bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative safety and efficacy of tibolone and escitalopram in postmenopausal women
Authors: Raj Rajnish , Sharma Namita , Garg Rohit , Goyal Ekram
Published: April 2023

Background:

A high prevalence of psychiatric disorders, particularly depressive and anxiety disorders among women is observed through the postmenopausal stage.

Aim:

The aim of this study is to compare the safety and efficacy of tibolone (TIB) and escitalopram (ESCIT) in postmenopausal women (PMW).

Materials and Methods:

It was an interventional, open-label, hospital-based, follow-up study conducted on 60 PMW with the diagnosis of depression as per the Diagnostic and Statistical Manual of Mental Disorder-5 criteria. Patients were divided into two groups of 30 each, i.e. Group I (TIB-2.5 mg/day) and Group II (ESCIT-10–20 mg/day). The primary outcome was assessed for change in climacteric symptom scores on Greene's Climacteric Scale (GCS), severity of depression and anxiety on Hamilton Rating Scale for Depression (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A), and sexual functioning on Arizona Sexual Experience Scale (ASEX). The secondary outcome of well-being was assessed on World Health Organization Quality of life (QOL)-BREF. All the observations were carried out from baseline and at 2, 4, 8, and 12 weeks.

Results:

Both the groups showed significant improvement in climacteric and depressive symptoms. However, at the 8th and 12th weeks, mean ± standard deviation scores were significantly lower in Group I (GCS score - 24.80 ± 4.92, 20.30 ± 3.56; HAM-D score - 16.57 ± 5.83, 10.2 ± 5.67) compared to Group II (GCS score - 27.27 ± 5.83 and 23.33 ± 5.70, HAM-D score - 19.97 ± 7.98 and 16.17 ± 10.11). No significant difference between the groups was seen for anxiety on HAM-A scores. Only in Group I, there was significant improvement in ASEX scores. QoL in Group I had shown significant improvement in physical and psychological domain compared to Group II at different time interval, i.e. 4th and 8th week onward. In Group I, Alternative Dispute Resolution was reported to be 23.3%, whereas it was 56.7% in Group II. However, none were serious to warrant discontinuation.

Conclusion:

TIB was better than ESCIT in improving depression, climacteric symptoms, and physical and psychological domain of QoL with an additional benefit of restoring sexual functioning.
Knowledge and practices related to menstruation among tribal adolescent girls
Authors: Kumari Shantna , Sood Sunaina , Davis Supriya , Chaudhury Suprakash
Published: April 2023

Background:

Despite the fact that every girl has to deal with menstrual hygiene, there is a lack of awareness about the process of menstruation and proper menstrual hygiene among adolescent girls, especially from tribal backgrounds.

Aim:

The aim of the study was to assess the knowledge and practices related to menstruation among tribal (Munda) adolescent girls.

Materials and Methods:

This was a community-based cross-sectional study. The sample for the study consisted of 150 girls belonging to Munda tribe in the age group of 13–18 years, recruited by purposive sampling from various schools of Khunti district of Jharkhand state. Interview guide was predeveloped, validated, and used to study the knowledge and practices related to menstruation among adolescent girls. The data were collected by a personal interview of the study subjects.

Results:

The mean age of menarche of the study subjects was 14.1 years. It was evident that only 48.67% of the participants were aware about menstruation before menarche and the most important source of the information about menstruation for them was their friends (53.33%) followed by mothers.

Conclusions:

Knowledge about menstruation is poor among tribal adolescent girls and practices included various myths and misconceptions.
Caregiver burden among working women and homemakers taking care of psychiatric patients
Authors: Kaur Navneet , Puria Alka , Kumar Ajay , Chaudhury Suprakash , Goyal Ekram , Singh Vivek Partap
Published: April 2023

Background:

Caregiver burden is defined as the physical, psychological or emotional, social, and financial problem that can be experienced by the members of family caring for impaired person. In India, women are twice more likely to become caregivers than men, despite emergence of men as caregivers.

Aim:

The aim of the study is to assess burden of illness among working women and homemakers taking care of psychiatric patients.

Materials and Methods:

This hospital-based, descriptive, cross-sectional comparative study was conducted on the caregivers who were recruited from outdoor patient department of psychiatry department of a tertiary care hospital attached to a medical college. Women who were 30–45 years old, working or homemakers and who were taking care of psychiatric patients diagnosed with schizophrenia and Bipolar affective disorder (BAPD) of either sex. Caregivers were first-degree relatives of patients. Sociodemographic data were recorded using a special performa and caregiver burden was assessed using caregiver burden questionnaire.

Results:

Overall mean caregiver burden scores in Group 1 and Group 2 were 55.66 ± 4.09 and 58.16 ± 3.97, respectively, with statistically significant difference (P < 0.05).

Conclusion:

Caregiver burden was more among working women compared to homemaker women.
Pattern of burden on the family of patients with schizophrenia and bipolar disorder
Authors: Khatoon Khurshida , Dhamija Sana , Gupta Nishtha , Padhi Debashis , Kiran Manisha , Chaudhury Suprakash
Published: April 2023

Background:

The concept of burden of care came from the realm of behavioral sciences primarily in the context of looking after a psychiatrically ill person. Caregivers of schizophrenia and bipolar affective disorder (BPAD) have to take over the totality of patient care since most of these patients are treated at home. As a result of this, they are exposed to negative consequences of caregiving.

Aim:

This study aims to assess and compare the pattern of burden among the families having patients with schizophrenia and bipolar disorder.

Materials and Methods:

This cross-sectional, observational study was conducted on the outpatient department level at Ranchi Institute of Neuropsychiatry and Allied Science. This study included 30 patients with schizophrenia and equal number of age- and sex-matched patients with bipolar disorder. The diagnosis was made as per criteria of International Classification of Diseases 10 diagnostic criteria for research. Their caregivers who gave consent for their participation in the study and satisfy the inclusion and exclusion criteria were included in the study by purposive sampling. Tools administered were socio-demographic datasheet and family burden inventory schedule.

Statistical Analysis Used:

Chi-square test, Fisher's exact test, and Mann–Whitney U test.

Results:

Total caregiver burden, financial burden, disruption of routine family activities, family leisure, family interaction, and subjective burden felt by caregiver were significantly more in caregivers of schizophrenia patients compared to caregivers of BPAD. There was no significant difference in the two areas of burden, i.e., effect on physical health of the caregivers and effect on mental health of caregivers.

Conclusion:

Caregivers of schizophrenia patients have significantly higher family burden as compared to caregivers of subjects with BPAD.
Prevalence of smartphone addiction and its relation with sleep disturbance and low self- esteem among medical college students
Authors: Dhamija Sana , Shailaja B , Chaudhari Bhushan , Chaudhury Suprakash , Saldanha Daniel
Published: April 2023

Background:

Use of smartphone is on the increase worldwide. They have revolutionized our lives to an extent that was unimaginable before the pandemic. Excessive use of smartphones reaching the levels of potential addiction among medical students and its relation to individual's sleep quality and self-esteem led us to study this prevalence.

Aim:

This stuay aimed to study the prevalence of smartphone addiction and its relation with self-esteem and sleep disturbance in medical college students.

Materials and Methods:

A cross sectional analytical study was carried out and the prevalence of smartphone addiction, self- esteem, and sleep disturbance was measured using standardized questionnaires smartphone addiction scale short form, Rosenberg self esteem scale, Pittsburgh sleep quality index assessment respectively.

Results:

Prevalence of smartphone addiction among medical college students was 52%. Smartphone addiction was seen more in boys than girls. There was a significant association between the smartphone addiction and sleep disturbance. However, there was no significant association between smartphone addiction and low self-esteem.

Conclusion:

The prevalence of smartphone addiction among medical students is found to be high and is associated with poor sleep.
Blasphemous thoughts in obsessive–compulsive disorder
Authors: Ali Tahoora , Mujawar Swaleha , Davis Supriya , Chaudhury Suprakash , Saldanha Daniel
Published: April 2023

Obsessive–compulsive disorders (OCDs) are one of the top 10 contributors of debilitating medical illnesses and are the fourth most common psychiatric disorder. Blasphemous thoughts, also known as scrupulosity, as an obsessional theme has piqued curiosities long before it was considered a neurosis. Such obsessions may or may not have an accompanying compulsion and comprise 5% of the patients of OCD. The case series is of three patients suffering from repetitive, intrusive, ego-dystonic, and distressing blasphemous thoughts, which are extremely distressing to them, rendering them unable to perform any other activity. The symptoms also indicate the presence of comorbid depressive and anxiety disorders, developing secondary to the blasphemous thoughts. Inadequate knowledge in this subtype of OCD mandates the need for more studying and research, especially with new texts suggesting the implementation of faith-assisted psychotherapy in addition to the conventional psychotherapy and pharmacotherapy.
Gut in COVID 19-is it worth noticing
Authors: Javadekar Narendra S.
Published: April 2023

Although much has been talked and written about the respiratory menace that Coronavirus disease causes, a close examination reveals that gut symptoms are equally important diagnostic markers for COVID-19. Almost 53% of COVID-19 patients experience gastrointestinal (GI) symptoms. The entry of the SARS Cov-2 virus is mediated through angiotensin-converting enzyme receptors which are abundant in the GI tract. The virus also affects the GI tract through the gut lung axis. In addition to the GI tract epithelium, hepatobiliary and pancreatic systems are also affected in COVID through multiple mechanisms. GI manifestations vary from relatively benign symptoms such as nausea vomiting diarrhea to rare cases of life-threatening mesenteric vein thrombosis. The relationship of the symptoms with morbidity and mortality is not clear. Anorexia is related to inflammation, and agneusia and anosmia carry a good prognosis. Psychiatric manifestations may be more common in those with GI affection, inflammation being the common pathogenic factor. Treatment is symptomatic, and proper hygiene precautions are necessary considering the possible fecal shedding of the virus, especially during endoscopic procedures on the GI tract.
COVID-19 moral dilemmas viewed through Eastern and Western philosophy
Authors: Maggu Gaurav , Sharma Sandeep , Jaishy Rajon , Jangid Surabhi
Published: April 2023

COVID-19 has been a considerable major stress factor and has led to a great increase in psychological illnesses. Literature related to spirituality and philosophy can provide solace in times like these. We have taken excerpts from Bhagwad Gita which is a spiritual and philosophical scripture, existential philosopher Albert Camus's La Peste and the myth of Sisyphus and writings of the philosopher Immanule Kant. These literary masterpieces can provide a wealth of guidance and solace to both the medical fraternity and affected people and their caregivers.

“We tell ourselves that pestilence is a mere bogy of the mind, a bad dream that will pass away. But it doesn't always pass away and from one bad dream to another, it is men who pass away.”

–Albert Camus
Quarantine
Authors: Davis Supriya , Samudra Madhura , Dhamija Sana , Chaudhury Suprakash , Saldanha Daniel
Published: April 2023

Quarantine is an age old methods of preventing the spread of infection by restricting the movement of persons or goods. It has again come to global attention due to its widespread implementation during the COVID-19 pandemic. While the public health utility of quarantine is well established, it is associated with few psychological effects which are neither well known nor recognized. In this communication, the psychological side-effects of quarantine and their prevention are briefly discussed.
Impact of COVID-19 pandemic on persons with psychiatric disorders
Authors: Sowmya A. V. , Javadekar Archana , Menon Preethi , Saldanha Daniel
Published: April 2023

From the beginning of COVID-19 pandemic, concerns have been raised about its effect on mental health and on patients with psychiatric illnesses. A few reports suggest that patients with COVID-19 have increased symptoms of anxiety disorders, post-traumatic stress disorder, depression, increased substance use, and insomnia. There is an increased trend seen in flare-up of psychotic symptoms and new emergence of psychotic symptoms in previously healthy adults. There is extensive research available on the impact of COVID-19 on physical health, but there is a paucity of studies on the effects of COVID-19 on psychiatric illness.
Neurobiological underpinnings of emotions
Authors: Singh Rishabh , Sharma Rachit , Chauhan V. S. , Chatterjee Kaushik
Published: April 2023

Emotion is a stirred-up state caused by physiological changes occurring as a response to some event and which tends to maintain or abolish the causative event. Understanding the neuroanatomical basis of the genesis and control of emotions is quintessential in understanding how biology affects the mind and in turn, helps in understanding our own nature. We present a short communication explaining the neurological basis of emotions.
Memory
Authors: Mujawar Swaleha , Patil Jaideep , Chaudhari Bhushan , Saldanha Daniel
Published: April 2023

Memory is the process of retaining of knowledge over a period for the function of affecting future actions. It can be divided into declarative and procedural types. The process of memory consolidation is done in the hippocampus. The long-term memories are spread among various areas of the cerebrum depending on the different perceptual properties. The process of long-term potentiation and molecular changes occurring during memory formation are discussed in detail below. The steps involved in memory formation include encoding, storage, and recall (retrieval) in that order. Amnesia is a phenomenon in which there is the problem in memory formation which can be due to trauma to the brain, certain diseases, or stressors. While the assessment of memory has greatly improved, we are only beginning to understand the underlying mechanisms.
Alzheimer's disease
Authors: Dangi Ankit , Chatterjee Kaushik , Banwa Manjur Shah , Chauhan Vinay Singh , Yadav Prateek
Published: April 2023

Fifty million people are affected with dementia worldwide with Alzheimer's disease (AD) accounting for 70%–80% of these cases. In India alone, 4.1 million people suffered from dementia in 2015. To date, there are no definitive treatment options for AD and the overall treatment gap in India stands at 90%. Attempts have been made to define AD biologically. This has been made possible due to advances in the identification of biomarkers that indicate the neuropathological changes responsible for AD. Identification of these biomarkers has implications for disease staging, prognostication, and identifying drug targets. Here, we summarize the advances in the field of biomarkers in AD.
Magnetic seizure therapy
Authors: Singh Rishabh , Sharma Rachit , Prakash Jyoti , Chatterjee Kaushik
Published: April 2023

Magnetic seizure therapy is a novel form of focal convulsive treatment wherein magnetic field passes through the scalp and skull without impedance. In many ways, it has the potential to be superior to electroconvulsive therapy (ECT) as the anesthesia-associated side effects and cognitive impairments are less. It also may be an alternative for those who do not opt for ECT because of the stigma associated with it.
COVID-19 pandemic, mental health care, and the UK
Authors: Bhugra Dinesh , Molodynski Andrew , Gnanapragasam Sam Nishanth
Published: April 2023

The unprecedented SARS-2 COVID-19 pandemic has had a profound impact on individuals, families, and societies worldwide. The impact of the illness does not only directly relate to poor health on infection but also social and political determinants of health. As such, the secondary effects of the pandemic have been profound. Mental health and well-being have been one such area of concern, with the causal links thought to occur in three ways. First: the impact on general population, particularly vulnerable groups such as BAME individuals; Second: the impact on people with pre-existing psychiatric disorders; Third: mental health of COVID patients and those who have recovered and their careers. There are lessons to be learnt from previous pandemics and the impact on mental health. There are high levels of anxiety, depression, substance use (particularly alcohol), posttraumatic stress symptoms, and survivor guilt. Within this context, there is a need to consider the differential impact on underprivileged populations. Vulnerable groups include women, children, elderly, minority racial and ethnic groups, LGBT + individuals and the poor. It is noted that these classifications are met with challenges related to definition, and there is significant heterogeneity within the groups and the focus on race, gender, and poverty must be seen through an intersectional lens.
Differentiation of hepatic encephalopathy from delirium tremens
Authors: Devabhaktuni Spandana , Patkar Prajakta , Pooja V. , Dhamija Sana , Gupta Nishtha , Chaudhury Suprakash , Saldanha Daniel
Published: April 2023

Hepatic encephalopathy (HE) is an important and potentially life threatening complication in alcoholic patients with decompensated liver function that develop even as they continue drinking. Delirium tremens, on the other hand, is an acute condition resulting from alcohol abstinence in a person dependent on alcohol, making it a life threatening diagnosis that requires intensive care and successful management of the withdrawal. Often in medical wards, these two conditions are mistaken and so is the management plan confused with each other. Making the right diagnosis early on during the hospital course is extremely important in these critical conditions so as to make an appropriate schedule for treatment and a better outcome for the same. A case series of patients who presented with a diagnostic dilemma is reported. Clinical examinations, diagnostic tools to measure the levels of ammonia and liver function tests and hemogram, West Haven criteria and Child–Pugh grading, and clinical scales of these patients are reported. Increased levels of ammonia were present in all the cases. The subtle similarities in the presentation of the two conditions often make it confusing for the clinician to distinguish between them. Using a simple test of measuring ammonia levels in the blood helps in such situations. The detection of raised levels of ammonia in cases of chronic liver disease helps in not just the diagnosis but also is an important prognostic indicator for development of HE.
Behavioral presentations of focal onset seizures
Authors: Maggu Gaurav , Dhamija Sana , Chaudhury Suprakash , Rohatgi Shalesh , Saldanha Daniel , Jain Shobhit
Published: April 2023

Seizures can have varied presentations and may have different etiological factors. A multidisciplinary approach should be used to treat them. It becomes difficult to diagnose seizures if they have an atypical presentation, particularly so when they manifest as behavioral disturbances. This case series demonstrates four cases with different psychiatric and behavioral manifestations of seizures where the diagnosis had to be done in a multi-disciplinary approach. Two of the cases highlight the fact that in the light of normal investigations, paying attention to detailed history is of prime importance.
Coverage and compliance of mass drug administration (MDA) programme for elimination of lymphatic filariasis in an endemic district of eastern Uttar Pradesh, India
Authors: Bashar Abu , Nandekar Sanket V. , Shrivastava Prerna , Singh Ravi Nandini , Srikrishnan Pushkar
Published: April 2023

Background & objectives:

Lymphatic filariasis is targeted for elimination in India through mass drug administration (MDA) with diethylcarbamazine (DEC) combined with albendazole (ABZ). To assess the coverage, compliance and causes for non-compliance towards MDA in an endemic district of Uttar Pradesh (U.P.), north India.

Methods:

A cross-sectional coverage evaluation survey was conducted in 24 rural and 6 urban clusters of Ghazipur district in eastern U.P. using multi-stage random sampling technique with probability proportional to estimated size (PPES). Data was collected in a semi-structured Performa from all the individuals in the selected households by interview technique. Bivariate analysis was performed to identify the factors associated with non-consumption of MDA drugs.

Results:

A total of 1422 individuals were surveyed from 30 randomly selected subunits of which 1401 (98.5%) were eligible for MDA at the time of the round. Majority of the participants were in the age-group of 15–59 years (67.0%) and were males (53.3%). The overall coverage of MDA (both drugs) among the eligible population in Ghazipur district was 58.5%. Compliance among those who had received both the drugs was 61.6% with effective coverage of 36.0%. The coverage was significantly higher in rural areas compared to the urban clusters (p<0.0001). The most common reason quoted for not consuming drugs was fear of side effects (34.9%). However, the incidence of adverse events among those who consumed the drugs was only 2.5%. None of the socio-demographic variables showed a significant association with the compliance to the drugs.

Interpretation & conclusion:

Coverage and compliance of MDA in Ghazipur district of U.P., India was found to be below satisfactory levels. Targeted Information Education and Communication (IEC) campaigns focusing on the safety of drugs and the necessity of MDA, and mass mobilization with effective monitoring and supervision is the need of the hour for effective coverage of MDA Programme.
Sero-molecular epidemiology of Japanese encephalitis virus in swine population of western Uttar Pradesh, India: Unraveling the geographical expansion of the virus
Authors: Kumar Santhosh S , Dhanze Himani , Mehta Deepa , Hussain Mir , Gupta Megha , Kumar M Suman
Published: April 2023

Background & objectives:

Swine is a good sentinel for forecast of Japanese encephalitis virus (JEV) outbreaks in humans. The present study was envisaged with objectives to know the sero-conversion period of JEV and to assess the prevalence of JEV in swine population of western Uttar Pradesh state of India.

Methods:

A total of 252 swine serum samples were screened using IgM ELISA over the period of one year to determine the sero-conversion rate and compared seasonally to check the transmission peak of virus. Further, 321 swine blood and serum samples were collected from all seven divisions of western Uttar Pradesh to determine prevalence of JEV using real time RT-PCR and ELISA.

Results:

Seasonal sero-conversion rate was high during monsoon and post-monsoon (32%) followed by winter (22.91%) and summer (10.71%) seasons. The sero-conversion was observed in all months indicating viral activity throughout the year in the region. The low degree of correlation was found between meteorological variables (day temperature, rainfall) and sero-conversion rate. A total of 52 samples (16.19%) were found positive by real time RT-PCR while sero-positivity of 29.91% was observed using IgG and IgM ELISA(s). The overall prevalence of JEV was 39.25%.

Interpretation & conclusion:

The presence of JEV was recorded throughout the year with peak occurrence during monsoon and post-monsoon season indicating that virus has spread its realm to western region of the state. The information generated in the present study will aid in initiating timely vector control measures and human vaccination program to mitigate risk of JEV infection in the region.
Susceptibility status of Aedes aegypti (Diptera: Culicidae) against insecticides of public health use in Delhi and NCR region, India
Authors: Prasad Pooja , Lata Suman , Kumar Dinesh , Gupta Sanjeev Kumar , Saxena Rekha , Arya Deepak Kumar , Singh Himmat
Published: April 2023

Background & objectives:

Aedes (Stegomyia) aegypti is a primary vector responsible for the transmission of various arboviral diseases in India. Without an effective drug or vaccine against these diseases, chemical insecticide-based vector control supplemented with source reduction remains the best option for their effective management. The development of insecticide resistance due to the continuous use of insecticides might affect the control operations.

Methods:

Adults and larvae of Aedes aegypti were collected from different localities in Delhi. Larvae were exposed to discriminating (0.02mg/l) and application (1mg/l) doses of temephos. WHO tube assay was conducted for F1 adults using impregnated insecticide papers of dichlorodiphenyltrichloroethane (DDT), malathion, deltamethrin, permethrin, cyfluthrin, and lambda-cyhalothrin.

Results:

Larvae of Ae. aegypti were found resistant (76.0%) to the discriminating dose of temephos, whereas suscep-tible (100.0%) to the application dose of the temephos. Adult Aedes (Fl) mosquitoes were resistant to DDT (23.7%), malathion (90.5%), deltamethrin (76.0%), permethrin (96.2 %) cyfluthrin (85.5%), and lambda-cyhalothrin (94.0%).

Interpretation & conclusion:

Indoor residual spray is not used in Delhi for vector control. Resistance in Aedes might be due to pesticide usage for agricultural activities in peripheral regions of Delhi. There is a need to investigate more on the insecticide resistance mechanisms for indirect resistance development. Understanding the insecticide susceptibility status of urban vectors is critical for planning effective control strategies.
Software Driven, Personalized Nutrition, and Lifestyle Intervention for Type 2 Diabetes Mellitus in Nigeria
Authors: Itopa Jimoh I. , Owolabi Funmilayo Abidemi , Ifeoluwa Oyedeji
Published: April 2023

We report a case of a 55-year-old newly diagnosed Type 2 diabetes mellitus (T2DM) patient with elevated glycated hemoglobin (HbA1c) of 12.1%. He received care at Zest Online Diabetes Clinic after facing challenges with access to care. He received lifestyle and medical treatment with the Zest mobile application for 3 months. The Zest model of treatment focuses on nutrition, physical activity, medication, and education to support self-management. The Zest care delivery model also involved a multidisciplinary team of experts: A dietitian, endocrinologist, nurse, and a digital coach to provide quality care remotely. After 3 months of receiving care, he returned with an HbA1c of 5.3%, net weight loss of 1.3 kg, and also a reduction in medication. This case report provides preliminary evidence that the Zest model: carbohydrate restriction, physical activity, diabetes self-management education, and behavioral coaching can effectively and safely treat T2DM through a digital platform.
Reactivation of latent human cytomegaloviral infection in critically ill patients
Authors: Uladzimiravich Harbachou Viktar , Ivanovna Dmitrachenko Tatyana , Mikhailovich Semenov Valery , Kanstantinavich Yahorau Siarhei , Yurievich Martov Vladimir , Viktorovich Kornilov Artem
Published: April 2023

Background & objectives:

Human cytomegalovirus (HCMV) is a frequent participant in the infectious process in critically ill patients. This study aimed to determine the incidence of HCMV reactivation in critically ill patients and estimate the clinical effect of reactivation on the course of the pathological process.

Methods:

To determine the incidence of HCMV reactivation, plasma and sputum samples were collected from 82 critically ill patients. HCMV reactivation was determined by quantitative PCR together with the presence of circulating HCMV IgG in the plasma. The statistical analysis of clinical data employed methods of descriptive (median with 95% confidence interval; minimum and maximum values, interquartile range) and nonparametric statistics [Mann-Whitney U test, odds ratio (OR), Kaplan–Meier survival analysis].

Results:

HCMV reactivation was found in 36.6 per cent of cases. An association between the presence of sepsis and the development of HCMV reactivation (P<0.001), as well as higher HCMV viral loads in septic patients, was found. There was also an association between the presence of HCMV DNA and the subsequent development of sepsis (OR=1.504). The involvement of HCMV in the emerging immunological shifts manifested by a decrease in CD8+ T-lymphocytes (P=0.01) and an increase in the immunoregulatory index (P=0.03) was found.

Interpretation & conclusions:

HCMV reactivation can influence the course of bacterial pathology with a deteriorating effect on such groups of patients. Monitoring the viral load of latent HCMV can be helpful in the assessment of the host immune status, the course of the pathological process, and its clinical prognosis.
Prevalence of hepatitis B & C infections in prospective blood donors deferred due to history of jaundice
Authors: Khan Mohd. Fawad Farooq , Afzal Kamran , Arif S. H. , Shahin Shadma
Published: April 2023

Background & objectives:

As per national guidelines, prospective blood donors with a history of jaundice of unknown cause are deferred permanently to prevent the transmission of hepatitis B and C. The validity of this guideline was tested by comparing prevalence rates of hepatitis B and C in prospective blood donors deferred due to a history of jaundice, with that of donors who were found fit.

Methods:

Blood samples of 212 consecutive donors (male, n=203) deferred due to a history of jaundice were studied for hepatitis B and C by rapid test kits as well as by chemiluminescence (n=115) or ELISA (n=97). Consecutive healthy donors (n=549; male, n=518) were also studied by ELISA (n=266) or chemiluminescence (n=283).

Results:

The cumulative prevalence detected by rapid test kit and ELISA/chemiluminescence tests of hepatitis B (n=10) and C (n=2) among donors deferred due to a history of jaundice (n=212) was 5.7 per cent [95% confidence interval (CI): 2.9, 9.9]. The prevalence of reactive results among healthy donors (n=549) by ELISA/chemiluminescence tests was 3.3 per cent (95% CI: 1.9, 5.2), which included hepatitis B (n=15) and hepatitis C (n=3) cases. Compared to healthy donors, the odds of seropositivity among jaundice-deferred donors was 1.7 (95% CI: 0.8, 3.6), P=0.15. For rapid test-negative deferred donors, the odds of seropositivity by ELISA/chemiluminescence declined to 0.4 (0.1, 1.5), P=0.19.

Interpretation & conclusions:

The prevalence rates of hepatitis B and C in prospective blood donors deferred due to a history of jaundice of unknown aetiology did not differ significantly from that in healthy donors. The current practice of permanently deferring such donors depletes valuable donor pool. A strategy of rejecting only those donors who are found reactive on pre-donation testing by rapid test needs further validation.
Identification of hepatitis B virus genotypes detected in Lahaul & Spiti district of Himachal Pradesh, India
Authors: Pacholi Sanchita , Chandra Bishwal Subasa , Barde Pradip V.
Published: April 2023

Background & objectives:

Infection by hepatitis B virus (HBV) results in acute or chronic hepatitis. Based on sequence differences of eight per cent or more, HBV is divided into 10 genotypes (A to J) and 35 sub-genotypes. Molecular characterization of the circulating HBV genome has helped in understanding the epidemiology and its clinical importance. Spiti valley in Himachal Pradesh, which shares its border with Tibet, is one of the most HBV prevalent areas in India. Since information about the circulating genotype/s of HBV in this area is limited, this study was conducted to identify the circulating HBV genotypes.

Methods:

The surface and partial reverse transcriptase gene regions were sequenced using 14 hepatitis B surface antigen-positive samples.

Results:

Out of the 14 hepatitis B surface antigen-positive samples 11 sample gave quality sequence for further analysis. All the 11 samples belonged to subtype ayw2. The phylogenetic and recombination analysis revealed that five out of 11 samples were of genotype CD1 and the rest six were of genotype D3.

Interpretation & conclusions:

The CD1 recombinant sub-genotype might have immigrated during past or present transcontinental migration between the adjacent countries. Further studies using full-genome sequencing and high sample size will be helpful to understand this epidemiology and to combat the high prevalence of HBV in the area.
Cost-effectiveness analysis of ‘test and treat’ policy for antiretroviral therapy among heterosexual HIV population in India
Authors: Singh Malkeet , Sharma Aman , Bahuguna Pankaj , Jyani Gaurav , Prinja Shankar
Published: April 2023

Background & objectives:

The World Health Organisation recommended immediate initiation of antiretroviral therapy (ART) in all adult human immunodeficiency virus (HIV) patients regardless of their CD4 cell count. This study was undertaken to ascertain the cost-effectiveness of implementation of these guidelines in India.

Methods:

A Markov model was developed to assess the lifetime costs and health outcomes of three scenarios for initiation of ART treatment at varying CD4 cell count <350/mm3, <500/mm3 and test and treat using health system perspective using life-time horizon. A few input parameters for this model namely, transition probabilities from one stage to another stage of HIV and incidence rates of TB were calculated from the data of Centre of Excellence for HIV treatment and care, Chandigarh; whereas, other parameters were obtained from the published literature. Total HIV-related deaths averted, HIV infections averted and incremental cost-effectiveness ratio per quality adjusted life years (QALYs) gained were calculated.

Result:

Test and treat intervention slowed down the progression of disease and averted 18,386 HIV-related deaths, over lifetime horizon. It also averted 16,105 new HIV infections and saved 343,172 QALYs as compared to the strategy of starting ART at CD4 cell count of 500/mm3. Incremental cost per QALY gained for the immediate initiation of ART as compared to ART at CD4 cell count of 500/mm3 and 350/mm3 was

JOURNAL/ijmer/04.03/02223309-202212000-00002/math_2MM1/v/2023-05-19T183840Z/r/image-tiff

46,599 and 80,050, respectively at reported rates of adherence to the therapy.

Interpretation & conclusions:

Immediate ART (test and treat) is highly cost-effective strategy over the past criteria of delayed therapy in India. Cost-effectiveness of this policy is largely because of reduction in the transmission of HIV.
The need for targeted behavioural HIV-related interventions for transgender women in India
Authors: Lodge William , Klasko-Foster Lynne , Mimiaga Matthew J. , Biello Katie B.
Published: April 2023

Background & objectives:

Transgender women (TGW) in India are at high risk of HIV infection. Despite behavioural interventions aimed at reducing HIV risk, no literature synthesis exists so far to evaluate their potential for reducing HIV incidence in India This review was aimed to identify and evaluate HIV-focussed behaviour change interventions for TGW in India.

Methods:

Literature from three databases were reviewed up to June 2, 2021, for studies describing behavioural interventions for HIV prevention among TGW in India. The inclusion criteria were studies that included TGW and reported intervention effects on HIV prevention-related behaviour. Data were analyzed descriptively.

Results:

Of the 146 articles screened, only three met the inclusion criteria. All three interventions were at the open pilot trial stage and included other high-risk groups (e.g. men who have sex with men). The interventions used behavioural counselling, increased sexually transmitted infection screening and sexual healthcare visits and leveraged community-based organizations to improve the outcomes. All these interventions showed modest improvements in health-seeking behaviour and access to services. However, none specifically targeted TGW.

Interpretation & conclusions:

The scoping review highlights the need for behavioural interventions for HIV prevention tailored to TGW in India. This study emphasizes the need for research to move to the next stage of intervention development and testing utilizing more rigorous evaluation methods, such as a randomized controlled trial.
Super Selective Angioembolization for Posttraumatic ArterioCavernosal Fistula Presenting with Nonischemic Priapism
Authors: Surwase Pavan , Lele Suhas , Ganpule Arvind , Sabnis RB
Published: April 2023

Arteriocavernosal fistula generally occurs from penetrating injury and is rarely secondary to blunt trauma. Patients typically present with a painless partial erection following some type of genitoperineal trauma; the resultant arterial damage leads to an arterial-lacunar fistula and occasionally, to an associated pseudoaneurysm. The case reported in this article is unique in a way that the patient presented after 4 months yet super selective angioembolization of the feeder artery yielded promising results. A 24-year-old man was reported to the outpatient department of our center with a history of road traffic accidents and subsequent perineal injury 4 months back. The patient had complaint of inability to get full rigid erection and persistent partial erection of penis for 4 months since the trauma. On clinical examination, the patient had a partial detumescent penis and normal testes. Doppler ultrasonography revealed extravasation of blood from the lacerated cavernosal artery as a characteristic color blush that extended into the erectile tissue. Magnetic resonance imaging of the perineum suggested the possibility of left-sided posttraumatic arteriocavernous fistula. Diagnostic angiogram of left iliac artery demonstrated arteriocavernous fistula, and selective arterial embolization of feeding artery left cavernosal artery was performed with metallic coils. Procedure was uneventful. Complete detumescence was achieved in the immediate postoperative period. Super selective angioembolization of the feeder’s vessel remains the treatment of choice even in patients with long-standing fistula and priapism secondary to it.
Aortic Injury in Blunt Trauma: Stay Sharp to Save Lives
Authors: Sharma Parth , Joseph Prakash , Abhilash Kundavaram Paul Prabhakar , Samuel Vimalin
Published: April 2023

A 21-year-old lady presented following a high velocity road traffic accident as a pillion rider. She was hemodynamically stable at presentation and complained of chest pain which was considered to be due to the multiple rib fractures she had sustained. However, a computed tomography of the thorax showed a Society for Vascular Surgery Grade II aortic injury for which she underwent endovascular repair. This case reviews the various presentations of blunt trauma associated aortic injuries and the implications of emergent management.
Aortic Aneurysms in Chronic Kidney Disease Patients: A Rare Duo – Series of Six Cases
Authors: Jha Manvendu , Srivastava Atul Kumar , Dhillan Rishi , Panda Sanjay
Published: April 2023

Aortic aneurysms are permanent dilatation of the aorta and occur predominantly in the infrarenal and proximal aorta. Abdominal aortic aneurysm (AAA) is a multifactorial disease, and environmental and genetic factors do play a role in its development. They are generally asymptomatic; however, their progressive enlargement increases the risk of rupture. Besides traditional risk factors, patients with chronic kidney disease (CKD) are at increased risk of AAA. We present six cases of AAA in patients with CKD.
Indian VenaSeal™ Experience Study Extension: Outcomes of Nonthermal, Nontumescent Endovenous Ablation (VenaSeal™) for the Treatment of Truncal Reflux in Varicose Vein Disease – An Indian Perspective with 2-Year Follow-up
Authors: Shah Rutvij Asitkumar , Bedi S Varinder , Yadav R Ajay , Agarwal Sandeep , Satwik Ambarish , Srivastava Apurva , Chaudhary Nikhil Vilas
Published: April 2023

Background:

Varicose vein disease is a common disease in nearly 37.25% of Indian population affecting quality of life. Endovenous thermal ablation has been the first-line treatment for superficial venous reflux. A new technique, available now, is nonthermal, nontumescent vein sealing system (VenaSeal™), which comprises endovenous delivery of cyanoacrylate tissue adhesive into the vein causing obliteration of lumen and has shown better results in terms of safety and efficacy. Being a new modality, only a handful of institutes across India perform this procedure and there is a scarcity of Indian data on its outcomes.

Aims and Objectives:

To evaluate the outcomes of VenaSeal™ glue ablation in terms of vein occlusion rates and improvement in VCSS score.

Materials and Methods:

The Indian VenaSeal Experience Study was carried out a year back, which was a single-center prospective study of 50 patients over 1 year and 4 months with 3 and 6 months of follow-up, and we aimed to evaluate the outcomes of VenaSeal™ glue ablation in terms of vein occlusion rates and improvement in venous clinical severity score (VCSS). This is an extension of that study with 200 patients (378 limbs) with similar parameters for outcome evaluation.

Results:

The study showed the mean age of study group to be 48.6 years and majority (87%) had an early varicose vein (C2/C3) disease. The average length of vein treated per limb was 62.6 cm and the average glue used per limb was 3.05 ml. All patients showed improvement in VCSS score averaging 2.3 ± 1.6 (P < 0.0001, n = 378) with target vein occlusion rate of 98% at 6 months (n = 182), 97% at 12 months (n = 126), and 95% at 2 years (n = 98).

Conclusion:

VenaSeal™ glue ablation procedure is a promising and effective modality for the treatment of varicose veins with excellent treatment success rates and maximum patient acceptability. However, complications such as severe phlebitis and anaphylaxis have been reported. It is a feasible option under local anesthesia, does not require tumescence, and hence an efficient outpatient department-based procedure.
Factors Predicting the Outcome of Musculoskeletal Injuries Associated with Vascular Trauma at a Tertiary Care Trauma Centre in South India
Authors: Kataria Hanish , Premkumar Prabhu , Samuel Vimalin , Selvaraj Dheepak , Stephen Edwin
Published: April 2023

Introduction:

Vascular injuries are uncommon in civilian settings and present after blunt and or penetrating trauma. These injuries require timely intervention to prevent loss of limb or life. The impact of vascular injuries is well described in the Western population; however, there is a lack of evidence of factors predicting the outcomes of vascular injuries associated with musculoskeletal trauma in the Indian population.

Methods:

The retrospective data of consecutive trauma patients presenting to our emergency/outpatient department were collected over 5 years from January 2014 to December 2019 from our electronic medical records. After clinical assessment and/or radiological findings, patients were considered for either nonoperative management or vascular repair. Orthopedic intervention preceded vascular repair to attain skeletal stabilization and to protect vascular repair. Outcomes were measured in terms of baseline demographic variables, clinical determinants, pattern of injury, type of management, limb salvage, and primary or secondary amputations and mortality.

Results:

There were a total of 109 (92%) males and 3 (8%) females with an age range from 11 to 71 years (median = 35.5). The majority of the injuries were in the 30–50 years age group (n = 50, 50%). Limb salvageability was attained in 81 (72.3%) patients. Twenty patients (17.9%) underwent primary amputations and 11 (9.8%) patients required secondary amputations. Blunt trauma, lower limb involvement, multiple fractures, the Mangled Extremity Severity Score (MESS), and popliteal artery injury were significant predictors of limb salvageability. Stepwise multiple regression analysis identified multiple fractures (P = 0.011) and MESS (P = 0.000) as ultimate predictors of limb outcome.

Conclusion:

Revascularization is critical to the success of limb salvage in patients with traumatic vascular injury. Concomitant orthopedic injuries pose significant challenges and are associated with a high risk of limb loss. Multiple fractures and MESS score ≥6 prognosticates poor limb salvageability.
Effects of Nutritional and Socioeconomic Status on Puberty
Authors: Oyewole Omosalewa A. , Adediran Adekunle S. , Oduwole Abiola O.
Published: April 2023

Context:

The onset of puberty is determined by genetic and environmental factors like socioeconomic and nutritional status. Previous studies have shown a disparity in the effect of socioeconomic factors on menarche and sexual maturation.

Aim:

This study was carried out to determine the effect of nutrition and socioeconomic status (SES) on puberty.

Settings and Design:

It is a descriptive, cross-sectional study among adolescent female secondary school students in Abeokuta, Nigeria.

Materials and Methods:

Subjects selected responded to questions on the proforma. Body mass index (BMI) was calculated from weight and height that were measured.

Statistical Analysis:

The data were analyzed using Microsoft ExcelR (Microsoft Corporation SP2 software microsoft office 2010 professional plus (PC) Intel Corporation's 386 microprocessor Redmond, Washington, USA) 2010 and SPSS 22.0 (SPSS Inc., Illinois, USA).

Results:

Participants' mean age and BMI were 14.4 ± 1.9 years and 19.1 ± 2.9 kg/m2, respectively. Subjects from high socioeconomic class (SEC) attained puberty and menarche earlier (12.0 ± 1.5 and 12.9 ± 1.5 years) than those from low SEC (13.5 ± 1.3 and 13.7 ± 1.1 years). These were statistically significant for breast development and menarche. Nutritional status had a negative correlation (r = -0.098) with menarcheal age but positive with pubic hair (r = 0.702) and breast development (r = 0.306).

Conclusion:

The mean age of menarche occurred earlier in this study when compared to most previous studies in Nigeria. Improved SES and nutritional status influenced the early age of onset of puberty and attainment of menarche.
Laparoscopic Reduction of Intussusception in a 13-Year-Old Girl with Multiple Intestinal Polyps
Authors: Bello Usman M. , Abdullahi Lawal B. , Abdulmajeed Soladoye A.
Published: April 2023

Intussusception has been one of the common causes of intestinal obstruction in infancy and early childhood period with a challenge in diagnosis in older children. It is the telescoping of a segment of bowel into another, commonly a proximal segment into a distal one. Intussusception in infancy and early childhood is usually primary or idiopathic as there is no associated pathological lead point involved. However, in older children and adult, there is most often time an identifiable lead point that predisposes to the intussusception.