bluuebunny/crossref_metadata_2025 huggingface dataset:
Time-Variant Chloride Ingress Models for Probabilistic Assessment of Concrete Bridge Decks with De-Icing Salt Attack
Authors: Aruz Petcherdchoo , Koonnamas Punthutaecha
Published: August 2024

This study is to propose time-variant probabilistic models of surface chloride and diffusion coefficient based on the survey data of 16 concrete bridge decks with the attack of de-icing salts. These models are developed, because there is no study that simultaneously considers both time-variance and probabilistic descriptors in the model for concrete bridge decks. From the study, it can be found that long-term surface chloride and its time-variant development are fitted with Log-normal and Weibull distributions, respectively. In addition, the 28-day diffusion coefficient and age factor are fitted with Log-logistic and Triangular distributions, respectively. Considering only the mean value in the models, the corrosion-free residual life of concrete bridge decks is equal to 18.3 years based on the target value of critical chloride of 1.2 kg/m3, whereas their cracking-free residual life is equal to 29.5 years based on the target value of critical chloride of 2.0 kg/m3. In comparison with the probabilistic analysis, it was nevertheless found that at year 18.3, there are 38% and 20% probabilities to have rebar corrosion and concrete cracking, respectively. However, at year 29.5, there are 63% and 42% probabilities to have rebar corrosion and concrete. Specifically, there are 6 and almost 7 out of 16 bridge locations having rebar corrosion in the year 18.3 and concrete cracking in the year 29.5, respectively.
Acetylsalicylic acid in primary prevention: a review
Authors: Campanini Mauro , Rizzi Eleonora , Fleetwood Thomas , Pinna Giuliano , Giacomini Greta Maria
Published: August 2024

The role of acetylsalicylic acid in secondary cardiovascular prevention is established. However, its role in primary prevention is much more controversial. In this review, we analyzed meta-analyses and trials regarding aspirin in primary prevention and, consequently, hemorrhagic risk related to anti-platelet therapy. Several factors have been considered (e.g., sex, comorbidities, bleeding risk factors, concomitant drugs, weight, age), aspirin’s pharmacokinetics included. In the end, we tried to individualize anti-aggregation therapy based on the risk/benefit ratio of every single subject. In conclusion, high-cardiovascular-risk subjects must be treated with acetylsalicylic acid in primary prevention according to their bleeding risk. For better cardiovascular stratification, other tools to detect risk modifier factors should be used (e.g., instrumental evaluations).
Does technique matter? A multilevel meta-analysis on the association between psychotherapeutic techniques and outcome
Authors: Grevenhaus Christin Janine , Flückiger Christoph , Theimer Lea , Benecke Cord
Published: August 2024

The extent to which psychotherapeutic techniques have an impact on outcome has been studied on a regular basis. To date, there are no meta-analytic attempts to clarify the association between techniques and outcome in multi-therapeutic approach measures. This study aims to conduct a meta-analysis of the described association. A three-level meta-analysis and moderator-analysis were used. The meta-analysis revealed 13 studies with a total of 177 effect sizes. There was a significant effect r=.193 (t[176]=4.77, p<.01) with higher use of psychotherapeutic techniques being associated with better outcome. Significant moderator was therapeutic approach-specific subscales. The mean effect of cognitive-behavioral techniques was r=.088 (t[147]=1.50, p=.14, d=0.18; s=11, k=79), and the mean effect of psychodynamic techniques was r=.286 (t[147]=5.06, p<.01, d=0.60; s=11, k=70). The measurements for psychotherapeutic technique (Comparative Psychotherapy Process Scale and Psychotherapy-Process Q-Sort) showed no significant difference related to the association between technique and outcome (F[1, 175]=0.38, p=.54). This meta-analysis showed a positive relation between psychotherapeutic techniques and outcome. This leads to the assumption that specific psychotherapeutic techniques have positive effects on post-treatment outcome.
A Successful Awake Fiberoptic Bronchoscopy Intubation of a Cardiomorbid Patient: A Case Report
Authors: Alsalah Qusai A. , Bael Peter R. , Abufara Arein A. M. , Alsahouri Mohammad I. , Abu Asbeh Yousef , Hamamdh Majde
Published: August 2024

Bronchoscopy is a widely used technique for diagnostic and therapeutic purposes. Though it requires anesthesia, many options are available, depending on the patient’s health status, the purpose of the procedure, and the type of bronchoscope used. One such health status is heart failure, a leading cause of death, and a common challenge of anesthesiology. We report a 60-year-old male patient who is a known case of heart failure with an ejection fraction of 15%, and an implanted cardioverter defibrillator, along with concurrent ischemic heart disease, diabetes mellitus, and hypertension, who presented complaining of dysphagia. This highly morbid patient was able to successfully undergo a bronchoscopic biopsy with nerve block anesthesia considering his inadequacy for conventional methods. This report aims to shed light on these challenging cases and alert anesthesiologists on how to manage such situations in patients with cardiac morbidities.
Superior Vena Cava Syndrome after Epicardial Pacing Wires Removal
Authors: González-Suárez Susana , Barbosa Carlos Sureda , García-Navia Jusset Teresa
Published: August 2024

Although most superior vena cava (SVC) syndromes are due to intrathoracic malignancies, some are iatrogenic, such as those following the intravenous implantation of pacemaker wires. To date, the occurrence of this syndrome after epicardial pacemaker removal has not been described. The initial auricular laceration after removal can be complicated by the administration of anticoagulant and antiplatelet drugs, forming a hematoma that compresses the SVC cranially. Therefore, standardized practice may be necessary in these patients to address anticoagulant and antiplatelet therapy, perform serial echocardiography, and pay attention to underlying symptoms, which may be insidious and delayed.
A Comparative Study on Conventional Adenoidectomy and Endoscopic Powered Adenoidectomy
Authors: Devi Sanu , Bhatnagar Aastha , Swami Gautam , Kamal Anil Kumar , Parihar Anil Kumar , Nidhi
Published: August 2024

Introduction:

Adenoids are a type of nasopharyngeal lymphoid tissue that is a component of Waldeyer’s ring. They are typically present from birth, reach their maximum size between the ages of 7 and 10 years, and then gradually decrease in size to become atrophied in adulthood. The objective of the current study is to compare conventional adenoidectomy using curette with power-assisted adenoidectomy.

Materials and Methods:

This randomized clinical trial was conducted at Teerthanker Mahaveer Medical College and Research Center from March 2023 to August 2023. A total of 40 patients were planned for adenoidectomy and randomly allocated under two groups. The conventional curettage adenoidectomy method was done on patients in Group A and patients in Group B who underwent power-assisted adenoidectomy using microdebrider. Both the groups were further compared in terms of surgical clearance of adenoids, operative time taken in procedure, injury to surrounding structures, and symptom score improvement on follow-up.

Results:

Surgical clearance was excellent in Group B with no adenoid tags left in all 20 (100%) patients, whereas few tags were left in 18 (90%) patients in Group A (P < 0.0001). The mean operative time (in minutes) for Group A was 22.4 ± 1.67, whereas Group B was 18.1 ± 1.76 (P = 0.001). Postoperative pain score in Group A was 3.7 ± 1.63, whereas for Group B was 2.8 ± 1.01 (P < 0.043). Recovery time in terms of number of days to return to normal diet and activities in Group A was 3.1 ± 0.3 days, whereas Group B was less 2.1 ± 0.2 days (P < 001). Postoperative nasal symptom score at 6 weeks in Group A was 1 in 1 patient and 2 in 4 patients with mean of 0.45 ± 83, whereas in Group B was 0 (P = 0.043).

Conclusion:

It was concluded from the study that power-assisted adenoidectomy was a better surgical procedure than conventional adenoidectomy. There was better improvement in nasal symptom score and surgical clearance by power-assisted adenoidectomy. Postoperative pain score and time taken for recovery after surgery were also less in power-assisted adenoidectomy.
Status of Nutritional Services to Vulnerable Population in West Bengal and Their Hardship during COVID-19 Pandemic: A Community-based Qualitative Exploration
Authors: Bandyopadhyay Kajari , Ray Soumalya , Das Nivedita , Mukhopadhyay Dipta Kanti
Published: August 2024

Introduction:

In response to the COVID-19 pandemic, restrictions were imposed on various activities including nutritional services. This study was conducted with the objective to explore the status of the nutritional services and to identify the hardship and barriers faced by the vulnerable population and challenges for service providers and program managers during the initial phase of pandemic.

Materials and Methods:

A community-based cross-sectional qualitative study was conducted among three vulnerable population groups (slum dwellers, tribal population, and residents of disaster-prone area) in three districts of West Bengal, the reference period being April–September 2020. To assess the status of nutritional services and identify existing barriers or challenges, the study employed a mixed-methods approach utilizing focus group discussions (FGDs) as well as in-depth interviews (IDIs) conducted with beneficiaries, service providers and program managers. One habitation in each district was selected to obtain case scenarios on food insecurity and hardship. Descriptive analysis of household surveys and thematic analysis of FGDs and IDIs were done, and the findings were triangulated.

Results:

Different nutritional services (supplementary nutrition, micronutrient supplementation, growth monitoring, nutrition counseling, and nutrition rehabilitation) were disrupted. Shifting from hot-cooked meals to dry take-home ration was the most conspicuous change during restoration phase. Food security was absent in majority of the households. Reduction of income affected their affordability, which along with difficult accessibility to diverse food items contributed to their hardship. Service providers identified several challenges, including increased workload due to both COVID-19 activities and a rise in beneficiaries, transportation difficulties, and experiences of stigma and discrimination. Long administrative decision-making process, additional hurdles due to cyclone, and containment zones were identified as challenges by the program managers.

Conclusion:

As the hardship of vulnerable population was pervasive, it is necessary to formulate mitigating measures in light of the identified challenges and to combat similar crises in future.
Exploring the Spectrum: An Original Observational Study of Posterior Reversible Encephalopathy Syndrome from Tertiary Center in Kerala
Authors: Sasidharan Aswathy , Pranaav S. Arun , Ghafoor P. A. Fazal
Published: August 2024

Introduction:

Posterior reversible encephalopathy syndrome (PRES) is a disorder of subcortical vasogenic edema causing reversible neurologic dysfunction which includes headache, altered sensorium, seizures, and visual disturbances. It is a relatively rare disease with a myriad of nonspecific symptoms with similar presentations to that seen in other diseases such as stroke and cortical venous thrombosis. Hence, accurate diagnosis is needed for early detection to guide the management of such patients. This is a single-center retrospective study from June 2022 to May 2024 to identify the demographic profile, etiologies, imaging features, and prognosis of patients diagnosed with PRES.

Materials and Methods:

Diagnosis of PRES was made on the basis of clinical history, neurological examination, and magnetic resonance imaging brain after ruling out other possible differential diagnoses. The patients who satisfied Fugate et al. criteria were included in the study. The data were collected from the hospital database. Patients with alternate diagnoses were excluded from the study.

Results:

There were 22 patients diagnosed with PRES. There were 20 (91%) females among the cohort. Eighteen (82%) patients had headache. Fourteen (64%) patients had seizures all of which were generalized tonic–clonic seizures. All had positive imaging findings with 2 patients having leptomeningeal enhancement in the presence of normal cerebrospinal fluid findings. Blood pressure (BP) was normal in 5 (22%) patients. Most of the patients were postpartum without a prior history of hypertension or preeclampsia.

Conclusion:

PRES is a reversible entity with the imaging findings primarily involving the posterior part of the brain. It can also involve anterior circulation and spinal cord. Normotensive PRES is possible and should not be overlooked if the patient has all features of PRES but has normal BP. It has a female predilection with the most vulnerable state being immediate postpartum. Although recurrence is possible, PRES does not require long-term medications. Complicated PRES presents with SAH and intracranial hemorrhage.
Endometrial Hormonal Receptor Expression and Blood Vessel Density in Abnormal Uterine Bleeding: A Cross-sectional Descriptive Study
Authors: Jetley Sujata , Bushra Bushra , Ahmad Nehal , Elahi Arifa Anwar , Jairajpuri Zeeba S. , Rana Safia , Khetrapal Shaan
Published: August 2024

Introduction:

Abnormal uterine bleeding (AUB) is bleeding which is abnormal in amount, duration, frequency, and cyclicity and differs from the normal pattern. The aim of the study is to evaluate the expression of endometrial estrogen (ER) and progesterone receptor (PR) immunohistochemically and blood vessel density in AUB patients. Furthermore, we will correlate hormonal receptor expression and blood vessel density with various endometrial pathologies presenting with AUB.

Materials and Methods:

A cross-sectional study of 60 cases with clinical diagnosis of AUB, (30 cases of cyclical endometrium and 30 cases of hyperplasia/carcinoma) was done. Histological typing of endometrial lesions was done. Microvessel density (MVD) was calculated by counting the average number of blood vessels/10 HPFs. Evaluation of MVD was done on hematoxylin and eosin (H and E) stain and also reticulin stain which highlighted the basement membrane. Immunohistochemistry for steroid hormone receptors, ER and PR was done as per avidin-biotin technique with Diaminobenzidine as the chromogen. Carcangiu scoring system for semiquantitative analysis of ER/PR expression in endometrial samples was adopted.

Results:

There was a significant difference in microvessel density between different histopathology microscopic diagnoses (P < 0.05). The mean value of microvessel density on reticulin stain was significantly higher as compared to the mean value of MVD on H and E. A decrease of the hormonal receptor expression, ER and PR was observed in parallel with the decreased histological degree of differentiation, the lowest values occurring in the case of endometrioid Grade 3 carcinomas.

Conclusion:

Angiogenesis is significantly correlated with increasing severity of the lesion. The correlation of immunohistochemical findings with histologic grade can be useful in predicting biological behavior in patients.
Modified Mallampati Test in Supine versus Sitting Position as a Predictor for Difficult Intubation – An Observational Study
Authors: Kotwani Manish , Kawale Netraj Namdev , Nam Pranav Balu , Kotwani Deepti
Published: August 2024

Background:

The modified Mallampati test (MMT) is routinely employed to predict difficult laryngoscopy and tracheal intubation. This test, as a standard, when conducted with a patient in a sitting position, exhibits limited practicality due to its relatively low sensitivity and specificity in predicting difficult tracheal intubation (DTI). It is hypothesised that MMT, when performed with a patient lying supine, may improve its efficacy as a predictor of DTI.

Methods:

This single-centre prospective observational study was conducted involving 455 adult patients requiring general endotracheal anaesthesia. During preanaesthetic evaluation, MMT was performed in the sitting position as a standard (sitting MMT). Subsequently, independent observers recorded the MMT in the supine position (supine MMT) before administering general anaesthesia. The sitting and supine MMT were correlated with Cormack and Lehane grades using the Chi-square test. Diagnostic performance metrics, including the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive predictive values (PPV) and negative predictive values, were employed to assess the predictive capabilities of MMT in both positions.

Results:

Out of 455 patients, 72 (15.8%) experienced difficult intubation (defined as Cormack–Lehane Grade III and above). Both MMT in the sitting and supine positions demonstrated strong predictive capabilities for DTI, with areas under the ROC of 0.799 and 0.779, respectively. While sitting in the MMT position exhibited higher sensitivity (55.6% vs. 28.8%), supine MMT demonstrated a superior PPV (86.1% vs. 55.6%).

Conclusion:

MMT, when conducted with a patient in a supine position emerges as an alternative and a reliable predictor for predicting DTI.
Exploring the incidence of balance and coordination deficits amongst obese adolescents attending school: Insights from an online cross-sectional survey
Authors: Choudhary Smriti , Sharma Abhishek
Published: August 2024

Background:

Balance is maintained through automatic postural adjustments that ensure stability during various activities. Developmental Coordination Disorder (DCD) is often associated with other developmental issues, such as attention-deficit hyperactivity disorder (ADHD), learning disabilities, speech-language delays, and behavioral and emotional difficulties. Body mass index (BMI) for age is widely used in clinical and public health settings to determine whether a child or adolescent is overweight or obese.

Aims:

This study aimed to systematically examine the prevalence of balance and coordination impairments among obese adolescents attending school.

Materials and Methods:

A cross-sectional survey was conducted on a sample of 368 school-going obese adolescents. A self-developed questionnaire assessing balance and coordination was administered to the participants. The BMI was calculated for each participant to confirm obesity status.

Results:

The study found a significant prevalence of balance and coordination impairments among the obese school-going adolescents surveyed. These impairments were observed across various activities requiring postural adjustments and motor skills.

Conclusions:

The findings suggest a notable incidence of balance and coordination deficits in obese adolescents, highlighting the need for targeted interventions in this population to address these motor skill challenges.
Oral transmucosal fentanyl citrate as breakthrough pain relieving medication: A pilot study
Authors: Dua Naresh , Annaram Randheer Kumar , Jain Pradeep , Yadav Priya , Dua Shubh , Sood Jayashree
Published: August 2024

Background:

Breakthrough pain in cancer patients is a common and distressing symptom that significantly impacts their quality of life. Traditional pain management strategies often fail to provide adequate relief. Oral transmucosal fentanyl citrate (OTFC) has emerged as a rapid-onset opioid analgesic, offering a potential solution for managing this challenging condition in home care settings.

Aims:

This study aims to evaluate the efficacy of OTFC in managing breakthrough pain and its effects on the quality of life in cancer patients treated at home.

Materials and Methods:

A pilot study was conducted with 40 cancer patients experiencing more than one episode of breakthrough pain daily. These patients were administered OTFC 400 μg for pain management. Degree of pain (NRS) and modified ‘Quality of Well-being’ (QWB) scores were analysed using data filled in by patients. Data were collected and analysed using paired t-tests to compare pre- and post-treatment scores.

Results:

The administration of OTFC resulted in a significant reduction in pain, as indicated by the decrease in NRS scores from 9.9 ± 0.304 to 0.5 ± 0.906 within 30 minutes (P < 0.0001). Additionally, there was a marked improvement in QWB scores, which increased from 26.18 ± 2.8 to 36.3 ± 3.16 over the same period (P < 0.001). Mild side effects, such as nausea, headache, and somnolence, were reported, but no serious adverse events were observed.

Conclusions:

We conclude that OTFC 400 μg is an effective and well-tolerated option for managing breakthrough pain in cancer patients and in improving the quality of life in home care settings.
Predictability of Nailfold Capillaroscopic Score in Diagnosing Retinopathy in Patients with Type 2 Diabetes Mellitus and its Utility as a Non-Invasive Tool for Differentiating from those Not Having Retinopathy
Authors: Raina Rohit , Chhabra Neha , Barnwal Shruti , Vasisht Shivani , Kansal Naveen Kumar , Kant Ravi
Published: August 2024

Background:

Diabetes mellitus (DM) is a chronic hyperglycaemic state associated with microvascular structural alterations. Nailfold capillaroscopy (NFC) is an in vivo study of microvascular circulation.

Aims and Objectives:

This study aimed to investigate the diameters of capillary loops and morpho-structural changes using a handheld dermatoscope in patients with type 2 DM (T2DM) with and without diabetic retinopathy (DR) and to establish nailfold capillary changes and NFC score as a non-invasive method to identify microvascular complication in T2DM patients.

Material and Methods:

A cross-sectional observational study was conducted in AIIMS Rishikesh for 6 months from August 2022 to February 2023. Our study participants were 100 adults more than 18 years of age diagnosed with T2DM, based on the American Diabetes Association (ADA) criteria. All patients were evaluated thoroughly for the presence of microvascular complications in the form of retinopathy. Based on this, they were divided into two groups—group 1 (T2DM with retinopathy) and group 2 (T2DM without retinopathy). Both groups were further subdivided into three subgroups based on haemoglobin A1c (HbA1c): the first group with HbA1c <7%, the second group with HbA1c 7–8.9% and the third group with HbA1c >=9%. For all the study participants, a detailed NFC was done for all 8 fingernails (excluding the thumb), using a handheld dermatoscope. Abnormal capillary shapes (ACS) were recorded by semi-quantitative score (NFC score).

Results:

A significant association was seen in capillary density (loops/mm) (5.83 ± 0.72 in the DR group and 6.3 ± 0.89 in the no-DR group) (P value = 0.005), capillary density (loops/3 mm) (P value = 0.005), total number of microhaemorrhages/3 mm (P value < .0001), total number of giant capillaries/3 mm (P value = 0.0004), total number of avascular areas/3 mm (P value = 0.0005), enlarged capillaries/3 mm (P value = 0.002), tortuous capillaries/3 mm (P value < .0001), abrogated/bushy capillaries/3 mm (P value = 0.004), number of fingers involved excluding the thumb (P value < .0001) and total nailfold capillaroscopic score (P value < .0001) between the two groups, one with DR and another without DR. Furthermore, the proportion of patients with abnormal nailfold capillaroscopic findings, abnormal NFC score, was significantly higher in patients with DR as compared to patients without DR (51.85% vs 4.35%, respectively) (P value < 0.0001).

Conclusion:

Our results suggest that NFC could possibly be used as an adjunctive tool in diabetics for diagnosing or monitoring microvascular complications with total NFC score being the significant predictor of DR at a cut-off point of >0 with the area under the curve (AUC) of 0.745 for correctly predicting DR.
Frontal Executive Function Assessment in Patients with Parkinson Disease Using Frontal Assessment Battery (FAB) at a Tertiary Care Center in Western India
Authors: Saini Pankaj Kumar , Gupta Gaurav Kumar
Published: August 2024

Background:

Cognitive impairment in Parkinson disease (PD) primarily consists of executive dysfunction. Frontal Assessment Battery (FAB), composed of six subsets to explore different functions related to the frontal lobe is a validated and easily performed tool for executive function assessment.

Aims and Objectives:

We performed this study to evaluate the clinical utility of the FAB for the assessment of executive dysfunction in PD and to study the correlation of FAB with other tests of executive functions such as fluency tests (lexical and semantic) and trail making tests (TMT A and B) in a group of Indian patients with PD.

Material and Methods:

We included 60 patients diagnosed with PD per the UK PD Brain Bank criteria. Our study included 40 healthy age, sex, and education-matched controls. We recorded clinical characteristics of patients [age, sex, disease duration, Hoehn and Yahr stage, and Unified Parkinson disease Rating Scale (UPDRS) scores] and Mini-Mental State Examination (MMSE) and FAB scores of both patients and controls in a prescribed pro forma.

Results:

In the study group, mean age was 52.53 ± 10.42 years, mean disease duration was 5.77 ± 3.27 years, mean MMSE was 28.4 ± 1.53, and mean FAB was 11.53 ± 2.30, and they had significantly decreased mean FAB scores as compared to controls. FAB scores also correlated significantly with age, disease duration, Hoehn and Yahr stage, UPDRS score, MMSE, fluency tests, and TMT.

Conclusion:

FAB is an easily performed bedside screening test for executive function assessment in PD, and it can be used to detect early and subtle cognitive impairments in PD.
Effect of Lockdown in the COVID-19 Pandemic on Dietary Habits and Self-Medication Practice in People Living in Jordan
Authors: Angor Malak M. , Nawasreh Areen O.
Published: August 2024

Background:

The pandemic of the coronavirus disease 2019 (COVID-19) has impacted Jordanian society, particularly on health.

Aims:

This study examined the effect of the COVID-19 pandemic lockdown on Jordanian society’s dietary habits and self-medication practices.

Methods:

We surveyed 1252 Jordanians of both genders between the ages of 18 and 65 years by questionnaire. Three questions were asked to evaluate the frequency of foods/drinks consumption, general eating habits, and self-medication practice of individuals of both genders during the lockdown.

Results:

Dietary habits and food quality affected weight (increase or decrease) by 69.5% during the lockdown. The highest percentages of “very high” consumption per week for fruits, processed juices, and fried foods were 37.6 %, 36.7%, and 29.4%, respectively. The highest percentage of “very little” consumption per week for drinking water, milk, and soft drinks were 12.5%, 8.5%, and 7.4%, respectively. The percentage of respondents who had taken medicine without a doctor’s prescription was 84.7%. The highest percentage (74%) was in using self-medication as a preventive measure against the coronavirus, followed by treating a cold/flu (61.4%), in both genders and age groups. The largest percentage (78.5%) was for using paracetamol, followed by ibuprofen and azithromycin (78.1% and 77.1%), respectively.

Conclusion:

Dietary habits and the quality of the foods consumed during lockdown affected participants’ weight (increase or decrease) by 69.5%. The percentage of participants who self-medicated was 84.7%.
Hypertension Severity and Inflammatory Burden as Evaluated by Neutrophil–Lymphocyte Ratio
Authors: Fahad Esraa H. , Al-Niemi Marwa S. , Hussain Nawar R. , Al-Kuraishy Hayder M. , Al-Gareeb Ali I.
Published: August 2024

Background:

Different studies implicated inflammation as associative or causative factor in the development of hypertension (HT). It has been reported that low-grade inflammation enhances development of HT, as high blood pressure is linked with high neutrophils, lymphocytes, C-reactive protein, and interleukin 6. Neutrophil–lymphocyte ratio (NLR) may reflect underlying chronic low-grade inflammation in different inflammatory disorders and cardiovascular diseases including HT. Telmisartan (TLS), which is an angiotensin II receptor type 1 blocker that used in the management of HT, may reduce the associated inflammatory disorders. Thus, the aim of the present study was to assess the level of NLR in relation to the HT severity in patients treated with TLS.

Methods:

Forty-four patients with severe HT compared with matched 20 patients with mild HT as controls were recruited. Anthropometric and biochemical variables as well as NLR were measured.

Results:

Blood pressure and lipid profile were higher in patients with severe HT on antihypertensive therapy other than TLS. TLS treatments had improved blood pressure; lipid profile and low NLR compared to patients with severe HT not were on TLS treatment.

Conclusion:

TLS reduces HT severity through reduction of NLR; therefore, it regarded the optimum angiotensin receptor blocker (ARB) drug in the management of HT. Thus, preclinical and prospective studies are warranted in this regards.
Prevalence and risk factors of Helicobacter pylori infection in military personnel
Authors: Wang Chunmei , Liu Jun , An Yang , Zhang Dan , Ma Rui , Guo Xiaozhong , Qi Xingshun
Published: August 2024

Background and Aims:

Helicobacter pylori infection is prevalent and recognized as a major cause of gastrointestinal diseases in the world. Previous studies on the prevalence of H. pylori infection in military personnel have shown some conflicting results. This study aimed to estimate the pooled prevalence of H. pylori infection and evaluate its risk factors in military personnel.

Methods:

The PubMed, EMBASE, and Cochrane Library databases were searched. We pooled the prevalence of H. pylori infection in military personnel using a random-effect model. Metaregression analysis was used to explore the sources of heterogeneity. Pooled proportion of H. pylori infection with 95% confidence interval (CI) was calculated.

Results:

Sixteen studies were included. Meta-analysis showed that the overall prevalence of H. pylori infection was 32% (95% CI = 31–33) in military personnel. There was a significant heterogeneity. Metaregression analysis showed that study region (P = 0.0004) and publication year (P = 0.023) were the potential sources of heterogeneity. In the subgroup analysis by study region, the highest prevalence was found in Asia (50.2%; 95% CI = 49–51.4). In the subgroup analysis by diagnostic methods for H. pylori, the highest prevalence was found when urea breath test was employed (47.9%; 95% CI = 46.5–49.3). The most common risk factor for H. pylori infection was familial aggregation, followed by living environment and age.

Conclusion:

H. pylori infection is common in military personnel. In future, we may require appropriate population screening for H. pylori infection by multiple diagnostic tests and increase the knowledge and awareness of the bacterial transmission among military personnel.
Phosphaturic mesenchymal tumor
Authors: Patra Sanjiban , Trivedi Priti , Jhaveri Chirag
Published: August 2024

Tumor-induced osteomalacia is a paraneoplastic syndrome resulting in renal phosphate wasting and decreased bone mineralization. Phosphaturic mesenchymal tumors represent a rare etiology of tumor-induced osteomalacia. They are exceptionally rare, probably accounting for < 0.01% of all soft tissue tumors. Most PMTs present as small inapparent lesions that require very careful clinical examination and radionucleotide scan for localization. Here we describe a case in a 65 years old woman with recurrent multiple bone fractures and subsequent detection of a tumor involving right femur and adjacent soft tissue, low phosphate level and elevated serum Fibroblast growth factor-23 (FGF-23).
The occult rheumatic scourge
Authors: Daga Pawan , Vaideeswar Pradeep , Goyal Ashutosh , Marathe Supreet P. , Bhargav Rishi
Published: August 2024

Aims:

To study the clinical and pathological manifestations of missed cases of rheumatic heart disease (RHD) and postulate possible reasons behind a missed diagnosis.

Materials and Methods:

Retrospective 20-year (2000–2019) autopsy data of chronic RHD were reviewed and patients, in whom the valvular deformities had been incidental autopsy findings, were selected. The clinical details of these patients were correlated with the morphology of the affected valves. On this pathological analysis, the patients were assigned to a category of subtle or significant valvular deformity. By clinically correlating, the latter group was subdivided into clinically misdiagnosed, clinically undiagnosed, and sudden cardiac death.

Statistical Analysis:

Nil.

Results:

Among the 475 cases of chronic RHD identified at autopsy in the study period, the disease was diagnosed incidentally in 69 patients (14.5%). Significant valvular deformity was noted in 61 cases while the other 8 cases had subtle valvular deformity. The most common cause of death was cardiac failure in 39 out of 69 patients (56%). Eleven (16%) patients had experienced sudden cardiac death. Among the undiagnosed cases, 5 (7%) of them had a diagnosis of non-rheumatic cardiac disease, while the other 14 (20.5%) patients had overwhelming non-cardiac diseases.

Conclusions:

Our study indicates that mortality and morbidity due to RHD are underdetermined. The patients remain undiagnosed due to either insignificant valvular involvement, clinically silent in the presence of significant valvular deformity, presence of other overwhelming diseases or misdiagnosis partly due to the resemblance with the other pathologies.
Acquired reactive perforating collagenosis, a rare entity at uncommon site
Authors: Ambalathinkal Jincy J. , Phiske Meghana M. , Someshwar Shylaja J.
Published: August 2024

Acquired reactive perforating collagenosis (ARPC), rare disorder characterized by transepidermal elimination (TEE) of collagen fibers, is seen in adult diabetics. Genetic predisposition, familial aggregation, trauma, bites and scratching are implicated. Diabetics develop microvascular diseases leading to intense pruritus causing repeated micro trauma leading to necrosis of connective tissue of dermis, causing TEE. Isolated papules, plaques and nodules with central keratotic plugs, are mostly seen on extensor surfaces of limbs but trunk and face may be involved. Histopathology shows extrusion of abnormal collagen fibers through epidermis. Multiple treatment modalities show variable response. A 52 year old diabetic female had multiple, itchy, well defined, erythematous papules and plaques with central adherent crusting on lower back since 1 month. Histopathology showed cup shaped epidermal depression filled with plug of altered collagen, acanthotic epidermis with hyperkeratosis and parakeratosis. Underlying epidermis was thin with fine slits through which vertically oriented basophilic collagen fibers were extruded.
Cystic hypersecretory carcinoma with invasion
Authors: Yami Hibu , Thambi Renu , Priya PV , Sundaram Sankar
Published: August 2024

Background:

Cystic Hypersecretory Carcinoma (CHC) is a rare subset of breast carcinoma. It is part of a spectrum of cystic hypersecretory lesions which includes cystic hypersecretory hyperplasia (CHH), CHH with atypia, CHC in situand CHC with invasion. Approximately 65 cases of cystic hypersecretory lesions have been reported; most of them were CHC in situand only 19 cases of CHC with invasion have been reported so far.

Case Presentation:

We are reporting 2 cases of 47 and 62 year old women with a palpable breast mass for 6 and 1 month duration respectively. Trucut biopsy was carried out for both which showed high grade ductal carcinoma in situwith microinvasion in the first patient and the latter showed a tiny focus of invasive carcinoma. Simple mastectomy and modified radical mastectomy (MRM) were done for the respective cases; both showed dilated cystic spaces filled with eosinophilic secretions (thyroid colloid-like), lining neoplastic cells that showed variable degrees of proliferation, atypia and in situcarcinoma. There were foci of invasion in both cases and hence a morphological diagnosis of CHC with invasion was made.

Conclusion:

Owing to a smaller number of reported cases, little is known about the biological behavior, prognosis and molecular profile of cystic hypersecretory carcinoma.
Predicting the Mental Health of Undergraduate University Students in Northeast India with Academic Psychological Capital: A Cross-sectional and Descriptive Study
Authors: Paul Fayaz Ahmad , Banerjee Indrajeet , Ali Arif , Ahmed Nurnahar
Published: August 2024

Background:

Undergraduate students are increasingly experiencing and being affected by mental health problems such as depression, anxiety, suicidal thoughts, stress, substance abuse, and self-injury. Transitioning from a high school to a university student is challenging, stressful, and demanding.

Objectives:

The present study aims to predict the mental health among undergraduate students in Northeast India with academic psychological capital.

Materials and Methods:

A cross-sectional and descriptive research study was conducted among undergraduate university students. One hundred and twenty students aged between 18 and 25 were recruited for the study through a multi-stage stratified random sampling technique with proportional allocation. The respondents were administered the sociodemographic datasheet, Academic Psychological Capital Questionnaire, and Mental Health Continuum Long Form. Data analysis was done with the help of the Statistical Package of the Social Sciences version 25. Ethical clearance was obtained from the Institutional Ethical Committee.

Results:

The present study’s findings indicate statistically significant correlations between all of the psychological capital (PsyCap) characteristics and variables related to mental health. Overall-life PsyCap (r = 0.729, P < 0.01), school-work PsyCap (r = 0.610, P < 0.01), and total PsyCap score (r = 0.695, P < 0.01) have a significant positive correlation with total mental health scores. The best model for predicting the mental health score overall-life optimism, overall-life efficacy, and overall-life hope was a linear combination of three of the eight PsyCap variables with R
2 = 0.486, F(3,227) = 51.38, P < 0.001.

Conclusion:

The study shows that PsyCap is associated with the mental health functioning of university students. The findings have important ramifications for the formulation and content of programs designed to support undergraduate students’ mental health and emphasize the value of further study into positive psychological traits as the cornerstones of university students’ positive mental health.
The effect of increasing the prescribed dose in stereotactic body radiotherapy for primary lung cancer without lymph node metastasis
Authors: Morishima Kosuke , Yamashita Hideomi , Miki Yosuke , Sawayanagi Subaru , Takenaka Ryosuke , Katano Atsuto
Published: August 2024

Background:

This study aimed to identify the efficacy of increasing the dose of stereotactic body radiotherapy (SBRT) for lung cancer.

Method and Materials:

Patients who received SBRT for primary lung cancer between 2002 and 2021 were evaluated retrospectively. The patients were categorized into the 48, 50, and 55 Gy groups according to the prescribed dose. Analyses were performed for all matched patients.

Result:

A total of 323 patients underwent SBRT for lung lesions at doses of 48, 50, and 55 Gy in four fractions. The median follow-up period in the 55 Gy group (32.3 months; Interquartile range (IQR), 15.1–54.1 months, P = 0.01) was significantly shorter than in the 48 Gy (47.0 months; IQR, 16,2–107.7 months) and 50 Gy (78.9 months; IQR 47.2–104.2 months) groups. The 3-year local progression-free survival (LPFS) was 90% in the 55 Gy group (95% confidence interval (CI), 62.4%–94.0%), 75.7% in the 48 Gy group (62.1%–85.0%), and 79.1% in the 50 Gy group (62.2%–89.1%). LPFS in the 55 Gy group was significantly higher than that in the 48 Gy group (hazard ratio (HR), 0.40; 95% CI, 0.20–0.79; P = 0.025). There is no significant difference in the local control rate between the 55 Gy group and the 50 Gy group (HR 0.60, CI 0.27–1.39). After propensity score matching, the 3-year LPFS in the 55 Gy group was 88.3% (CI, 71.2–95.5%). LPFS in the 55 Gy group did not significantly differ from that of the 48 Gy group (HR, 0.47; CI, 0.17–1.35) and the 50 Gy group (HR, 0.83; CI, 0.28–2.51).

Conclusion:

We conducted the analysis using propensity score matching. It was not apparent whether there was a significant difference in the effect of increasing the dose, owing to a lack of power caused by the small number of cases after propensity score matching. A prospective study is in progress, and the results are awaited.
Increased Expression of Genes Involved in Biofilm Formation in a Multidrug-Resistant Environmental Pseudomonas Aeruginosa Isolate
Authors: Alva Prathiksha Prabhakara , Sundar Shraddha , D'Souza Caroline , Premanath Ramya
Published: August 2024

Introduction:

Pseudomonas aeruginosa is an important opportunistic pathogen associated with majority of the hospital-acquired infections in immunocompromised patients, worldwide. Biofilms formed by this bacterium increase its resistance toward antibiotics, which in turn increase morbidity and mortality. As environmental isolates of P. aeruginosa are also capable of producing virulence-associated traits, they can be considered as potential pathogens.

Materials and Methods:

This study was undertaken to compare the expression of some of the biofilm genes such as algD, pslA, pslB, pelA, and pelD in environmental and clinical isolates of P. aeruginosa isolated from Coastal Karnataka. The expression of biofilm-forming genes in strong biofilm-forming P. aeruginosa isolated from sputum (HS26), wound swab (HW20), and environment (EN4) were quantified at different time points of incubation (18, 25, 48, and 72 h). In addition, the sensitivity of the selected isolates to commonly used antibiotics (amikacin, aztreonam, carbenicillin, ciprofloxacin, cefotaxime, imipenem, and gentamicin) was investigated.

Results:

The current investigation revealed the presence of a multidrug-resistant environmental isolate with higher expression of the biofilm genes as compared to the clinical ones. In the environmental isolate, the relative expression of pslA, pslB, pelD, and pelA gene was increased by 11, 10, 10, and 9 folds, respectively, at 48 h.

Conclusion:

The study suggests the possibility of such multidrug-resistant biofilm-forming environmental isolates of P. aeruginosa getting transferred to the hospital setting and causing life-threatening biofilm-associated infections.
Effectiveness of health education package on hand hygiene knowledge, attitude, and practices among food handlers in a tertiary care hospital in Delhi
Authors: Chauhan Saurabh , Parashar Mamta , Khandekar Jyoti , Singh Mitasha
Published: August 2024

BACKGROUND:

Food handlers can serve as a medium for potential foodborne infections through contaminated hands, posing a public health hazard. Poor handwashing practices among them can be a source of foodborne illnesses through cross-contamination. Health education intervention using multiple channels is one of the most effective tools for improving hand hygiene behavior.

OBJECTIVE:

This study aimed to determine the change in hand hygiene knowledge, attitude, and practices (KAP) among study participants following the implementation of a health education intervention package.

MATERIALS AND METHODS:

A before-and-after intervention study on 111 food handlers of food establishments in a tertiary care hospital in Delhi was conducted in 2021–2022. A tool was prepared with a scoring system to rate the hand hygiene KAP of food handlers. Health education was given to all, and scores on the same tool were reassessed after 8 weeks using an interview schedule and observational checklist based on the World Health Organization (WHO)’s five keys and Food Safety and Standards Authority of India (FSSAI) guidelines. The intervention package included a health talk, audiovisual aids, and a demonstration of handwashing steps.

RESULTS:

The mean scores of hand hygiene KAP improved significantly after the intervention with a difference of 5.24 ± 0.95 (P = 0.02), 3.14 ± 0.42 (P = 0.03), and 4.18 ± 1.97 (P = 0.03) out of total scores of 7, 5, and 15, respectively, with maximum improvement seen in practices of a duration of handwashing >20 seconds improving from 6.3% to 81.1% (P < 0.05) after the intervention and least improvement in use of towel or napkin to turn off tap improving from 2.7% to 4.5% after the intervention, respectively.

CONCLUSIONS:

The study findings conclude that handwashing with soap and water and following the steps of handwashing are one of the most important practices to improve hand hygiene practices. It emphasizes the need to ensure the implementation of the existing guidelines for food establishments strictly in medical institutions. Thus, education on hand hygiene using a combination of channels in medical institutions should be meticulously planned and held at regular intervals to achieve the desired change.
Comparison of Surgical Outcomes of Laparoscopic Ventral Mesh Rectopexy and Stapled Transanal Rectal Resection for Managing Obstructed Defecation Syndrome
Authors: Bhandarkar Sanatan , Kalikar Vishakha , Supe Avinash , Patankar Suneel Roy
Published: August 2024

Background:

Obstructed defecation syndrome has several underlying causes and is a prevalent but poorly understood condition. It is characterized by the inability to pass stool even when one experiences the urge to defecate. Initial therapy for ODS usually involves diet modifications, pelvic floor exercises, and biofeedback, which can considerably reduce symptoms. Surgical intervention may be recommended for individuals who present with certain anatomical anomalies and who do not respond to conservative therapies.

Objectives:

To assess and compare the surgical outcomes of laparoscopic ventral mesh rectopexy (LVMR) and stapled transanal rectal resection (STARR) for ODS management.

Design:

The study conducted a retrospective review of prospectively gathered data on the outcomes of 162 patients treated for ODS at our facility between January 2015 and January 2022 using either LVMR or STARR.

Settings:

The study was conducted at our facility between January 2015 and January 2022, evaluating 162 patients with ODS who underwent either LVMR (118 patients) or STARR (44 patients).

Patient and Methods:

The Modified Longo’s Scores (MLS) were used as the primary evaluation tool, determined preoperatively and postoperatively at 1 month, 6 months, and 12 months.

Sample Size:

A total of 162 patients were included in the study, with 118 patients who underwent LVMR and 44 patients who underwent STARR for the treatment of ODS at our facility between January 2015 and January 2022.

Results:

Preoperative MLS for LVMR patients averaged 23.41, which was similar to that of STARR patients (23.52), showing no statistically significant difference. After 1 month, the mean MLS showed a significant decrease of 93.3% among LVMR patients and that of 18.0% among STARR patients from the preoperative mean MLS, indicating a significantly greater change among LVMR patients than among STARR patients. Similarly, after 6 months, the preoperative mean MLS for LVMR patients and STARR patients revealed a substantial decline of 95.4% and 6.5%, respectively, with LVMR patients experiencing a considerably greater change than STARR patients. After 12 months, the mean MLS showed a significant decrease of 96.6% and 3.6% among LVMR and STARR patients from the preoperative mean MLS, respectively, with change being significantly more among LVMR patients than STARR patients.

Conclusion:

LVMR can be the preferred method because it outperforms STARR in terms of alleviating ODS symptoms.

Limitations:

This research involved a retrospective study using a small sample size and a short follow-up period.

Conflicts of Interest:

None.