bluuebunny/crossref_metadata_2025 huggingface dataset:
IMMUNE THROMBOTIC THROMBOCYTOPENIC PURPURA: PATHOPHYSIOLOGY, DIAGNOSIS AND OPEN ISSUES.
Authors: Trisolini Silvia maria , Laganà Alessandro , Capria Saveria
Published: June 2024

Immune thrombotic thrombocytopenic purpura (iTTP) is a life-threatening thrombotic microangiopathy characterized by microangiopathic hemolytic anemia, thrombocytopenia, and ischemic end organ injury due to microvascular platelet-rich thrombi. iTTP pathophysiology is based on a severe ADAMTS13 deficiency, the specific von Willebrand factor (vWF)-cleaving protease, due to anti-ADAMTS13 autoantibodies. Early diagnosis and treatment reduce the mortality. Front-line therapy includes daily plasma exchange (PEX) with fresh frozen plasma replacement and immunosuppression with corticosteroids. Caplacizumab is recently added to the front-line therapy. Caplacizumab is a nanobody that binds to the A1 domain of vWF, blocking the interaction of ultra-large vWF multimers with the platelet, and thereby preventing the formation of platelet-rich thrombi. Caplacizumab reduces mortality due to ischemic events, refractoriness and exacerbations after PEX discontinuation. Until now, the criteria for response to treatment mainly took into account the normalization of platelet count and discontinuation of PEX, now with the use of caplacizumab, leading to rapid normalization of platelet count, it has been necessary to redefine the response criteria, taking into account also the underlying autoimmune disease. Monitoring of ADAMTS13 activity is important to identify cases with low value of activity (<10IU/L), requiring the optimization of immunosuppressive therapy with addition of rituximab. Rituximab is effective in patients with refractory disease or relapsing disease, currently the use of rituximab has expanded, both in front line treatment, and during follow-up as pre-emptive approach. Some patients do not achieve an ADAMTS13 remission following the acute phase despite steroids and rituximab treatment, requiring an individualized immunosuppressive approach to prevent clinical relapse. In iTTP, there is an increased risk of venous thrombotic events (VTEs) as well as arterial thrombotic events and most occur after platelet normalization. Until now, there is no consensus on the use of pharmacological thromboprophylaxis in patients on caplacizumab, because the drug is known to increase bleeding-risk.
Olifantshoek: Oase van die Langberg
Authors: Bergh J.S.
Published: July 2024

No abstract available.
Van stamvader Adriaan tot Ernst Jacobus van Jaarsveld, 1702-1986: 'n stukkie familiegeskiedenis van onder
Authors: Jooste E.P.
Published: July 2024

No abstract available.
Effectiveness of Erector Spinae Plane Block as Perioperative Analgesia in Midline Sternotomies: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Patel Nimesh , Fayed Mohamed , Maroun Wissam , Milad Hannah , Adlaka Katie , Schultz Lonnie , Aiyer Rohit , Forrest Patrick , Mitchell John D.
Published: July 2024

With the advancements in regional anesthesia and ultrasound techniques, the use of non-neuraxial blocks like the erector spinae plane block (ESPB) has been increasing in cardiac surgeries with promising outcomes. A total of 3,264 articles were identified through a literature search. Intervention was defined as ESPB. Comparators were no regional technique performed or sham blocks. Four studies with a total of 226 patients were included. Postoperative opioid consumption was lower in the group that received ESPB than the group that did not (weighted mean difference [WMD]: -204.08; 95% CI: -239.98 to -168.19; P < 0.00001). Intraoperative opioid consumption did not differ between the two groups (WMD: -398.14; 95% CI: -812.17 to 15.98; P = 0.06). Pain scores at 0 hours were lower in the group that received ESPB than the group that did not (WMD: -1.27; 95% CI: -1.99 to -0.56; P = 0.0005). Pain scores did not differ between the two groups at 4–6 hours (WMD: -0.79; 95% CI: -1.70 to 0.13; P = 0.09) and 12 hours (WMD: -0.83; 95% CI: -1.82 to 0.16; P = 0.10). Duration of mechanical ventilation in minutes was lower in the group that received ESPB than the group that did not (WMD: -45.12; 95% CI: -68.82 to -21.43; P = 0.0002). Given the limited number of studies and the substantial heterogeneity of measured outcomes and interventions, further studies are required to assess the benefit of ESPB in midline sternotomies.
Anesthetic Choice for Percutaneous Transcatheter Closure of the Left Atrial Appendage: A National Anesthesia Clinical Outcomes Registry Analysis
Authors: Hickman William , Dada Rachel S. , Thibault Dylan , Gibson Christina , Heller Scott , Jagadeesan Vikrant , Hayanga Heather K.
Published: July 2024

Context:

Left atrial appendage closure (LAAC) was developed as a novel stroke prevention alternative for patients with atrial fibrillation, particularly for those not suitable for long-term oral anticoagulant therapy. Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography.

Aims:

Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice.

Settings and Design:

Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry.

Material and Methods:

Retrospective data analysis from 2017–2021.

Statistical Analysis Used:

Independent-sample t tests or Mann–Whitney U tests were used for continuous variables and Chi-square tests or Fisher’s exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics.

Results:

A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017–2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03–0.80, P = 0.0261).

Conclusions:

While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017–2021. Anesthetic management for LAAC varies with geographic location.
Knowledge and Awareness of Rheumatoid Arthritis among the Population of Al Qunfudhah, Saudi Arabia: A Cross-sectional Study
Authors: Alzubaidi Hassan Ali , Taha Medhat Fotoh , Alfaqih Ali Nori , Hafiz Waleed , Alhayli Ahmed Ali , Alfaqih Hassan Mohmmed , Alothayqi Mohammed Hussain , Alfaqih Mohammed Ali , Alfaqih Khalid Abdullah , Alsayed Ali Abdullah
Published: July 2024

Introduction:

Rheumatoid arthritis (RA), a chronic autoimmune ailment, incites inflammation and degradation of joint synovium, predominantly impacting hands, wrists, and knees. It elicits joint pain, swelling, and potential complications such as deformities, carpal tunnel syndrome, pericarditis, pleuritis, anemia, and uveitis. Evaluating RA knowledge in Al Qunfudhah, Saudi Arabia, this study aims to discern its preventive implications.

Methods:

A descriptive cross-sectional study encompassing individuals aged 18 years and above in Al Qunfudhah, Saudi Arabia, was undertaken. An online questionnaire, informed by literature and expert consultation, covered socioeconomic–demographic details, RA history, and participant comprehension regarding disease aspects such as risk factors, symptoms, and treatment.

Results:

A total of 441 eligible participants completed the study questionnaire. Participants’ ages ranged from 18 to 60 years with a mean age of 31.2 ± 12.8 years old. Exact of 250 (56.7%) participants were females. A total of 229 (51.9%) had an overall good knowledge of RA and 212 (48.1%) had a poor knowledge level. High education showed a significant association with participants’ knowledge level (P < 0.05).

Conclusion:

Approximately half of the study participants demonstrated a sufficient understanding of RA, notably among those with higher education, especially in the health-care sector. The majority accurately identified key symptoms and risk factors and acknowledged the pivotal role of rheumatologists in disease management.
Unlocking the Enigma: Systemic Lupus Erythematosus, Pancreatitis, and Pleural Effusion
Authors: Khan Ulma , Pandit Sanjay , Chawla Kishore , Dharra Gaurav , Aggarwal Rupal , Garg Sagar
Published: July 2024

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by a wide range of clinical manifestations due to its potential to affect multiple organ systems. While joint pain, skin rashes, and renal involvement are among the most common presentations, SLE can occasionally manifest in more atypical ways. Acute pancreatitis (AP) and massive pleural effusion, although rare, are potential complications of SLE. This case report highlights the unique presentation of a 33-year-old female presented with AP concurrent with a massive pleural effusion, later diagnosed with SLE. The aim of this report is to shed light on this unusual combination of symptoms in SLE patients and to emphasize the importance of a comprehensive clinical approach in the diagnosis and management of such cases.
Prevalence of Tuberculosis Infection among Various Risk Groups in India: A Systematic Review and Meta-Analysis
Authors: Chauhan Arohi , Parmar Malik , Dash Girish , Solanki Hardik , Chauhan Sandeep , Sahoo Krushna Chandra , Vadera Bhavin , Rao Raghuram , Kumar Ravinder , Rade Kiran , Pati Sanghamitra
Published: July 2024

Treatment of tuberculosis (TB) infection (TBI) to prevent active TB disease is a key component of the National Strategic Plan to end TB in India, without which the strategies to end TB would be futile. There is a need to rapidly scale up access to effective shorter regimens for tuberculosis preventive treatment (TPT) to a wider set of risk groups. This applies for identifying high-risk groups for TPT expansion. Thus, our aim with this review is to determine the TBI prevalence in different risk groups in India. We searched databases like Embase, Medline, Scopus, and CINAHL for studies published between 2012 and 2023 to estimate TBI in different risk groups in India. The PRISMA guidelines were followed when reviewing the publications, and a predetermined search strategy was used to find relevant sources across various databases. Using MetaXL (MS excel) software, we pooled data based on a random-effects model, along with heterogeneity testing using Cochrane’s Q and I2statistic. A total of 68 studies were included from 10,521 records. TBI pooled prevalence was estimated using the IGRA data, while in the absence of IGRA data, TST data were utilized. The key findings revealed a total of 36% pooled TBI prevalence for all risk factors, 59% among smokers, 53% among diabetics and alcoholics, 48% among malnourished, 47% among contacts of TB patients, 44% among HIV, 36% among pregnant women, 35% among COVID-19 patients, 31% among healthcare workers, 18% among sarcoidosis patients, and 15% among rheumatoid arthritis patients in India. Our review depicted a high TBI burden among groups such as diabetes mellitus, smokers, malnourished, and alcoholics. WHO has yet to recommend for systematic screening and treatment for TBI among these groups for want of evidence which this study provides, highlighting the need to reprioritize the risk groups for tailored TPT strategies.
Burden of Infertility, Its Risk Factors, Perceptions and Challenges Faced by Women of Peri-urban Community from Ahmedabad City: Mixed Method Study
Authors: Sharma Rashmi , Bakshi Harsh , Patel Parita , Patel Brijesh , Gajjar Sanju , Dave Roshni , Bapat Nirav , Mehta Rajesh , Mehta Latika , Chaudhary Pradhyuman
Published: July 2024

Background:

Infertility is globally prevalent and India accounts for 25% of the global burden, but it is still a neglected reproductive health issue. To estimate the prevalence of infertility, its determinants, perception and challenges faced by couples from the peri-urban area of Ahmedabad City.

Materials and Methods:

A community-based cross-sectional study was conducted in peri-urban areas of Ahmedabad City. For quantitative data collection, 689 couples were selected through probability proportion-based sampling (PPBS). Data was collected through a questionnaire during (1) phase I for socio-demographic details of the community and identification of eligible couples, (2) phase II for assessing the presence of infertility and its risk factors along with the assessment of depression and anxiety, and (3) phase III for Clinico-social profiling of all infertile couples (detected during second phase). Some of these women were involved in qualitative components to know the perceptions, challenges, etc. faced while seeking infertility treatment.

Result:

Study population of 917 families (n = 3891) yielded 689 women of reproductive age group (RAG) with a period prevalence of 7.4% (5.5%–9.4%); separately being 3.5% and 3.9% for primary and secondary type respectively. Socio-demographic determinants like age, education, occupation, addiction, and lifestyle-related illnesses like diabetes and hypertension exhibited no significant association with infertility. However, asthma, mental illnesses, and hormonal diseases like polycystic ovarian disease (PCOD) were associated and exhibited a significant association with infertility. Preventable risk factors like reproductive tract/sexually transmitted infections (RTI/STI) showed a significantly positive association with infertility.

Conclusion:

The period prevalence of infertility was 7.4%, with the secondary type being more common. Asthma, mental illness, RTI/STI and age at menarche showed significant association. Screening and treatment for RTI/STI can prevent complications like infertility. Stigma associated with infertility and lack of treatment facilities in the government sector makes it difficult to deal with and neglected health problems.
Alcohol-induced psychotic disorder with hallucinations (alcoholic hallucinosis): A case series
Authors: Janiani Ankit , Ali Tahoora , Garg Garima , Chaudhury Suprakash , Javedekar Archana , Singh Amarbir
Published: July 2024

Alcohol-induced psychotic disorder with hallucination (alcoholic hallucinosis) occurs after long-term abuse of alcohol and is characterized by intermittent or continuous symptoms during a period of excessive alcohol consumption or immediately after that period. Symptoms commonly include hallucinations, mostly of the auditory type, and affective disturbances, in a background of clear consciousness. In this case series, four subjects with a history of chronic alcohol consumption were evaluated for hallucinatory symptoms after chronic alcohol intake. All of them had auditory hallucinations, with an anxious affect and no cognitive deficits. Only one case had visual hallucinations. The psychotic symptoms in all the patients were completely remitted with antipsychotics. Resumption of alcohol consumption increases the risk of relapse. The pathophysiology of alcoholic hallucinosis is not yet established and needs to be studied further for better diagnosis and management.
Perspectives regarding COVID-19 vaccination among unvaccinated persons with mental illness
Authors: Saroja Shankarappa Asha Charitha , Gopalakrishanan Rajesh , Packirisamy Thangadurai , Kuruvilla Anju
Published: July 2024

Background:

The risk of COVID-19 infection and related health consequences is higher among persons with mental illnesses (PMI). Vaccines have had an impact in reducing the morbidity and mortality in patients with COVID-19 infection. Understanding the reasons for vaccine hesitancy in PMI is crucial for promoting vaccine acceptance in this population, but it remains an under-researched topic.

Aims:

This cross-sectional study assessed perspectives among unvaccinated PMI regarding COVID-19 vaccination in a tertiary care teaching hospital. Factors associated with vaccine hesitancy in this population were explored.

Materials and Methods:

One-hundred consecutive PMI attending the psychiatric outpatient clinic who had not taken the COVID-19 vaccination were recruited after obtaining informed consent. A semi-structured questionnaire was used to elicit knowledge, attitudes, and practices regarding COVID-19 vaccination. The Oxford vaccine hesitancy scale was used to assess vaccine hesitancy; the Brief Psychiatric Rating Scale and Depression Anxiety Stress Scale-21 were administered to assess current psychopathology.

Results:

A majority of the participants (62%) were unwilling for the vaccination, the most common reasons being the perception that they were not at risk of infection, and worry about the possible side effects of the vaccination. Factors associated with low vaccine hesitancy were higher levels of education, greater perception of the risk of contracting the disease, belief that vaccination was effective, and easy accessibility to the vaccine.

Conclusion:

Improving awareness, providing accurate information, and ensuring better accessibility to vaccines are necessary to improve vaccine coverage among PMI. Mental health professionals need to assume an active role in providing education and clarifying misconceptions among our vulnerable patient population to help mitigate vaccine hesitancy.
Rare Sites and Presentations of Pleomorphic Adenoma – A Case Series
Authors: Madhu Megha , Bhat Vadisha , Kamath P. Shrinath D. , Aroor Rajeshwary , Alva Shravan , Bhat Shubha P.
Published: June 2024

Pleomorphic adenoma is the most frequently occurring benign salivary gland neoplasm, commonly in the major salivary gland. Sometimes, it can also occur in the minor salivary glands, the common site being the palate, the lips, and the cheeks. Rarely, it can also be seen in locations such as on the tongue, floor of the mouth, pharynx, retromolar area, tonsil, and nasal cavity. We discuss some interesting cases of uncommon locations of pleomorphic adenoma involving minor salivary glands and its clinical, diagnostic, and treatment aspects. Here, we present four rare presentations of pleomorphic adenoma treated in our department. The patient details and clinical pictures were taken after informed consent.
Comparative Evaluation of Cephalometric Parameters in Different Kinds of Vertical and Different Kinds of Horizontal Facial Patterns – A Cephalometric Study
Authors: Goje Santosh Kumar , Basu Sanjana
Published: June 2024

Introduction:

An individual can have a vertical, horizontal, or an average growth pattern, usually associated with an increased, decreased, or normal lower anterior facial height (LAFH), respectively. Irrespective of the growth pattern determined cephalometrically, the individual might have acceptable facial proportions. The treatment plan varies for such individuals.

Materials and Methods:

One hundred cephalograms with normal/increased and decreased clinical LAFH were included in this study. The sample was divided into four groups; 1A and 1B; 2A and 2B. Cephalometric parameters were compared among the vertical growers with increased and normal LAFH (1A and 1B); and horizontal growers with decreased and normal LAFH (2A and 2B) using an unpaired t-test.

Results:

Statistically significant differences were found between the two variants of vertical and horizontal growers. Cephalometrically hyperdivergent individuals (Group A) showed two variants; clinically normal and increased LAFH. Similarly, hypodivergent group (Group B) had both variants.

Conclusions:

The cephalometric parameters alone might not always be indicative of the true growth pattern of the individual. The clinical LAFH is a better parameter to determine the facial pattern and must be considered during orthodontic treatment planning.
Incidental Paraparesis during Late Pregnancy: “A Rare Occurrence”
Authors: De Anirban , Dwivedi Deepak , Manikandan A. , Jha Deepika
Published: June 2024

Tuberculosis (TB) is a major global epidemic and a leading cause of infectious disease death. Pregnancy has always been medically challenging in the wake of extrapulmonary TB, which creates another dimension of diagnostic and management pandemonium. We present our index case, which is an antenatal case presented late in the pregnancy associated with nonspecific back pain, which progressed to paraparesis, diagnosed with limited diagnostic modalities during pregnancy as Pott’s spine and underwent extensive multidisciplinary management at a tertiary care center with a favorable outcome. Here, we aim to discuss and extrapolate the approach to a discrete form of Pott’s spine with a varied presentation in pregnancy, its elusive quandary diagnosis and long-term patient management for a successful fetomaternal outcome.
Misconduct in Research: Perception and Attitude among Postgraduate Students and Faculty in a Teaching Hospital in Mangalore
Authors: Thapar Rekha , Kumar Nithin , Thummar Bhakti , Unnikrishnan Bhaskaran , Mithra Prasanna , Vijendran Sruthi , Cheema Harleen , Dixit Prachi , Verma Abhay Pratap , Kothari Prashanth
Published: June 2024

Background:

Misconduct in research refers to unethical behavior in the conduct of research which includes fabrication, falsification, plagiarism, and other practices that violate the integrity of the research process. Perceptions and attitudes toward research misconduct differ across individuals and educational systems.

Methods:

In this facility-based cross-sectional study, 103 faculty and 57 postgraduates of Kasturba Medical College, Mangalore, were assessed regarding their attitude toward research misconduct using the attitude toward plagiarism (ATP) questionnaire. Institutional Ethics Committee approval was obtained before the commencement of the study. Independent t-test was applied to assess the difference in mean perception and attitude scores between the faculty and postgraduates and P < 0.05 was considered to be statistically significant.

Results:

The mean age of the faculty and the postgraduate was 38.3 ± 9.3 years and 26.1 ± 2.9 years. The positive attitude ATP scores for the faculty and postgraduates were 31.2 ± 7.9 and 36.6 ± 8.1, respectively, which reflects a moderate approval toward plagiarism. The negative attitude and general perception ATP scores of 21.9 ± 3.8 and 23.8 ± 6.4 depicted a moderate level of disapproval toward plagiarism among the faculty. Postgraduates had a mean negative attitude ATP score of 22.1 ± 3.1 and 28.1 ± 7.0 for subjective norms, also suggesting an overall moderate tolerance toward plagiarism. Overall, the faculty and postgraduates had a low tolerance toward various aspects of research misconduct.

Conclusion:

Attitudes and perceptions toward plagiarism are complex and context dependent. Promoting awareness of academic integrity and the value of original work is essential to foster a culture that discourages plagiarism and encourages proper citation and acknowledgment of sources.
Ranson Criteria – Old is Gold in Evaluating Acute Pancreatitis?
Authors: Mahajan Ojas , Mahajan Satish , Khurana Kashish , Raut Sarang , Pantbalekundri Nikhil
Published: June 2024

Acute pancreatitis (AP) is a communal gastrointestinal condition that can vary in severity and morbidity. The “Ranson Score,” which was created in 1974, was the 1st scoring scheme to predict the cruelty of AP. While the “Ranson Score” has remained popular for decades, it is to have some flaws, such as limited predictive power. It has also been chastised for requiring 48 h to compute the concluding score, which has been found to cause administration delays. Using the electronic databases Medline, PubMed, Embase, and Google, a literature search in English was carried out. The exploration terms were Ranson Criteria OR “Ranson Score” OR AP OR Diagnostic Criteria. Researchers concluded that the “Ranson Score” is comparable to other recent counting systems for classifying AP severity and predicting death, making it a valuable tool for prognosticating AP in contemporary clinical practice. The studies also demonstrated that there is no one best grading system for predicting mortality and severity in AP patients. There are advantages and disadvantages to using each measure, and variations in research outcomes may be attributed to changes in people’s characteristics, AP etiology, and clinical care heterogeneity. The “Ranson Score,” despite being the ancient scoring system known, has preserved its clinical validity over time. These features, combined with its comparative easiness of use and applicability in reserve/constrained situations, make the “Ranson Score” an important and useful instrument in present clinical practice.
Human Resources in Health Care – Governance, Operation, Handling, and Oversight
Authors: Kadam Shubham , Luharia Anurag A , Mishra Gaurav Vedprakash , Tivaskar Suhas Pruthviraj
Published: June 2024

In this article, the topic of human resource management (HRM) is examined as a technique to raise employee output, which, in turn, increases patient pleasure and contentment with the services that are delivered. Care that is not only risk-free but also timely, patient-centered, cost-effective, and delivered in an equitable manner should be the major priority of any health-care system. Training, motivation, and retention of employees should be prioritized as part of HRM, along with the introduction of novel strategies and the rigorous, data-driven planning of how those resources will be utilized. In the modern health-care system, many employees have not received adequate training or have not yet achieved the needed level of mastery in the competencies they are expected to possess. It has become increasingly clear that to deliver high-quality medical services, it is necessary to provide patients with care that is individualized to meet their specific requirements. To stay up with the rapid changes taking place in the health-care industry, the field of human resources development needs to modernize its procedures. In addition, the management of human resources requires keeping an eye on how the rules and regulations governing the health-care system impact staff members. To provide high-quality medical care, it is essential to perform a gap analysis, incorporate appropriate available skills to close the gap, diversify the work among the available team, and use quality improvement methodologies to create an interdisciplinary group for better patient-centered health care.
Effect of Matrix Rhythm Therapy in Individuals with Musculoskeletal Pain
Authors: Tiwatane Shrinidhi , Tejani Neelam , Saini Seema , Sangoankar Mrudula , Palekar Tushar
Published: June 2024

Matrix Rhythm Therapy is a cell biological therapy which activates and rebalances specific physiological vibrations of skeletal muscle and nervous system approach was developed at the university of Erlangen, Germany. Low coherent magneto mechanical waves are applied to synchronize the regeneration and function of the cell. A new therapeutic and clinical modality matrix rhythm therapy was developed by Dr. Ulrich Randoll was developed in a year 1989. The purpose of this review was to analyse effect of Matrix Rhythm Therapy on pain due to different orthopedic conditions. Search materials and methods was English journal articles that focused on knee osteoarthritis related pain were searched via PubMed, Google scholar, NCBI and Science direct and databases, using the terms ‘Pain’, ‘Matrix Rhythm Therapy’. Search results showed Total 18 articles were reviewed; 8 articles were excluded and 10 articles were included in study as they intended the research content. Study Concluded that This research effort produces appropriate collection and relation of Matrix Rhythm Therapy and its effect on Pain.
Tips for Facilitating Cinemeducation Sessions
Authors: Shankar P. Ravi , Kalra Juhi , Joshi Anuradha
Published: June 2024

Movies can play an important role in health professions education. They can deeply influence the cognitive and affective domains and can stimulate reflection. The authors have been facilitating cinemeducation sessions for a decade. In this article, they share tips for facilitating cinemeducation sessions.
Assessment of Perception of Learning by Undergraduate Dental Students in Delhi-NCR Region using Dundee Ready Educational Environment Measure: A Cross-Sectional Study
Authors: Rani Sapna , Khan Uswah , Dhawan Pankaj
Published: June 2024

Background:

Education in any dental institution and curriculum plays a vital role in the growth of students, which will help them acclimatize to the increased demand for dentistry.

Purpose:

This study aimed to evaluate the students’ perception of course curricula in three dental institutes in the Delhi-NCR region among undergraduate students and interns.

Materials and Methods:

This cross-sectional study was conducted among undergraduate students from first year till interns in three dental institutes of the Delhi-NCR region based on the Dundee Ready Educational Environment Measure (DREEM) questionnaire. The DREEM questionnaire was distributed using Google Forms. Six hundred seventy students from three institutes participated in the questionnaire, and data were tabulated and subjected to statistical analysis by the Kruskal–Wallis and the Mann–Whitney test.

Results:

The total mean DREEM score was 158.8/200 in the present study, which is excellent. The overall scoring of the domain showed a significant difference for the fourth BDS for students’ perception of atmosphere (P = 0.001) and for the third-year students for students’ academic self-perception (P = 0.004). In the present study, all subdomains scored > 2, which means students had positive attitudes toward learning.

Conclusion:

Although students had positive learning perceptions in all three institutes, there were some problematic areas, such as stress during dental courses, for which policies should be formulated and implemented in dental institutes. The students were found to be too tired at the dental institute; they could not enjoy the program. Student-centered teaching programs can be employed to improve on the weaknesses of institutes.
Normal Values of Spleen Stiffness in Healthy Volunteers and Effect of Meal on Liver Stiffness and Spleen Stiffness
Authors: Luekiatphaisan Natrada , Tanpowpong Natthaporn
Published: July 2024

Background:

The portal hypertension leads to variceal bleeding. Spleen stiffness (SS) is useful in estimating esophageal varices risk and less invasive as compared with reference standard method (hepatic venous pressure gradient). Using different methods of ultrasound elastography as well as different novel system provide different value of SS.

Methods:

After the approval by the institutional review board, we enrolled volunteers aged over 18 years who had no obesity, excessive alcohol use, history of systemic disease, hepatobiliary disease, or malignancy. Spleen and liver stiffnesses were measured with LOGIQ E10 SWE by two radiologists. Volunteers ingested a 460 kcal liquid meal. The spleen and liver stiffnesses were performed at baseline and 60, 120 and 180 min after meal.

Results:

A total of 46 volunteers participate and two volunteers were excluded. The mean SWE SS was 12.6 ± 1.18 kPa. There was no statistically significant difference between sex, age and spleen size. SS trends to decrease with time. In first 2 h after meals, there was no significant difference from baseline. After 3 h, SS significantly decreased from baseline. In contrast, liver stiffness trend to increase with time and significant elevate from baseline at 3 h. Intraclass correlation coefficient between the two radiologists showed fair agreement for SS and substantial agreement for liver stiffness.

Conclusion:

Our outcomes may be a reference value for evaluating SS in patients with other illnesses in clinical setting the utilize SWE with LOGIQ E10. SS decreased with time after a meal in normal volunteers and significant difference at 3 h. In contrast, liver stiffness increases with time after a meal in normal volunteers and significant difference at 3 h. There is importance of the operator’s expertise in SWE measurement should be considered for SS.
Cross-sectional study on the risk of breast cancer and practices among young women in Central India
Authors: Tiwari Arti , Singh Maharaj , Sahu Bharati , Pareek Shatrughan
Published: June 2024

Background:

Our study focused on evaluating the risk factors associated with breast cancer among young women and highlighting the significance of early screening in this population, considering that breast cancer has the most common prevalence in women.

Materials and Methods:

This cross-sectional study enrolled women aged between 20 and 40 years who participated through a self-administered questionnaire. Data collection spanned 6 months, during which 250 young women were randomly recruited from different colleges in Jabalpur city, Madhya Pradesh, India.

Results:

Among the 250 women surveyed, 45 (18.0%) experienced early menarche and 33 (13.20%) had previously used oral contraceptives (OCP). In terms of preventive practices, 176 women (70.4%) had not engaged in breast self-examination, while 200 (80%) had not undergone clinical breast examination (CBE). However, 50 (20%) reported practicing CBE only when experiencing pain. None of the participants had undergone mammography. Regarding attitudes toward consumption of hormonal pills, 123 (49.2%) agreed that they would not take them without a prescription. Furthermore, approximately 91% did not follow weight management strategies, and 38.4% practiced meditation for stress reduction. Moreover, among the 250 young women surveyed, 218 (87.2%) did not engage in regular physical exercise (at least 3 h/week).

Conclusions:

While young women exhibit some risk factors for breast cancer, they often neglect appropriate preventive measures. Hence, it is recommended to commence breast cancer screening early, especially for those at elevated risk. Emphasizing awareness of breast self-examination is crucial. Moreover, launching screening programs is essential to facilitate timely detection and reduce mortality rates linked with breast cancer, especially among India’s younger female population.
Cervical cancer screening utilization among HIV-positive women in Edo State, Nigeria
Authors: Osunde Ngozi R. , Anayo Mercy N. , Patience Ona , Omoregie Favour E.
Published: June 2024

Background:

The enhanced risk of cervical cancer among women with human immunodeficiency virus (HIV) stems from the close association between HIV and increased rates of persistent human papillomavirus (HPV) infection. Detecting pre-malignant lesions early through screening is crucial, as cervical cancer is preventable. Identifying these lesions promptly could potentially save many women’s lives.

Objective:

This study aimed to assess the utilization of cervical screening services among women attending an HIV clinic in Edo State, Nigeria. Specific objectives included examining awareness levels, utilization rates, and potential barriers to access.

Materials and Methods:

This cross-sectional study was conducted at an institution and involved HIV-positive women attending an HIV clinic from August 2022 to July 2023. The study utilized a convenience sampling method with a sample size of 370 participants. Data reliability, deemed adequate at 0.781, was data reliability of 0.781 obtained was adequate for the study utilized. Analysis was performed, and findings were presented using frequency tables. Hypotheses were tested using χ2at a significance level of 0.05.

Results:

The participants’ mean age was 38.25 ± 4.51 years, with an average age at menarche of 15.12 ± 3.56 years, age at first intercourse at 18.21 ± 3.41 years, and years of HIV status at 7.11 ± 2.12 years. The mean duration of antiretroviral therapy (ART) was 6.72 ± 5.21 years. One hundred ninety-one individuals (51.6%) reported awareness of screening, while 65 (17.6%) had undergone screening. There was a significant association between awareness of screening and its utilization. (P< 0.001 removed). Among the 305 participants who had not undergone screening, 261 (85.6%) expressed willingness to do so. Barriers to cervical cancer screening included fear of the results (257 participants, 84.3%), financial constraints (200 participants, 65.6%), absence of symptoms (240 participants, 78.3%), and lack of motivation (289 participants, 94.8%).

Conclusion:

The study findings indicated insufficient awareness among participants and low utilization of screening services. As a result, it is recommended that enhancing healthcare workers’ abilities to promote cervical cancer awareness and encourage adherence to screening within this population is crucial to boost uptake.
Functional outcome of distraction osteogenesis in infected nonunion of the tibia
Authors: Arjun J. , Sivanandan Hari , Soundarajan Karuppanan , Christin Shebin , Maheswara Reddy Chereddi H.
Published: June 2024

Background:

The tibia is a bone located beneath the skin. Open fractures of the tibia, which involve significant soft tissue damage and bone loss, pose a challenge for trauma surgeons. The prevalence of long bone fractures is on the rise, attributed to the escalating number of road traffic accidents and other household mishaps, resulting in an increased occurrence of nonunion cases. Consequently, this study aims to evaluate the healing rates in long bone nonunion fractures and examine the complications associated with the treatment device. Managing infected tibial nonunions remains a formidable task for orthopedic surgeons.

Materials and Methods:

A retrospective study was conducted on 30 patients diagnosed with infected nonunion of tibial fractures treated with limb reconstruction systems (LRSs) in the Department of Orthopaedics at Vinayaka Missions Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, India. Inclusion criteria comprised patients aged between 20 and 55 years with tibial fractures failing to unite within 6 months, radiological evidence of nonunion, willingness to provide written informed consent and suitability for surgery.

Results:

The results revealed that most patients fell within the age group of 40–50 years, with an average age of 40.9 years in our study. Out of 30 patients, 17 were male and 13 were female. Regarding bony results, 20 patients (66.7%) exhibited excellent outcomes, 6 patients (20%) showed good results, 3 patients (10%) had fair outcomes, and 1 patient (3.3%) had poor outcomes. Functional outcomes showed that 20 patients (66.7%) experienced excellent results, 6 patients (20%) showed good outcomes, 3 patients (10%) had fair outcomes, and 1 patient (3.3%) had poor outcomes.

Conclusion:

This study concludes that the LRS fixator facilitates early ambulation, reducing the risk of osteoporosis, and soft tissue dystrophy. The average union time was 4 months, influenced by comminution, infection, nonunion type, smoking, and fracture pattern.
The role of diffusion-weighted MRI in the evaluation of imaging for prostate carcinoma: A systematic review
Authors: Mishra Komal , Pavanan Asish , Parihar Pratapsingh Hanumansingh
Published: June 2024

Background:

Prostate cancer is one of the most common cancers in men. In recent times, diffusion-weighted imaging (DWI) sequence magnetic resonance imaging (MRI) techniques have been used in the diagnosis of prostate cancer. The present systematic review aims to analyze the effectiveness of DWI in diagnosing prostate cancer.

Methodology and Results:

Publicly available English databases, such as PubMed and Google Scholar, were searched until 2020. We reviewed 965 research articles, and 10 were selected based on inclusion and exclusion criteria. The study found that the apparent diffusion coefficient (ADC) value decreases as the total diffusion volume increases. Tumor cells have significantly lower ADC values compared to normal or non-tumor cells. DWI was found to have higher sensitivity and accuracy than the T2W MRI technique. However, Choline-PET/CT was slightly more effective in diagnosing prostate cancer compared to DWI.

Conclusion:

DWI is a promising MRI technique that can enhance diagnostic performance in conjunction with other conventional MRI techniques to diagnose prostate cancer.
Implementation of stroke protocol: Insights from a tertiary care facility in urban India
Authors: Sharma Neha , Tyagi Shweta , Jain Nitin , Kumar Rajnish , Prakas Govind , Goyal Nitisha
Published: June 2024

Background:

Stroke is the second leading cause of death globally and ranks third for combined death and disability. Over the past two decades, there has been a significant rise in stroke incidence, mortality, and morbidity, with low- and middle-income countries being disproportionately affected. The effectiveness of thrombolytic therapy for acute ischemic stroke has led centers specializing in acute stroke care to develop protocols for rapid identification and triage of stroke patients. It is recommended that various stakeholders be educated on recognizing and managing stroke early and implement stroke protocols to improve coordination between different departments.

Materials and Methods:

The study was conducted in the emergency department of a tertiary care center in urban India from September 2021 to September 2022. We aimed to determine the average door-to-imaging (DTI) and door-to-needle (DTN) times for patients presenting with acute ischemic stroke. Additionally, we examined the factors contributing to delays in DTN time management of acute ischemic stroke at our center.

Results:

During the one-year study period, 131 patients with acute stroke presented to our center. One patient was under 18 years old, 10 patients arrived more than 4.5 h after symptom onset, and 2 patients had contraindications for thrombolysis. Consequently, 118 patients were included in the study. The average DTI time was 23 min, and the average DTN time was 58 min. Of these, 106 patients (89.8%) had a DTN time of less than 60 min. The most common cause of treatment initiation delay was obtaining consent (n = 7; 58.3%), followed by an unreliable time of symptom onset (n = 3; 25%) and delays due to resuscitation (n = 2; 16.6%).

Conclusion:

Acute stroke is a time-sensitive emergency where early thrombolysis can significantly reduce both morbidity and mortality. However, due to a lack of awareness and accessible resources, many patients often arrive outside the treatment window. Despite these limitations, a substantial number of patients do reach the hospital in time. Implementing a stroke protocol and utilizing innovative methods to reduce time can ensure these patients benefit from the global “standard of care” treatment for stroke.
Tuberculosis of the thyroid gland: A rare case report
Authors: Galani Manisha Kamlesh , Galani Kamlesh Jamnadas , Lakhani Swati Nileshkumar
Published: June 2024

Tuberculosis (TB) of the thyroid gland is exceedingly rare, even in regions like India, where tuberculosis is prevalent, with an estimated incidence of 0.1–0.4%. While tuberculosis can affect various organs, its involvement in the thyroid, pancreas, striated, and cardiac muscle is uncommon. Diagnosis poses a challenge due to the lack of distinctive clinical features—microscopic examination revealing epithelioid granulomas, sometimes with caseous necrosis and Langhans-type giant cells, aids in diagnosis. Confirmation typically involves detecting acid-fast bacilli through staining techniques like Ziehl Neelsen (ZN), molecular diagnostic methods such as TB Gene Expert or polymerase chain reaction for Mycobacterium tuberculosis (TB PCR), and histopathological examination of excised specimens. Recently, we encountered a case involving a 21-year-old male presenting with a 2-month history of diffuse neck swelling. Clinical examination suggested thyroid swelling, confirmed by ultrasound, showing a cystic lesion with necrotic areas, suggestive of thyroiditis, accompanied by bilateral cervical lymphadenopathy. Fine Needle Aspiration Cytology revealed necrotizing granulomatous thyroiditis, prompting further investigation for tuberculosis. TB Gene Expert and ZN staining performed on fine needle aspiration cytology (FNAC) material confirmed tuberculosis, leading to anti-tuberculous treatment, which resulted in a positive response. In presenting this case, we aim to highlight the rarity of tuberculosis affecting the thyroid gland and emphasize the importance of considering minimally invasive diagnostic methods, such as FNAC and molecular techniques, before resorting to surgical interventions. This case underscores the significance of clinicians’ awareness regarding unusual tuberculosis presentations and the availability of advanced diagnostic tools to ensure timely and appropriate management.
Epidemiological profile of animal bite victims attending anti-rabies clinic in a tertiary care hospital in eastern Rajasthan: An observational study
Authors: Raj Ankit , Singh Shalini , Sharma Dharmesh , Yadav Rajeev
Published: June 2024

Background:

India has been classified by the World Health Organization as an endemic country with the highest incidence of rabies-related deaths globally. Therefore, any instance of a dog or wild animal bite is considered a potential exposure to rabies. The National Action Plan for Dog-Mediated Rabies Elimination emphasizes the importance of formulating state and district-level action plans tailored to local circumstances and evidence. A cross-sectional study analyzed the epidemiological traits of animal bites reported at the anti-rabies clinic of a tertiary hospital in Jaipur, Rajasthan, India.

Materials and Methods:

The research was conducted at Sawai Man Singh Medical Hospital in Jaipur, India, from September to October 2022. A pretested interviewer-administered questionnaire was used to collect data on the socio-demographic and epidemiological features of animal bites from a sample of 328 victims. Descriptive statistics and a spatial map were employed to analyze the results.

Results:

Among animal bite victims, 73% were males, and 35% fell within the age group of 5–18 years. The majority of cases, accounting for 92%, were categorized as category III exposure, with 61% of the victims being bitten on their lower limbs. Dogs were responsible for 76% of the bites, while monkeys accounted for 21%. Approximately 74% of dog bites were inflicted by stray dogs, and 82% of these incidents were unprovoked.

Conclusion:

The study highlights a higher prevalence of category III exposure and monkey bites compared to previous research, along with subpar adherence to prior immunizations. Most animal bite incidents were observed in public areas, particularly on streets and tourist destinations. These findings emphasize the importance of customizing district and state action plans to the specific context in Rajasthan to combat rabies effectively.