%) were male, and the remaining 104 (36.24%) were female. In people with Keros classification right side, 62 (21.60%) falls under Type I, 209 (72.82%) were Type II, and 16 (5.57%) were Type III. In people with Keros classification left side, 33 (11.50%) were Type I, 240 (83.62%) were Type II, and 14 (4.88%) were Type III.

Conclusion:

Keros Type II OF was more common in the study population, and the least common was Type III. The knowledge of OF depth may help the radiologists analyze this region's scans and minimize complications associated with surgeries in this delicate area.
The association between food diversity and serum antioxidant indices in cataract patients compared to healthy subjects
Authors: Heidari Naeimeh , Nabie Reza , Jabbari Masoumeh , Irannejad Niri Zahra , Zeinalian Reihaneh , Asghari Jafarabadi Mohammad , Arefhosseini Seyed Rafie
Published: August 2021

Background:

Cataract is a chronic disorder that is related to antioxidant–oxidant imbalance situation. We aimed to investigate the association between food diversity and serum antioxidant and oxidant indices in cataract patients compared to healthy subjects.

Materials and Methods:

In this case–control study, ninety volunteers (aged > 50 years) were divided into the cataract (n = 45) and healthy control (n = 45) groups. Anthropometric variables, physical activity and stress levels, food diversity score, serum total oxidant capacity (TOC), and total antioxidant capacity (TAC) measurements were done for all participants.

Results:

Serum TAC, even after adjustment for stress level, was significantly higher in healthy people compared to cataract patients (P < 0.001). In addition, serum TOC was significantly lower in healthy controls compared to cataract patients (P < 0.002). In healthy group, there was a weak significant positive association between serum TAC and meats group diversity (r = 0.149, P = 0.047). In addition, there was a moderate negative association between meats group diversity and TOC in the healthy controls (r = −0.712, P = 0.041). In the cataract group, there was a significant negative association between serum TOC and diversity score of fruits (r = −0.811, P = 0.017) and meats group (r = −0.926, P = 0.046) as well as total score of food diversity (r = −0.466, P = 0.003).

Conclusion:

It seems that increase in total dietary diversity and food groups' diversity can have a beneficial effect on oxidant situation among cataract patients.
Obesity researches in youth
Authors: Atoofi Mehrdad Kazemzadeh , Qorbani Mostafa , Asayesh Hamid , Rezaei Nazila , Moghaddam Sahar Saeedi , Djalalinia Shirin
Published: August 2021

Background:

The alarming trends of obesity/overweight in youth have been interested policy makers and other stakeholders to exact follow and analysis of related scientific evidence. The present paper quantify the trends of outputs of youth obesity/overweight researches in Middle East countries.

Materials and Methods:

The Scopus database systematically searched as the most comprehensive multidisciplinary database, for all related obesity/overweight that focused on youth age groups concerns, from 2000 to 2017. These scientometrics analysis included the trends of scientific products, citations, and other scientometric index in Middle East countries.

Results:

During 2000–2017, in the field of youth obesity, 2350 papers published (0.40% of total 591,105 indexed paper of this region) by Middle East countries. In this regard, Iran with 574 publication (24.43%) had the first rank. After that Turkey and Saudi Arabia, respectively, with 489 (20.81%) and 313 (13.32%) papers, had the next ranks. Over 18-year period, based on the findings all of Eastern Mediterranean countries follow the progressive plans for topics related to youth obesity. Between them, Iran and Turkey have significant growth rates (0.77% and 0.40%, respectively). Scientometric indicators such as “number of published papers,” “number of citations” confirmed that during the 2000–2017 the P-trends of total number of related published papers and the correspond citations, in region countries, were significant (2168 papers and 34,132 citations, P < 0.001).

Conclusion:

Most of countries at global and regional levels follow ascending trends in publications and citations in obesity/overweight fields. Iran's position has grown significantly among them. Maintaining and promoting this position requires careful planning and special attention. The findings also could be used for better health policy and complementary researches.
Anticoagulation therapy in COVID-19 patients with chronic kidney disease
Authors: Shafiee Mohammad Ali , Hosseini Sayyideh Forough , Mortazavi Mojgan , Emami Anahita , Mojtahed Zadeh Mahtab , Moradi Sanaz , Shaker Pouyan
Published: August 2021

Coagulopathy and derangements in the coagulation parameters are significant features of COVID-19 infection, which increases the risk of disseminated intravascular coagulation, thrombosis, and hemorrhage in these patients, resulting in increased morbidity and mortality. In times of COVID-19, special consideration should be given to patients with concurrent chronic kidney disease (CKD) and COVID-19 (CKD/COVID-19 patients) as renal dysfunction increases their risk of thrombosis and hemorrhage, and falsely affects some of the coagulation factors, which are currently utilized to assess thrombosis risk in patients with COVID-19. Hence, we believe extra attention should be given to determining the risk of thrombosis and bleeding and optimizing the timing and dosage of anticoagulant therapy in this unique population of patients. CKD/COVID-19 patients are considered a high-risk population for thrombotic events and hemorrhage. Furthermore, effects of renal function on paraclinical and clinical data should be considered during the evaluation and interpretation of thrombosis risk stratification. Individualized evaluation of clinical status and kidney function is necessary to determine the best approach and management for anticoagulant therapy, whereas there is a lack of studies about the population of CKD/COVID-19 patients who need anticoagulant therapy now.
Are Children and Younger People more Susceptible to the Newer Strains of SARS-CoV-2 than Previous Ones? Current Evidence
Authors: Bashar Abu , Begam1 Nazia
Published: August 2021

The clinical impact of the new SARS-CoV-2 lineage B.1.1.7 on children and young people (aged 18 years or younger) regarding acute respiratory COVID-19 is yet to be fully defined. Media reports of increases in admissions to hospital and more serious illnesses in children and young people have resulted in chaos and panic in public and implicated the B.1.1.7 variant as a cause of more pathogenic infection within this group.
Exploring Perspectives on Mental Well-Being of Urban Youth from a City in South India
Authors: Kumar Shuba , Mohanraj Rani , Lidiya Angelin , Karthikeyan D , Kannan Latha , Azariah Fredric , Sinha Moitreyee , Raghavan Vijaya , Kumar Suresh , Thara R
Published: August 2021

Background:

Mental health needs and concerns of young persons in resource-poor settings remain poorly understood and inadequate. How young people understand and perceive mental well-being might differ based on their setting. Hence, the aim of this study was to understand how young people in urban settings perceived mental health and well-being. It also explores their perceived barriers to mental well-being.

Materials and Methods:

A qualitative study, using focus group discussions and in-depth interviews (IDIs), was conducted with youth aged 18–24 years from three different settings, namely educational institutions, workspace, and urban slums, in Chennai city, South India. The following three themes related to mental health well-being were identified (i) What does it mean? (ii) What affects it? and (iii) How do young people cope?

Results:

Four focus group discussions (9–10 participants in each) and 15 IDIs were conducted. Findings revealed that mental well-being was affected by relationship issues, academic/career pressures, and social mores; seeking mental health care was stigmatizing and differences in societal norms left young women feeling vulnerable and frustrated.

Conclusion:

Results highlight the various mental health challenges faced by young people in urban settings in India and underscore the need for more research to better understand the interactions between individual and environmental factors. These, in turn, would inform the development of early interventions to promote mental health and help cope with mental problems among young people.
Stress, Well-being, and Burnout in Georgian Medical Students
Authors: Berdzenishvili Ekaterine , Kadhum Murtaza , Molodynski Andrew , Bhugra Dinesh
Published: August 2021

Much attention has been focused on the well-being of health-care staff and more recently medical students. This small-scale study formed a part of a major international initiative and used standardized measures of health, substance misuse, and burnout. We found high levels of stress from several key sources alongside the rates of 80% and 83% for the disengagement and exhaustion subscales of the Oldenburg burnout scale. The rates of mental health problems as measured by the General Health Questionnaire-12 short version were 68%.
Tele-health Services – Can “Virtual” be as Good as “Real”?
Authors: Dhillon Harpreet Singh , Sasidharan Shibu
Published: August 2021

COVID-19 pandemic has pronounced unimaginable ripples in the normal functioning of the world we live in and has also compelled us to bring a paradigm shift in health-care provisions and how we practice it. Telehealth services have almost dramatically replaced traditional in-person treatment, especially in mental health services. This significant change in the practice of medicine has forced us to question our very perception of ideal health care. Telemedicine will do for health care what the personal computer has done for the office. Or so its proponents believe. Its opponents believe that it represents a threat to the doctor–patient relationship and is an intrinsically unsafe way of practicing medicine. In this brief clinical update, we delve into the core of telemental health services and try to unravel its impact on human lives during this pandemic.
Quasifolds, diffeology and noncommutative geometry
Authors: Iglesias-Zemmour Patrick , Prato Elisa
Published: August 2021

After embedding the objects quasifolds into the category

\{

Diffeology

\}

, we associate a

\boldsymbol{C}^*

-algebra with every atlas of any quasifold, and show how different atlases give Morita equivalent algebras. This builds a new bridge between diffeology and noncommutative geometry – beginning with the today classical example of the irrational torus – which associates a Morita class of

\boldsymbol{C}^*

-algebras with a diffeomorphic class of quasifolds.
Identifying Nontraditional Epidemic Disease Risk Factors Associated with Major Health Events from World Health Organization and World Bank Open Data
Authors: Lugo-Robles Roberta , Garges Eric C. , Olsen Cara H. , Brett-Major David M.
Published: August 2021

Health events emerge from host, community, environment, and pathogen factors—forecasting epidemics is a complex task. We describe an exploratory analysis to identify economic risk factors that could aid epidemic risk assessment. A line list was constructed using the World Health Organization Disease Outbreak News (2016–2018) and economic indicators from the World Bank. Poisson regression employing forward imputations was used to establish relationships with the frequency with which countries reported public health events. Economic indicators demonstrated strong performance appropriate for further assessment in surveillance programming. In our analysis, three economic indicators were significantly associated to event reporting: how much the country’s urban population changed, its average forest area, and a novel economic indicator we developed that assessed how much the gross domestic product changed per capita. Other economic indicators performed less well: changes in total, female, urban, and rural population sizes; population density; net migration; change in per cent forest area; total forest area; and another novel indicator, change in percent of trade as a fraction of the total economy. We then undertook a further analysis of the start of the current COVID-19 pandemic that revealed similar associations, but confounding by global disease burden is likely. Continued development of forecasting approaches capturing information relevant to whole-of-society factors (e.g., economic factors as assessed in our study) could improve the risk management process through earlier hazard identification and inform strategic decision processes in multisectoral strategies to preventing, detecting, and responding to pandemic-threat events.
Prevalence of HIV Infection and Resistance Mutations in Patients Hospitalized for Febrile Illness in Indonesia
Authors: Merati Tuti P. , Karyana Muhammad , Tjitra Emiliana , Kosasih Herman , Aman Abu T. , Alisjahbana Bachti , Lokida Dewi , Arlinda Dona , Maldarelli Frank , Neal Aaron , Arif Mansyur , Gasem Muhammad Hussein , Lukman Nurhayati , Sudarmono Pratiwi , Lau Chuen-Yen , Hadi Usman , Lisdawati Vivi , Wulan Wahyu Nawang , Lane H. Clifford , Siddiqui Sophia
Published: August 2021

HIV prevalence in Indonesia is increasing, and only 64% of infected individuals know their status. In a prospective cohort of 1,453 hospitalized patients with unexplained fever, 46 (3.2%) had HIV, including 15 (1.1%) patients without a prior HIV diagnosis. Among 31 subjects previously known to have HIV, 21 (68%) had been receiving combination antiretroviral therapy (cART) at the time of enrollment. Of 39 HIV cases with HIV RNA levels ≥ 100 copies/mL, sequencing for genotype analysis and resistance testing was successful in 30 (77%) subjects. The most common HIV subtypes were AE (90%) and B (10%). Five (16.7%) subjects had resistance mutations to nucleoside and non-nucleoside reverse transcriptase inhibitors, and all of them were on cART. No evidence of transmitted drug resistance was found in newly diagnosed individuals. Hospital-based screening may be an efficient method to expand HIV testing and identify a significant number of new cases. Access to care, close monitoring, expansion of anti-retroviral options, and ensuring availability of CD4 determinations, viral load testing, and genotyping are crucial to control of the epidemic in Indonesia.
Maternal Correlates of Poliomyelitis Vaccination Uptake: Evidence from Afghanistan, Pakistan, and Nigeria
Authors: Muzammil Muhammad , Zafar Sameen , Aziz Shazia , Usman Muhammad , Amir-ud-Din Rafi
Published: August 2021

Poliomyelitis (polio) is a communicable viral disease that mainly affects under-5 children. This study focuses on the impact of women’s empowerment and women’s working status on the uptake of polio vaccination of children in polio-endemic countries, including Pakistan and Afghanistan, and Nigeria, the latter of which has recently been declared polio-free. The polio vaccination status can be divided into no vaccination (NV), incomplete vaccination (IV), and complete vaccination. We used data from the most recent Demographic and Health Surveys (DHS) rounds for this manuscript. Multinomial logistic regression-based estimates suggest that mothers’ working status, empowerment, age, education, father’s education, and household wealth status reduce the risk of NV and IV in the polio-endemic countries (Afghanistan and Pakistan) and Nigeria. In addition, the mothers’ working status, empowerment, age, education, and father’s education increase the child’s healthcare information that helps complete polio vaccination of the child. On the other hand, the children whose mothers work in the agriculture sector or are engaged in a blue-collar job are more likely to remain unvaccinated than women in white-collar jobs. Similarly, mothers engaged in government jobs are more likely to get their children fully vaccinated than unemployed mothers. Thus, as a child’s polio vaccination is strongly dependent on a mother’s working status and empowerment, the focus of public policy on empowering women and promoting their labor force participation may increase polio vaccination uptake, besides adopting other measures to increase immunization.
Chikungunya in Guerrero, Mexico, 2019 and Evidence of Gross Underreporting in the Region
Authors: Nunez-Avellaneda Daniel , Tangudu Chandra , Barrios-Palacios Jacqueline , Salazar Ma. Isabel , Machain-Williams Carlos , Cisneros-Pano Jonathan , McKeen Lauren A. , Blitvich Bradley J.
Published: August 2021

The local public health authorities reported nine cases of chikungunya in Mexico in 2019, none of which occurred in Guerrero, a coastal state in the southwest. To test the hypothesis that chikungunya is grossly underreported in Mexico, acute sera were collected from 639 febrile patients from low-income households in Guerrero in 2019 and serologically assayed for chikungunya virus (CHIKV). Analysis of the sera by plaque reduction neutralization test revealed that 181 (28.3%) patients were seropositive for CHIKV. To identify patients with acute CHIKV infections, a subset of serum samples were tested for CHIKV-specific IgM by ELISA. Serum samples from 21 of 189 (11.1%) patients were positive. These patients met the chikungunya case definition established by the WHO. In conclusion, we provide evidence that CHIKV remains an important public health problem in Mexico and that the true number of cases is severely underestimated.
The “Galamsey” Menace: Implications on the Archaeological Record at Awudua Dada, Western Region, Ghana
Authors: Biveridge Fritz
Published: August 2021

This article discusses the socio-cultural consequences of small-scale artisanal gold mining on the archaeological record and other heritage resources at Awudua Dada, located in the Prestia-Huni Valley District of the Western Region, Ghana. The settlement witnessed vibrant commercial exchanges between Wassa and Dutch traders in the mid-seventeenth century because of its abundant gold resources, much of which was exchanged for novel European trade goods such as varieties of alcoholic beverages, guns, gunpowder, and finished metal products among many others. Currently abandoned and desolate, groups of small-scale artisanal gold miners continue to prospect gold there, and along the banks and bed of the Ankobra River which lies close-by. Archaeological, historical, and ethno historical research constituted the principal methods used to derive data for the study which revealed that mining had not only negatively impacted the archaeological record and other cultural resources there but had also caused significant environmental degradation.
Philogenetics of Sea Urchin Tripneustes gratilla using Cytochrome Oxidase Subunit 1 Gene
Authors: Abidin Nurul , Mogea Rina A. , Binur Robi
Published: August 2021

Sea urchin Tripneustes gratilla is multifunction organism that can be used as potential food source because of its high nutrient content. This organism can also be utilized bioindicator of sea waters and as a modal of organism for studying biology’s purposes. The purposes of this research is studying Filogenetic of sea urchin T. gratilla from waters of Wasior and Serui. The research has been doing at the Biotechnology Laboratory of the state of University of Papua on November to December 2009. The sample was extracted by using Chelex 10 % and was amplified with PCR technic (polymerase chain reaction). Sequencing of CO I gens (cythocrome oxidase subunit I) was done using sequencher ABI 377 (Apllied Biosystem). The result of nucleotid sequence data was analyzed utilizing MEGA 4.0.2. This researchs result showed that the gen fragment that was succesfully amplified 601 bp. The sequence result of nucleotid which was analyzed the variaty of nucleotid between the sample from two waters. Filogenetic analyzing toward individu of the two waters produce the two clusters. The first cluster consist of SER 01 and sub cluster which is consisted of WSR 02 and SER 02. While, the second cluster consist of only WSR 01. This result showed that every individu from Wasior (WSR 02) has close genetic relation with other individu from Serui (SER 02), that proved there is genetic flow between the two waters.
Capacitor-less Low-Dropout Regulator for Analog Sensing using 90nm Technology
Authors: M. S Pavan , , Nagabushanam M. , Hawaldar Sushmita , Gangadharaiah S. L.
Published: August 2021

The capacitor-less-output-low-dropout (CLO-LDO) regulator proposed in this study can manage a wide variety of load currents. To offer temperature independent controlled LDO output, the LDO's 0.844V reference voltage is obtained using BGR, the optimized design is presented that provide full range stability, fast transient response. These benefits allow the proposed LDO regulator to operate over a wide range of operating circumstances, with very high current efficiency 99.99% and low voltage drop 100mV, operating using very low quiescent current of 0.02µA, at the output of regulator. The proposed regulator design is constructed in 90nm CMOS technology, the structure of the regulator is implemented using a Two-stage operational amplifier to obtain large DC gain 50dB to improve supply noise rejection, and a feedback loop, and exhibits better performance in terms of large phase margin 64.516 degrees with no load and 70.63degree full load.
Application of a Memristive Neural Network for Classification of COVID-19 Patients
Authors: Kirilov Stoyan , Todorova Violeta , Nakov Ognyan , Mladenov Valeri
Published: August 2021

The global pandemic of COVID-19 has affected the lives of millions around the globe. We learn new facts about this corona virus every day. A contribution to this knowledge is described in the paper and it is related to employment of memristor neural networks and algorithms that help us analyze patients’ data and determine what patients are at increased risk for developing severe medical conditions once infected with the COVID-19. An efficient separation of potential patients in ill and healthy sub-groups is conducted using software and hardware neural networks, machine learning and unsupervised clustering. In the recent years, many works are related to reducing of neural chips area for the hardware realization of neural networks. For this purpose, a partial replacement of CMOS transistors in neural networks by memristors is made. Some of the main memristor advantages are its lower power consumption, nano-scale sizes, sound memory effect and a good compatibility to CMOS technology. In this reason, the main purpose of this paper is application of a memristor-based neural network with tantalum oxide memristor synapses for COVID-19 analysis. Additional experiments with data clustering are conducted. Experiments show that in fact patients with specific underlying health conditions and indicators are more predisposed to develop severe COVID-19 illness. This research is helpful for engineers and scientists to easier identifying patients that would need medical help
Characterization and nutritional assessment of traditional dairy products from the Zlatibor region, Republic of Serbia
Authors: Milićević Dragan , Pleadin Jelka , Janković Saša , Nedeljković-Trailović Jelana , Lešić Tina , Vranić Danijela , Krešić Greta
Published: August 2021

The aim of this study was to determine the nutritional properties of raw milk, cheese and a traditional creamy dairy product called kajmak originating from the Zlatibor region in Serbia. Chemical composition, minerals, fatty acid (FA) profile, lipid quality indices, and the dietary intake of saturated fatty acids (SFA), cholesterol, salt and sodium were investigated in three sampling sessions during the period June–September 2019. All chemical properties of raw milk, cheese and kajmak differed significantly (P<0.05), except lactose, salt and total proteins. Palmitic acid (C16:0) was present in the highest share, followed by oleic (C18:1cis-9) and myrstic (C14:0) acids, with no significant differences (P>0.05) between products. Among the FAs, conjugated linoleic acids (CLA) were determined, and mean values of total FAs ranged from 0.16% in raw milk and kajmak to 0.31% in cheese. The recommended values for the lipid quality indices were not obtained for the analysed products. Despite a high sodium content, the tested dairy products can be considered valuable sources of calcium, chromium, zinc and selenium. In the future, additional efforts should be employed in product modification with the aim of optimising nutritional value and to obtain the protect designation of origin.