bluuebunny/crossref_metadata_2025 huggingface dataset:
An Investigation of the Visitor's Spatial Experience in Virtual Exhibitions
Authors: Öztürk Rana , Orhun Simge Esin
Published: December 2023

Along with the technological advancements in the digitalisation of physical objects and spaces, the COVID-19 pandemic has created an urgent necessity for cultural institutions to display exhibition content online. Exhibition making is a process of knowledge production through an order of display that is integrated into the spatial and architectural context of an exhibition space. The authors believe that virtual tours that are developed by simply creating a replica of the physical exhibition and the virtual display of individual artifacts offer limited spatial experience. They believe that virtual exhibitions as alternatives to physical experience of exhibitions still require a critical reflection in terms of their spatial context, effectiveness, benefits, and limitations. By examining the results of a three-week workshop with communication design students, the chapter discusses the current use of staging and navigation possibilities for displaying digital content. It further highlights the spatial relationality as a key concern for the translation of physical exhibitions into virtual space.
Healthcare 5.0 Fundamentals
Authors: Naureen Ayesha , Vamshi K. , Krishna K. Chaithanya , Hussain Mohammad Manzoor
Published: December 2023

Healthcare 5.0 signifies a radical paradigm shift in the healthcare sector in an era of technology that is advancing at an exponential rate. In this chapter, the author goes into the fundamental ideas and real-world uses that support this revolution. The historical view presented in this chapter shows how healthcare concepts have changed through time, from earlier iterations to the current Healthcare 5.0. It highlights the crucial part that technology has played in influencing this new era of healthcare.
Introduction to Cloud Computing and Healthcare 5.0
Authors: Gowda V. Dankan , S. V. Shashikala , Y. M. Manu , Kaur Mandeep , Jha Sudhanshu Kumar
Published: December 2023

Healthcare delivery is poised to undergo a paradigm shift as a result of the convergence of cloud computing and Healthcare 5.0, which promises to revolutionize patient care. In order to enable Healthcare 5.0, a patient-centric strategy that combines cutting-edge technologies and data-driven insights to customize healthcare experiences, this chapter serves as an introduction to the transformative potential of cloud computing. Beginning with a thorough explanation of cloud computing's fundamental principles, architecture, and distinguishing features, the chapter moves on to its main points. Introduced is the idea of healthcare 5.0, emphasizing its emphasis on patient empowerment, personalized medicine, and the harmonious fusion of medical knowledge and technology. By utilizing telemedicine, cloud-based data analytics, and artificial intelligence (AI), Healthcare 5.0 seeks to go beyond the conventional one-size-fits-all method of providing healthcare services.
Healthcare 5.0
Authors: Dhanasekaran P. , Velusamy Sakthivel , Pavithra R. , Hemawathi  , Santhosh Kumar
Published: December 2023

Healthcare 4.0 is a term coined by the healthcare sector in response to this transformation. In the present investigation, the authors present a blockchain-based federation learning strategy for smart healthcare, where the edge nodes control the blockchain to avoid a single point of failures and the MIoT gadgets use federated instruction to fully utilize the distributed medical information. The proposed intelligent system uses federated deep extreme neural networks for lung illness prediction. Additionally, for improved lung disease prediction, the proposed model is strengthened using a fused scaled deep extreme machine learning algorithm. The merged scaled federated deep extreme predictive machine learning model is utilized to verify the best cancer illness predictions in the smart healthcare sector 5.0 that has been provided. The results of the indicated fused balanced federation extreme deep learning methodology was 98.3%, surpassing the most recent reported methods.
Generative AI and Healthcare 5.0
Authors: Maliya Rama M. , Thakkar Shruti
Published: December 2023

Over the past century, the global healthcare system has undergone remarkable transformations driven by technological advancements. Healthcare 1.0 represented ancient healing practices, reliant on manual record-keeping and lacking efficiency. The advent of computers in the 1980s ushered in Healthcare 2.0, enabling centralized digital records and improved communication. Healthcare 3.0 introduced affordable smart wearable devices, capable of monitoring health metrics. In Healthcare 4.0, the integration of AI with smart devices led to patient-centric care, global collaboration, and enhanced research efficiency, propelling the healthcare sector into a new era of progress.
Introduction to Artificial Intelligence and Its Importance in Modern Business Management
Authors: Thakur Reetika
Published: December 2023

Artificial Intelligence (AI) has emerged as a groundbreaking technology offering unparallel opportunities to enhance business efficiency and competitiveness. Recently, AI has gained notable attention in the business world as companies have started to recognize the potential of AI to revolutionize businesses and unlock new opportunities for growth and innovation. This chapter provides an introduction to AI and its importance in modern business management. It discusses the origin, evolution, and different types of AI; and subsequently delves into the applications, benefits, challenges, and future of AI. The chapter concludes that an ethical global governance framework should be developed for frontier AI applications used in businesses to make them more reliable and trustworthy. Also, there should be government intervention in the form of ethical auditing and ethical guidelines for the use of AI by the organizations. Thus, with the right approach, AI can be a valuable asset to businesses, helping them to succeed in an increasingly competitive and turbulent business environment.
The Future of Finance
Authors: Rao Amar , Hossain Mohammad Razib
Published: December 2023

The convergence of behavioral finance and artificial intelligence (AI) has attracted substantial attention in recent years, representing a dynamic amalgamation of insights stemming from psychology and economics with state-of-the-art technology. AI's prowess extends to bias detection, wherein it meticulously examines patterns in investment decisions. It adeptly identifies prevalent biases like loss aversion and overconfidence by contrasting responses to losses and gains. Furthermore, AI plays a crucial role in uncovering biases related to social and ethical considerations, such as ethnoracial equity, and aids in identifying and mitigating biases within AI models themselves. Cutting-edge frameworks, crowdsourced failure reports, bias auditing tools, and psychophysics-inspired methodologies all contribute to the comprehensive detection of biases. In summary, the synergy between behavioral finance and AI revolutionizes our comprehension of financial decision-making.
Artificial Intelligence for Innovative Customer Services in the Hospitality Industry of India
Authors: Singh Lakhvinder , Dhankhar Dinesh
Published: December 2023

Artificial intelligence (AI) is a new technology that has been applied in tourism and hospitality businesses to enhance customer experiences. In hospitality industry, there have been researches about AI applications, yet it is not widely applied in hotels in Indian aspect. Therefore, the purpose of this chapter is to identify the customer experience from use of AI in hotels in India. The research methodology used in the study was quantitative research with field survey. The target respondents were contacted in national capital region (NCR) of India for data collection. The survey results came out quite surprising with differing opinions of respondents. Most respondents agreed that applying AI is a modern trend to follow. Some of the important points to respondents were always-on service, fast access to service and cleanliness. Many respondents would prefer to interact with employees more than AI machines. Due to the wide knowledge of AI and limitation of the research, further research should be done to gain better perspectives on AI approaches in hotels.
Role of Artificial Intelligence in Business Dynamics
Authors: Nag Ashish , Bhatia Arun , Sharma Aditi , Kumar Vipan , Sharma Vipul
Published: December 2023

Artificial intelligence (AI) has appeared as an innovative technology that is restructuring the business operations in maximum business sectors. This chapter highlights the role of AI in business mainly attached with its functions like operations, marketing, finance, selling, R&D, etc. Further, this piece of literature will also discuss its adaptability along with its current potential and future prospects. Artificial intelligence (AI) is an innovative area which is found to be very useful for commercial and domestic purposes. The blend of AI in industry and business can enhance the capacity of production and marketing. Making use of this AI is also providing a competitive edge to many companies. Apart from marketing, it also has the ability to modernize business with inventive ideas. It also acts as a modern tool for complex problem solving and decision making. Hence, the authors will discuss the growth of business using AI aids and its role in functional part of the business.
The AI Revolution
Authors: Kumar Rajesh , Sharma Vishal
Published: December 2023

The financial services industry is undergoing a considerable transition due to the fast-paced development of artificial intelligence (AI) and allied technologies. This chapter explores the influence of AI on financial services, including its origins, fundamental ideas, and diverse applications. Credit scoring, fraud detection, customer service, investment strategies, financial education, customized banking, portfolio management, marketing strategies, and regulatory compliance are just a few areas where AI have been deployed. There are various concerns regarding the use of AI in financial services, such as issues with data security and privacy, the need for localization to serve a variety of customer bases, operationalization difficulties, the necessity for trust and transparency, the dearth of necessary skills, and the complexity of AI-driven decisions. This chapter highlights the crucial part AI will play in deciding the direction of financial services in the future and the need of preserving ethical standards to make sure AI continues to be a driver for progress in the sector.
A Comprehensive Review on the Integration of Artificial Intelligence in the Field of Education
Authors: Dayal Gopali , Verma Pooja , Sehgal Shallu
Published: December 2023

Artificial intelligence (AI) has become an integral part of every profession, permeating various departments, including education. In the educational sphere, AI applications are instrumental in personalizing learning experiences, automating administrative tasks, and enhancing engagement. This study explores the significance of AI in education, its multifaceted applications, and the key features that make it a transformative force, ultimately elevating teaching and learning methodologies for educators and students alike. This study is divided into four parts where we discuss the role of AI in the education world, the potential applications of AI in education, and the challenges and future directions of AI in the real world. Through this study, the authors highlight how AI contributes to the growth and development of the education world.
Artificial Intelligence
Authors: Anshima ­ , Bhardwaj Bhawana , Sharma Dipanker
Published: December 2023

The world is advancing rapidly with modern technologies penetrating peoples' individual, professional, and communal lives. Organizations are being drawn to AI-human collaborations for making choices and operational tasks performed by advanced technologies. Businesses are learning how to adapt to thrive in constantly changing and shifting business environments. To acquire a competitive edge in the face of increasing global competition, HR practices must integrate AI to become more effective. However, due to its limitation of explaining the output produced, there still exist paradoxes around the implementation of AI in the HR area. On the one hand, organizations are leaning towards implementing AI because of its efficacy; on the other hand, some people are opposed to AI because they worry about losing their jobs, biased decision-making, and ethical issues. After all, decision outcomes are not always interpreted. The following chapter aims to explore challenges and opportunities regarding the use of AI in HRM.
Retention of Knowledge From “Baby Boomers” Prior to Leaving the Workforce
Authors: Krumsiek Kim J.
Published: December 2023

This chapter will explore the strategies used by human resource managers to retain the tacit knowledge of “Baby Boomers” before they leave the workforce. With five generations working together in the workplace, organizational leaders need to support employee knowledge retention and knowledge sharing. Knowledge transfer from Baby Boomers to younger generations continues to be a challenge for organizational leaders, especially with the increase in Baby Boomers leaving the workforce. Knowledge retention is critical to an organization's success due to knowledge being a valuable asset. The chapter will share findings from a qualitative inquiry that explored effective knowledge retention strategies used by some U.S. human resource managers to retain tacit knowledge from “Baby Boomers” before they left the workforce.
Recovery of Flared Natural Gas with High CO2 Content Using SOFC CHP System: Feasibility Study for Neem-Field, Sudan
Authors: Bargo Mohammed I.
Published: December 2023

Flared natural gas emissions are one of the main sources of environmental pollution and global warming. To recover this gas, the presence of impurities like CO2 in high concentrations forces oil producers to escape from investing in such intensive processing. Several implementations of no flaring methods have been reported in the literature, however, there have been limited concerning the bulk-CO2 natural gases. This research developed an innovative idea for the use of the SOFC CHP system to recover flared bulk-CO2 associated gas of Neem-Field in Western Sudan. The exergy of the system and the performance of the SOFCs are investigated in this paper, in addition to environmental and economic analysis. The simulation (Cycle-Tempo©) results demonstrate that the proposed system can generate 1 MW electrical power and 0.068 MW thermal energy with efficiency approached 43.3% (based on LHV). The exergy analysis showed that 38% of system losses occurred in the air preheaters. Instead of conventional gas-burning, recovering the flared gas reduced the equivalent CO2 GHGs emissions by 80%. Overall, the novel solution found to be environmentally friendly, and economically appealing with a total capital investment estimated to be US$1.175 million and a cost of electricity (COE) of 4.07 cents per kWh.
Genetic Algorithm Based Combinatorial Optimization for the Optimal Design of Water Distribution Network of Gurudeniya Service Zone, Sri Lanka
Authors: Senavirathna K. H. M. R. N. , Walgampaya C. K.
Published: December 2023

This paper brings an in-detail Genetic Algorithm (GA) based combinatorial optimization method used for the optimal design of the water distribution network (WDN) of Gurudeniya Service Zone, Sri Lanka. GAmimics the survival of the fittest principle of nature to develop a search process. Methodology employs fuzzy combinations of pipe diameters to check their suitability to be considered as the cost-effective optimal design solutions. Furthermore, the hydraulic constraints were implicitly evaluated within the GA itself in its aim for reaching the global optimum solution. Upon analysis, the results of GA approach delivered satisfactory design outputs.
Spatial Pattern of Generation and Management of Household Hazardous Waste in Enugu Metropolis, Enugu, Nigeria
Authors: Ubachukwu N. N. , Mshelia A. M. , Salihu A. C.
Published: December 2023

The paper examined the spatial pattern of Household Hazardous Waste (HHW) generation and management options in the Enugu Metropolis. Ten (10) layouts were randomly selected from forty one (41) residential layouts that make up Enugu Metropolis. A total of 300 structured questionnaires were randomly administered to households, while oral interviews were conducted in the Enugu State Waste Management Agency (ESWAMA). The study showed that home cleaning waste was the most frequently generated HHW, accounting for 19%. This was followed by glasses (17%) and batteries (14.8) while the less generated include e-waste (10.4%), motoring products (8.7%), and paints (7.1%). Government Residential Area (G.R.A) generated the highest amount of HHW with a percent value of 13.1%, followed by New Haven (12.7%), Iva-Valley (10.6%), Ogui (10.2%) and Independence layout (10%). The relationship between dwelling type and quantity of HHW generated showed that the buildings with multiple rooms generated the highest (31%) amount of HHW, followed by three bedroom apartments. Lowest income earners (5,000-20,000 naira) were known to generate highest quantity, while houses with income above 250,000 naira generate less quantity. The study showed that 22.7% of the households indicated that they have no means of disposing of HHW, 2.7% indicated that they keep them or reuse them, 2.6% pour liquid HHW down their sinks or drains, 5% take them to a landfill site, the remaining 67% dispose of them in anyhow. Thus, there is a need for sensitization as this will encourage waste sorting, as well as help in educating the public on the need to purchase fewer hazardous products.
Diagnosis and management of Wilson’s disease: Current perspectives
Authors: Pachipala Sudheer , Agarwal Ayush , Garg Divyani , Garg Ajay , Srivastava Achal K
Published: December 2023

Wilson’s disease (WD) is an autosomal recessive disease caused by mutations in theATP7Bgene on chromosome 13q. The clinical manifestations of WD are varied and occur due to copper accumulation in organs such as the liver and brain. Although there are various laboratory findings and radiological signs suggestive of WD, they are non-specific and can be abnormal in various clinical conditions. If left untreated, the disease is fatal; therefore, early diagnosis and treatment is of utmost importance. Although several guidelines have been formulated, a clear management consensus is lacking. We performed a comprehensive literature search using the PubMed database before November 1, 2022, to extract relevant information for this narrative review with the aim of providing updates on the diagnosis and management of WD.
Three-dimensional Assessment of Temporomandibular Joint Volume, and Condylar and Glenoid-fossa Morphology: A Cone-beam Computed Tomography Study
Authors: Mehta Shivam , Gandhi Vaibhav , Patel Apexa , Chen Po-Jung , Lin Meng-Hsuan , Kuo Chia-Ling , Tadinada Aditya , Yadav Sumit
Published: December 2023

Background:

The condylar and glenoid fossa morphology can alter in patients with temporomandibular disorders (TMD), which can lead to changes in the temporomandibular joint (TMJ) space volume. Volumetric evaluation of TMJ can represent the entire three-dimensional (3D)-joint space between the condyle and glenoid fossa.

Aims:

To perform 3D assessment of TMJ volume, condylar, and glenoid-fossa morphology using cone-beam computed tomography and evaluate the correlation between these parameters.

Settings and Design:

Thirty-four patients (age: 13.50 years) who had no previous history of TMD were included.

Materials and Methods:

The volume of TMJ space was measured and divided into anterior, posterior, medial, and lateral TMJ volume. The antero-posterior (AP) and medio-lateral (ML) condylar width, AP and ML glenoid-fossa width, and glenoid-fossa depth were evaluated.

Statistical Analysis Used:

Statistical analyses were performed with R software at a 0.05 significance level. Each parameter was compared between the left and right sides using a paired-t test. The correlations between the parameters were obtained by the Pearson correlation coefficient.

Results:

There was no significant difference between lateral and medial TMJ volume; however, posterior TMJ volume was significantly greater than anterior TMJ volume. A significant correlation was observed between AP glenoid-fossa width and TMJ volume, glenoid-fossa depth and TMJ volume, AP position of the condyle and anterior TMJ volume, ML position of the condyle and medial TMJ volume, glenoid-fossa width and condyle width in AP and ML dimension, glenoid-fossa depth and AP glenoid-fossa width.

Conclusions:

In addition to the evaluation of condylar and glenoid-fossa morphology, assessment of TMJ space volume is important for comprehensive evaluation of the joint.
Subclinical hypothyroidism and anti-thyroid peroxidase antibodies in primary open-angle glaucoma: A case–control study
Authors: Unnikrishnan Suma , Anilakumari VP , Mohammed Ferzana
Published: December 2023

Purpose:

To evaluate the association among subclinical hypothyroidism, anti-thyroid peroxidase (anti-TPO) antibody, and primary open-angle glaucoma (POAG).

Study design:

Case–control study.

Methods:

The cases consisted of patients with POAG and controls were age- and sex-matched patients from the general eye clinic with no history of glaucoma. Blood samples were taken from the participants’ antecubital veins and sent for measurement of thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), and anti-thyroid peroxidase (anti-TPO) antibody. Data was analyzed using the Mann–Whitney U test and the Chi-square test. Odds ratio with 95% confidence interval (CI) was calculated. A two-tailed P value less than 0.05 was considered for statistical significance.

Results:

There were a total of 63 cases and 63 controls. Subclinical hypothyroidism was present in 20.6% of patients in the glaucoma group and 4.8% of patients in the control group (P < 0.01). The odds of subclinical hypothyroidism in patients with POAG compared to controls was 5.2 (95% CI 1.7–22). Anti-TPO antibody positivity was higher in the glaucoma group (22.2%) than in the control group (14.3%), but this did not reach statistical significance (P = 0.25).

Conclusion:

This study suggests an association between POAG and subclinical hypothyroidism. Further research is needed to establish the cause-and-effect relationship between these two conditions.
Newborn screening for congenital hypothyroidism, congenital adrenal hyperplasia and glucose-6-phosphate dehydrogenase deficiency in Bihar: A pressing priority in today's time
Authors: Kumari Bandana , Raj Khushboo , Sharma Sadhana , Kumar Sushil , Chowdhry Bhabesh K. , Kumar Amit
Published: December 2023

Background and Objective:

Newborn screening (NBS) aims towards early detection of congenital disorders or prevention of intellectual and physical defects and life-threatening illness. Three disorders namely congenital hypothyroidism (CH), congenital adrenal hyperplasia (CAH) and glucose-6-phosphate dehydrogenase deficiency (G-6-PDD) were selected for a preliminary study for NBS. The study aimed to establish NBS in the Indian scenario that could lay a framework for future such initiatives.

Methods:

A screening programme was conducted at a tertiary care hospital for 1 year. All the neonates born at All India Institute of Medical Sciences (AIIMS), Patna, were screened for their blood levels of glucose-6-phosphate dehydrogenase (G-6-PD), 17-hydroxyprogesterone (17-OHP) and thyroid-stimulating hormone (TSH). Heel-prick blood samples were collected within 48–72 h of birth, and the level of these parameters was accessed by enzyme immunoassay (EIA).

Results:

A total of 492 neonates were born from January 2020 to December 2020, of which 369 newborns were screened for CAH, CH and G-6-PDD. Of 369 neonates, one case (male) had an increased level of TSH, six cases (all males) had an increased level of 17-OHP and no case was found with G-6-PDD.

Interpretation and Conclusions:

Preliminary data on the prevalence of various genetic disorders revealed that CAH is the most prevalent disorder followed by CH in the population of Bihar. More efforts need to be undertaken to create awareness and to make screening a successful programme in India. A cost-effective nationwide screening programme is highly recommended for the detection of such cases at the earliest to avoid their future complication.
Phenotypic characterization and antifungal susceptibility profile of Candida isolates from women with vulvovaginal candidiasis at a community health center linked to a teaching institution in the Sub-Himalayan region of North India
Authors: Rawat Sangeeta , Singh Rajender , Mittal Garima
Published: December 2023

Introduction:

Vulvovaginal candidiasis (VVC) is considered a common gynecological problem among females of reproductive age group. 70–75% of women report having had candidal vulvovaginitis at some point in their lifetimes and 40–50% suffer recurrent candidal vulvovaginitis.

Objectives:

This study aims to identify the Candida species involved in VVC and to determine their antifungal susceptibility pattern.

Materials and Methods:

The present study was a cross-sectional study conducted on 257 females (18–55 yr) with complaints of abnormal vaginal discharge. For detection of Candida, the swab samples were subjected to Gram stain, 10% KOH mount, and culture on Sabouraud dextrose agar (SDA). Candida species identification was done by subculturing Candida isolates onto CHROMagar, corn meal agar (Himedia), and further confirmation was done by MALDI-TOF MS. Antifungal testing was done using the disk diffusion method.

Results:

A total of 257 females with complaints of abnormal discharge were enrolled in this study. Out of 257, C. albicans 37 (58.7%) and 26 (41.3%) isolates were identified as non-albicans Candida. Out of 63 positive cases, a maximum number of study subject belongs to the age group 26–35 years (50.8%). Along with vaginal discharge, itching (65.37%) is the most common complaint. VVC was found to be most predominant in patients with prolonged antibiotic therapy (38.1%), and in pregnant females (15.9%).

Conclusion:

Understanding the emerging fungal pathogens and their drug susceptibility patterns is essential for the effective management of infections. Drug resistance can lead to treatment failure and highlights the need for alternative treatment options or strategies.
Examining corporate support issues with health literacy as a key factor: The Case of a Hiroshima corporation
Authors: Li Yuan , Kawasaki Hiromi , Yamasaki Satoko , Nakaoka Sae , Shiraishi Misa , Cui Zhengai
Published: December 2023

Context:

Given the dramatic decline in Japan's labor force, promoting women's participation in the workforce is essential.

Aims:

We aimed to take a Hiroshima company as an example and analyze the influencing factors of health literacy (HL) to clarify the issues of the active participation of female employees.

Methods and Materials:

From February to March 2023, a cross-sectional study was conducted by a company in Hiroshima prefecture that contained many male employees. A total of 1,114 valid respondents were received. Employees' demographics, menstrual-related concerns, women's activity promotion support, and HL were investigated in this study.

Statistical Analysis Used:

The Chi-square test and logistic regression using SPSS statistical software version 25 were used.

Results:

There were significant differences between high and low HL with age, women's menstrual problems, and women's activity promotion support. The participants who were unaware of women's menstrual-related problems and their company's implementation of women's activity promotion support were more likely to have high HL. In addition, female employees (including female management) and male management have significantly different cognitions about women's activity promotion support.

Conclusions:

This study found that overall HL among employees in male-dominated companies is low, even among participants who were aware of women's menstruation-related health issues and the company's women's activity promotion support. Increased women's representation in management can bridge policy perception gaps. Male-dominated companies should enhance HL via career programs, health education, and improved communication for active female engagement.
Gap identification for improvement in maternal and early infant health care practices among tribal pregnant women in an aspirational tribal district Sirohi, Rajasthan
Authors: Dwivedi Rakhi , Goel Akhil D. , Vyas Varuna , Yadav Suraj S. , Sharma Prem P. , Bhardwaj Pankaj , Singh Pratibha , Singh Kuldeep
Published: December 2023

Background:

Sirohi is one of the aspirational districts of Rajasthan which is also tribal-dominated. The maternal and early infant health indicators are worrisome compared to regional or national statistics. First-trimester registration of pregnant women is 54% in district Sirohi, which is much less as compared to registration in the state of Rajasthan (63%) and India (59%). Four antenatal care (ANC) visits of pregnant women are 32% in district Sirohi, which is also much less as compared to ANC visits in the state of Rajasthan (39%) and India (51%). However, there was no tribal-specific data regarding maternal and early infant health.

Objective:

The study aims to identify gaps for improvement in maternal and early infant health care practices among tribal pregnant women in an aspirational tribal district of Sirohi, Rajasthan.

Materials and Methods:

It was a cross-sectional study conducted among 560 tribal pregnant women to assess the existing maternal, and early infant health care knowledge and practices through a pre-validated questionnaire in the tribal population of district Sirohi Rajasthan.

Result:

Nineteen per cent (19.5%,n= 109) of tribal pregnant women got married between the age of 10 and 17 (less than the legal age of marriage of 18 years). There is a significant relationship between early age at marriage and low educational statusP< 0.001,r= 0.241 among participants. Measurement of weight, blood pressure and urine examination was done in 32.5% (n= 181), 19.5% (n= 109) and 7.1% (n= 39), respectively, among tribal pregnant women. The majority (94.6%) of the pregnant tribal women (385/407) were anaemic. Approximately 60% (n= 337) of mothers were unaware of thermal protection (skin-to-skin care). Sixty per cent (n= 334) of tribal pregnant women preferred to seek consultation regarding antenatal and infant health care from doctors, while 40.1% (n= 224) were more comfortable seeking advice from traditional birth attendants (TBAs).

Conclusion:

The study finds inadequate knowledge and practice towards maternal and early infant care among tribal pregnant women. As TBAs influence tribal pregnant women, systematic training and involvement of TBAs in maternal and child health are indispensable.
Comparison of the efficacy of intravenous labetalol versus oral nifedipine in patients with severe pregnancy-induced hypertension beyond 30 weeks of gestation
Authors: Agarwal Manika , Rukshana Makakmayum , Basu Ritisha , Shullai Wansalan K. , Singh Santa A.
Published: December 2023

Hypertensive disorders of pregnancy affect 5% to 10% of all pregnancies globally. The aim of treatment is to bring down blood pressure (BP) quickly and smoothly, which is safe for the mother and baby. The aim of our study was to study the efficacy and safety of intravenous labetalol and oral nifedipine in severe pregnancy-induced hypertension.

Materials and Methods:

It is a retrospective observational study, intravenous labetalol 20 mg was given initially in escalating doses of 40 mg, 80 mg, 80 mg, and 80 mg every 15 mins up to a maximum dose of 5 or until the goal BP ≤150/100 mmHg was reached. Some women with severe pregnancy-induced hypertension were given oral nifedipine to control their BP according to the choice of the attending consultant. Nifedipine 10 mg tablet was given initially in repeated doses of 10 mg every 15 mins up to a maximum of five doses or until the goal of BP ≤150/100 mmHg was reached.

Results:

In our study, we found that there was a strong statistical significance in stabilizing the BP with oral nifedipine than with intravenous labetalol drug used. The majority of the patients in the oral nifedipine group got to normal BP quicker when compared to intravenous labetalol group patients.

Conclusion:

From this study, both drugs were found to be safe and effective in the reduction in BP. The use of nifedipine may be recommended in low-resource settings since it has an oral regimen and dosage is simple when compared to incremental intravenous dosing of labetalol.
Assessment of health-related quality of life and its determinants among COVID-19 intensive care unit survivors
Authors: Neelima Mariyala , Chivukula Satya K.
Published: December 2023

Background:

Health-related quality of life (HRQoL) is a multidimensional concept encompassing the physical, functional, emotional, and social/family well-being of an individual. Recent reports suggest that Covid-19 may lead to poorer HRQoL of the patients infected both in the short and long term. The present study aimed to assess the health-related quality of life and their determinants among COVID-19 intensive care unit (ICU) survivors.

Materials and Methods:

In the study, 107 COVID-19 (RTPCR positive) patients admitted to the (ICU) of a tertiary care centre from August 2021-January 2022 were taken from the hospital records. Line listing of all the patients was done, and the study population was selected using the lottery method under a simple random sampling method. The study population was contacted by telephone and requested their willingness to participate in the study. EQ-5D-5L was used to assess quality of life, which is a standard instrument to assess HRQoL (developed by the EuroQol group in 2011). The EQ-5D-5L essentially consists of the EQ-5D descriptive system and the EQ visual analogue scale (EQ-VAS). Data entry was done using Microsoft excel 2019 version and data analysis using MedCalc version 20.015.

Results:

The mean EQ-5D-5L utility score was 0.51 ± 0.43. The mean EQ-VAS score was 68.97 ± 22.27. A significant association between co-morbidities and EQ-5D-5L utility score where those with co-morbidities had a lesser EQ-5D-5L score compared to those without co-morbidities. The mean duration of ICU stay in days was 12.29 ± 12.17. A significant negative correlation between the duration of ICU stay and EQ-5D-5L. (r = −0.26,P= 0.0006*).

Conclusion:

COVID-19 patients with comorbidities had a significantly poor quality of life. These findings may help healthcare professionals and decision-makers to better understand the consequences of COVID-19 on the HRQoL.
Klinefelter syndrome in primary care: A case and review
Authors: Richmond Chad , Hartfield Richard , Powell Leonard , Mancuso Alison
Published: December 2023

Reviewed here is a case of Klinefelter Syndrome (KS) diagnosed by a primary care physician after recognition of key features of KS, confirmed by karyotype, along with a discussion of factors associated with this patient's diagnosis and care. Recognition of the key features of this syndrome is important in order to provide proper screening, risk mitigation and treatment to these patients.
Monitoring the Family Health Centres in Kerala, India: Findings from a facility survey
Authors: Sankar Hari , Joseph Jaison , Negi Jyotsna , Nair Arun B. , Nambiar Devaki
Published: December 2023

Introduction:

Kerala, a south Indian state, has often been cited globally as a model for better health outcomes at low cost but faces unique challenges in achieving Universal Health Coverage (UHC). To propel the efforts in achieving UHC, the Government of Kerala announced the “Aardram” health reform initiative, emphasising improving the quality of primary care service delivery. The reforms started in 2017, and in the first stage, 170 of 848 Primary Health Centres (PHCs) were upgraded to Family Health Centres (FHCs). The facilities were provided with additional doctors, nurses, and paramedical staff; the working hours were extended, and the range of services offered increased. In support of these processes, we carried out a facility assessment to assess differences between upgraded FHCs and existing PHCs.

Materials and Methods:

We conducted a facility-based cross-sectional assessment in eight primary care facilities of Kerala, FHC (N=4) and PHCs (N=4) from June to October 2019. A structured questionnaire covering utilisation and coverage of selected priority services for various populations and health outcome data was filled out by health staff to report data for the financial year 2018-19. Data were analysed in Microsoft Excel spreadsheets for easy analysis and replication by state stakeholders.

Results:

Coverage indicators such as full antenatal care and full immunization coverage were not appreciably different in FHCs as compared to PHCs. However, key reform-related differences were observed. On average, FHCs had 0.8 medical officers and one staff nurse per 10,000 population, whereas PHCs had 0.7 medical officers and less than 0.4 staff nurses per 10,000 population, even as the size of populations served by these human resources varied greatly across both types of facilities. The number of outpatient department visits per 10,000 population annually was 11,343 persons in FHCs and 9,580 persons in PHCs. FHCs also provided additional services such as screening for depression and chronic obstructive pulmonary disorders.

Conclusion:

Aardram primary healthcare reforms are still in their early days and appear to be associated with improved service coverage at the institutional level. However, some patterns are uneven: reforms should be carefully documented, and population-level impacts monitored over time.
Study of the prevalence of tobacco consumption among apparently healthy adult males in an urban area
Authors: Ahmed Shafique , Nimonkar Ravi A. , Sharma Vishal , Pardal Maninder Pal Singh , Rajiva K.
Published: December 2023

Background:

Keeping in view the role of tobacco consumption as a modifiable risk factor in various diseases and gaps in scientific knowledge among the apparently healthy adult male population in India, the researchers chose to undertake this study.

Materials and Methods:

A cross-sectional study was conducted among apparently healthy adult males employed in various government offices to determine the prevalence of tobacco consumption. The minimum sample size to estimate a 95% confidence interval for the prevalence of tobacco consumption with 5% absolute precision was calculated to be 340. However, 500 subjects were included in the study. The tool used for data collection was the “personal interview technique.” Standard statistical methods were utilized for data analysis.

Results:

The overall mean age (standard deviation (SD)) of the study subjects was 30.96 yrs (4.32). Overall, the mean (SD) of number of years of tobacco use was 5.64 years (1.98). The mean (SD) of number of cigarettes smoked per day was 6.36 (3.09). The prevalence of current smokers showed a statistically significant increase from the age groups of 20–29 yrs to 50–59 yrs (P < 0.001). All subjects in the study were able to name at least three harmful effects of tobacco consumption. The overall mean amount spent on tobacco consumption per month was Rs 536.97 (1.44% of basic salary). Overall, the most common reason for smoking was peer pressure, where 40 (93.02%) gave this reason. Of forty-three tobacco users, 27 (62.79%) expressed a desire to quit tobacco consumption. The most common reason for expressing a desire to quit tobacco was the ill effects of tobacco consumption, where 23 (85.18%) tobacco users gave this reason.

Conclusion:

Our study on the prevalence of tobacco consumption among government employees provides an adequately clear picture of this public health epidemic in India. There is an immediate need for target group-specific policies for tobacco control, which should be integrated with the relevant national health programs at all levels.
Risk factors and fetomaternal outcome in pregnancy-related acute kidney injury
Authors: Sandilya Shipra , Rani Kumari Usha , Kumar Rajesh
Published: December 2023

Introduction:

Pregnancy-related acute kidney injury (PRAKI) is acute kidney injury (AKI) occurring during pregnancy, labor, and postpartum period. AKI is defined as suddenly impaired kidney function with the retention of nitrogenous and other waste products. In high population country like India, not all deliveries are done tertiary care. Even not all are registered one if delivery is conducted at a hospital setup. The majority of patients are being managed by available obstetrician at local places. Early diagnosis and timely management of complications related to pregnancy are very important to avoid PRAKI. We aim to study maternal risk factors and fetomaternal outcome in PRAKI.

Materials and Methods:

A prospective study is conducted between 2021 and 2022 in the Department of Obstetrics and Gynaecology, VMMC, and Safdarjung Hospital, New Delhi. For antenatal and delivered women up to 6 weeks, 50 patients were recruited according to KDIGO (Kidney Disease International Global Outcomes) criteria. Patients were followed with CBC, serum electrolytes, serial KFT, urine input/output monitoring, and USG-KUB. Dialysis was done if indicated. Complete renal recovery was considered if S.Cr ≤1.0 mg/dl within 6 weeks of diagnosis of AKI. For statistical significance, a P value of less than 0.05 was considered.

Results:

The majority of patients were unbooked, 21–25 years of age, and belonged to lower socioeconomic status (54%). Risk factors were: preeclampsia (28%), puerperal sepsis (24%), PPH (20%), abruption (14%), pyelonephritis (4%), acute gastroenteritis (4%), gestational hypertension with superimposed preeclampsia (2%), antepartum eclampsia (2%), and thrombotic microangiopathy (2%). Hemodialysis is required in 23 (46%). Complete renal recovery was seen in 40 (80%) and partial renal recovery in 3 (6%). Maternal mortality was 14% and causes were: puerperal sepsis (57%), preeclampsia with severe features with MODS (29%), and antepartum eclampsia with hepatorenal failure (14%). Fetal outcome: 76% live birth, 24% intrauterine death, and 16% early neonatal death.

Conclusion:

Most common risk factors for PRAKI are preeclampsia followed by puerperal sepsis and PPH where all are preventable causes.
Prevalence and Etiological Profile of Anemia in Hospitalized Geriatric Patients
Authors: Lohmror Anurag , Seervi Dinesh , Yadav Mahesh , Yadav Ramnarayan , Agarwal Mahendra Kumar
Published: December 2023

Background:

Anemia is a common health problem in the elderly and is associated with a wide range of adverse outcomes. The prevalence of anemia at older age is increasing as a result of improved diagnostics and demographic changes in our societies. The aim was to determine the prevalence of anemia in a cohort of hospitalized geriatric population and the possible underlying etiology.

Subjects and Methods:

This was a cross-sectional study among patients aged more than 60 years hospitalized in medical wards. Anemia was defined based on the World Health Organization criteria: Hb <12.0 g/dL in women and Hb <13.0 g/dL in men.

Results:

Anemia was observed in 214 patients (73.3%). The average age of the study participants was 68.16 ± 1.32 years. The mean hemoglobin level was 8.48 ± 2.26 g/dl. About 51% had moderate anemia and 34% had severe anemia. Morphologically, microcytic anemia was the most common type (49.5%). Overall, nutritional causes of anemia exceeded nonnutritional causes (49%, n = 105 vs. 42.5%, n = 91). Iron deficiency anemia was the most common nutrient deficiency anemia seen in 49 participants (22.9%), followed by Vitamin B12 in 34 (15.9%) and folate in 10 (4.7%). Anemia of inflammation was diagnosed in 69 (32.2%) and hematological disorders in 6.1%. Common chronic diseases causing anemia were infection/autoimmune disorders in 35 (16.3%), chronic renal failure in 20 (9.3%), and solid-organ malignancies in 14 (6.5%). The etiology was multifactorial in 19 patients (8.9%) and unexplained in 8 (3.7%).

Conclusions:

Anemia was frequently diagnosed in this series of elderly hospitalized patients with a high burden of moderate-to-severe anemia. Most of them had an underlying treatable etiology. Potentially correctable nutritional deficiencies, such as iron, Vitamin B12, or folate deficiency, were identified as the most common causes. Unexplained anemia appears to be rare in hospitalized older patients.
Spectrum of Biopsy Proven Renal Disease in the Elderly – A Retrospective Observational Study from South India
Authors: Thangaraju Sugan Gandhi , Ramudu Venkatraman , Thoppalan Balasubramanian
Published: December 2023

Background:

Despite the increasing proportion of the elderly population, renal biopsies are restricted to few centers. We studied the elderly renal biopsy data from a tertiary care center in South India.

Materials and Methods:

A retrospective observational study was done in patients more than 60 years of age who underwent native kidney biopsy for various clinical indications from January 2014 to June 2022 and was compared with the renal pathology data of adults 18–60 years of age who underwent native kidney biopsy for various indications during the same study.

Results:

Hundred and five (n = 105) elderly biopsies were included in the study. The mean age was 65.7 years (interquartile range: 60–85 years). Forty-two (40%) were type 2 diabetics. Infection-related glomerulonephritis (IRGN) (20, 19.04%), acute tubular necrosis (ATN) (15, 14.28%), membranous nephropathy (11, 10.47%), and acute interstitial nephritis (10, 9.52%) were the common pathologies observed in the elderly. The most common indication for renal biopsy was rapidly progressive renal failure (RPRF) (n = 28, 26.6%) and IRGN was the most common cause of RPRF. 76.2% of diabetics had nondiabetic renal disease, the most common being IRGN (8, 25%). Crescentic glomerulonephritis (GN), ATN, and cast nephropathy were observed significantly more frequent in the elderly than in those 18–60 years of age. IRGN and pauci-immune vasculitis were the causes of crescentic GN in the elderly.

Conclusion:

Our study highlights the importance of IRGN as the most frequent pathology in the South Indian elderly population both in diabetics and nondiabetics.