bluuebunny/crossref_metadata_2025 huggingface dataset:
Concordance of assessment of insight by different measures in obsessive-compulsive disorder
Authors: Grover Sandeep , Ghosh Abhishek , Kate Natasha , Sarkar Siddharth , Chakrabarti Subho , Avasthi Ajit
Published: October 2021

Aims:

This study aimed to examine the (a) prevalence of various levels of insight among patients with obsessive-compulsive disorder (OCD) and (b) correlation of insight specifier (Diagnostic and Statistical Manual [DSM]-5) and other established measures of insight in OCD.

Methods:

One hundred and twenty-five outpatients with a diagnosis of OCD were assessed by Brown Assessment of Beliefs Scale (BABS) and DSM-IV's insight specifier. The insight specifier of DSM-5 was determined by item one (“conviction”) of BABS. Dimensional Yale-Brown Obsessive-Compulsive Severity Scale was used to assess the frequency and severity of dimensional obsessive-compulsive (OC) symptoms.

Results:

The mean age of the participants was 31.2 (±11) years. Seventy-seven (61.6%) of the participants were men. There was a high correlation (r = 0.73) between the insight specifiers of DSM-5 and DSM-IV. Insight categories of DSM-5 had modest correlations with BABS total score and BABS-based insight categories. Significant associations were observed between the level of insight and comorbid psychotic illness, hoarding and symmetry dimensions of OC symptoms, severity of depressive, and OC symptoms. The first two associations were consistent across group comparisons (insight-groups based on DSM-IV and BABS) and correlation (with total BABS score).

Conclusions:

Majority of the patients with OCD have good insight and application of different tools influence the assessment of insight in OCD. The DSM-5 insight specifier has strong and significant correlation with the DSM-IV's insight classification and categorization of insight by BABS.
Antisuicidal efficacy of ketamine infusion in suicidal patients of depressive disorder
Authors: Pathak Umesh , Ahuja Sunil Kumar , Dwivedi Rajeev , Mishra Nimisha , Kumar Pradeep , Mishra Dheerendra Kumar , Singh Rajesh
Published: October 2021

Background:

The efficacy of ketamine in the rapid alleviation of depressive and suicidal symptoms has been observed over the past few years around the globe. Exploration of rapid antisuicidal efficacy of ketamine in Indian subpopulation can be a good preventive pharmacological option for unprecedented rise in suicides in India.

Aim:

To assess efficacy of ketamine infusions on suicidal patients of depressive disorder. Severity of depression and suicidality were quantified daily over 1 week.

Materials and Methods:

This was a randomized control study, comprised sixty patients of age group 18–60 years, with a diagnosis of depressive episode, having the Modified Scale for Suicidal Ideations (MSSI) score >20 with exclusion of severe medical or surgical illness, pregnancy, and breast-feeding females. Patient were assigned to ketamine and normal saline group. Three infusions were given over 1 week on day 0, day 2, and day 4. Assessments were made at baseline using the 17-item Hamilton Depression Rating Scale (HAM-D17) and MSSI, for depression and suicidality, respectively. Assessments were repeated at 6 h after first infusion and then every day for 1 week.

Results:

There were significant reductions in HAM-D17 score and MSSI score within 6 h of the first dose in the ketamine group as compared to the normal saline group. Significant sustained improvement was seen on further days till 1 week in the ketamine group as compared to the normal saline group.

Conclusion:

Ketamine might be a reasonable choice to fulfil the efficacy gap created by the delayed antisuicidal onset of standard treatments.
Prevalence of anemia and iron deficiency among patients with heart failure admitted in a tertiary care hospital of sub-Himalayan region in North India
Authors: Katna Akhil , Dhiman Himanshu , Sharma Rajesh , Raina Sujeet , Kumar Mukul , Yadav R S
Published: October 2021

Objective:

Anemia and iron deficiency (ID) are common in patients with chronic systolic heart failure (HF). The study was planned to find out the prevalence of anemia and ID in patients of chronic HF among patients admitted in a tertiary care hospital from Himachal Pradesh, India.

Methods:

This was a hospital-based open cohort observational descriptive study conducted on patients diagnosed with chronic HF. The study period was of 1 year. HF was defined on the basis of 2016 ESC Guidelines for diagnosis and treatment of acute and chronic HF. Anemia was diagnosed on the basis of WHO definitions (<13 g/dl in males and <12 g/dl in females). ID was diagnosed as serum ferritin <100 μg/dl (absolute ID) or serum ferritin 100–299 μ/dl and transferring saturation <20% (functional ID).

Results:

A total 61 patients (41 females and 20 males) were included in the study over 1 year. Out of 61 patients, 48 (78.7%) were found to be iron deficient. Thirty-four patients were having absolute ID, whereas 14 were having functional ID. Anemia was found in 29 patients (47.5%). Nineteen patients were having ID without anemia.

Conclusion:

Anemia and ID are common in patients with HF in the sub-Himalayan region in North India. Hemogram and iron profile should be included in the investigation protocol during management of HF in Indian patients.
Comparison of Global Registry of Acute Coronary Events and Thrombolysis in Myocardial Infarction Risk Scores in non-ST-Elevation Acute Coronary Syndrome
Authors: Routray Satyanarayan , Satpathy Chhabi , Mohanty Nirmal Kumar , Dash Bijay Kumar , Satapathy Rajendra Prasad
Published: October 2021

Context:

The Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) scores in predicting coronary disease severity in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) have not been proved.

Aims:

We aimed to compare the GRACE score with TIMI risk score for prediction of the angiographic severity of coronary artery disease (CAD) in patients with NSTE-ACS.

Settings and Design:

This was an observational cross-sectional study.

Subjects and Methods:

Total 202 NSTE-ACS (NSTE myocardial infarction and unstable angina) patients were included. The GRACE and TIMI scores were estimated. Coronary angiogram was done and the Gensini score and vessel score were used to assess the severity of CAD.

Statistical Analysis Used:

SPSS software version 27.0 was used for statistical analysis. For comparison of two means, independent sample t-test/Mann–Whitney U-test was used, while for more than two means, one-way ANOVA/Kruskal–Wallis test was used. The receiver operating characteristic (ROC) curve was applied for the predictability of GRACE and TIMI scores for severity of disease.

Results:

A positive association between the Gensini score and vessel score was observed with both the GRACE (P = 0.001) and TIMI (P = 0.001) scores. The area under the ROC curve for the GRACE score was 0.765 (95% confidence interval [CI] = 0.676–0.854), significantly superior to the area under the ROC curve of the TIMI score (0.715; 95% CI = 0.618–0.812). Risk factors such as higher age, hypertension, smoking history, dyslipidemia, ECG changes such as ST deviation and T inversion, and Killip classification showed a statistically significant association with severity of disease.

Conclusions:

Both the GRACE and TIMI risk scores were a good predictor of angiographic severity of CAD in patients with NSTE-ACS, and the GRACE score was found to be superior to the TIMI risk score.
The association between Nonalcoholic Fatty Liver Disease and Cardiovascular Disease
Authors: Choudhary Narendra Singh , Saraf Neeraj , Kuchay Mohammad Shai , Kasliwal Ravi R
Published: October 2021

Cardiovascular diseases (CVDs) are the leading cause of mortality in India. Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in India. People with NAFLD generally share common metabolic risk factors with CVD; yet, NAFLD is independently associated with CVD. As NAFLD is easily diagnosed due to the availability of ultrasound, the awareness regarding association of NAFLD to CVD may prevent both cardiovascular and liver-related morbidity/mortality. We discuss association of NAFLD and CVD and preventive potential in the Indian population.
The Prevalence, Causes, and Management Strategies for Stress Among Health-Care Professionals of Delhi-National Capital Region
Authors: Mehrotra Rahul , Gupta Mayank , Bhagwati Mohit , Jain Dinesh
Published: October 2021

Background:

Stress at workplace has an adverse impact not only on the employees in terms of health, well being, and job dissatisfaction, but also affects the organization in terms of quality of output, absenteeism, and attrition which ultimately has detrimental financial implications. Health care professionals comprise of an important group that are majorly affected by workplace stress because of the nature of their work environment.

Methods:

The current study was undertaken to ascertain the presence of self perceived stress among healthcare workers in multispecialty hospitals of the National Capital Region of Delhi and to find the expected remedial measures that could be implemented to mitigate stress. In a questionnaire based study, a self administered questionnaire was used to assess stress and related factors using convenience-sampling technique. The response data were extracted and analyzed using Microsoft Excel, which was used for data analysis, tabulation, and graphical presentation.

Results:

Total 110 responses were received. Three quarter of the respondents identified significant stress in their life, with the highest stress reported by nursing staff at 98%, doctors at 67%, and administrative staff at 56%. The study shows a significant association of self reported stress with age of the respondents (P < 0.001). Respondents among age group of 15–25 years reported the highest prevalence of stress (P < 0.001). Women reported a higher level of stress than men, (P < 0.001), and nurses reported the highest level of stress followed by doctors and then administrative staff. Different methods to relieve stress were also discussed and it was found that two thirds (67%) of our study respondents would like to meditate at work.

Conclusion:

Stress is common among all categories of healthcare workers. Meditation can be a safe, effective, and feasible modality which can be offered at the workplace to safeguard the mental health of the health care workers and reduce their levels of stress.
Clopidogrel Resistance in Cardiovascular Disease Patients and its Association with Gene Polymorphisms
Authors: Parameshwara S , Manjula B , Bhaktha Geetha , Kallaganad Gurupadappa , Ranjith Kumar G K
Published: October 2021

Aims:

To determine the genotypic and allelic frequencies of multidrug resistance protein 1 (MDR1), CYP2C19, and P2Y12 gene and their polymorphisms in the Shimoga population who admitted for treatment in McGann teaching district hospital-Shimoga Institute of Medical Sciences (SIMS), Shimoga.

Materials and Methods:

It is a cross-sectional study that was conducted in McGann teaching district hospital, SIMS, Shimoga. Patients who were admitted to the Intensive coronary care unit due to cardiovascular disease (CVD) were recruited for the study. Sociodemographic data with venous blood samples (5 ml) were collected along with informed consent. Genotyping of the MDR1, CYP2C19, and P2Y12 polymorphisms were done using the polymerase chain reaction (PCR) restriction fragment length polymorphism method. Descriptive and inferential statistics were done using the Statistical Package for the Social Sciences software. The genotypic and allelic frequency was calculated using the Hardy-Weinberg equilibrium.

Results:

Out of 40 CVD cases, 60% were male and 40% were female and the mean age was found to be 57.13 ± 11.57 years. The percentage of the obese group was more compared to other groups of body mass index. Risk factors such as diabetes, hypertension, food custom, smoking, and tobacco consumption were not significant while alcohol consumption was seen to be significant among the study population at a 5% level of significance. The genotypic frequencies for a heterozygous and mutant type of MDR1 (C3435T) and CYP2C19*2 (G681A) were found to be 35%, 2.5%, 57.5%, and 5%, respectively. Whereas the gene polymorphism of CYP2C19*3 and P2Y12 was not observed in the present study population.

Conclusions:

This is the first gene polymorphism study with respect to clopidogrel resistance in the Shimoga population. We have demonstrated the presence of polymorphism in the MDR1 and CYP2C19 genes in this study population. A further elaborate study should be conducted for a better understanding of genetic with nongenetic factors involved in poor response toward clopidogrel drug using a large population.
Left-Sided Anomalous Origin of the Coronary Artery from the Opposite Sinus
Authors: Sarojadevi Ashida Thulaseedharan , Thenmozhi Senthilvelan , Kuppuswamy Badrinath Aritakulu , Somasundharam Suresh Babu
Published: October 2021

Anomalous origin of the coronary artery from the opposite sinus (ACAOS) is a significant subclass of coronary artery anomalies. Ischemic symptoms can develop at any age and judicious use of imaging modalities is needed to guide treatment. We present a short review of this rare coronary anomaly left-sided ACAOS diagnosed in a 42-year-old gentleman.
Adenoid Cystic Carcinoma of Submandibular Salivary Gland
Authors: Aparna P. Venkatalakshmi , Venkatesh J. , Sankari S. Leena , Narmatha N.
Published: October 2021

Adenoid cystic carcinoma (ACC) is a relatively rare epithelial malignant tumor of the major and minor salivary glands with deceptive benign histologic appearance characterized by indolent, locally invasive growth with a high propensity for local recurrence and distant metastasis. Typical ACC has a cribriform pattern, presenting a very aggressive course among the histologic variants. According to the Armed Forces Institute of Pathology (AFIP), ACC was considered the fifth most common malignant epithelial tumor of the salivary gland. ACC is more common in the minor salivary gland, the palate being the most common site, submandibular salivary gland and least followed by sublingual and parotid glands. ACC accounts for about 1% of all malignant tumors of the oral and maxillofacial regions. Thus, considering its rarity, we would like to discuss a case report of ACC of the submandibular salivary gland in a 52-year-old female patient with a typical histological pattern, which would epitomize all cases of ACC along with extensive management.
Efficacy of Transcutaneous Electric Nerve Stimulation over Systemic Pharmacotherapy in the Management of Temporomandibular Joint Disorders – A Systematic Review and Meta-Analysis
Authors: Gopi Indra , Maragathavalli Gopal , Uma Maheshwari T. N.
Published: October 2021

Temporomandibular disorders (TMDs) encompass numerous clinical complications that involve the temporomandibular joint (TMJ), masticatory musculature, and its associated structures, or both. Abundant research in this field has been conducted; however, there is no conclusive evidence reported in the effective management of TMD using physical therapy such as Transcutaneous Electric Nerve Stimulation (TENS). The systematic review and meta-analysis aimed to compare and evaluate the efficacy of transcutaneous electric nerve stimulation over systemic pharmacotherapies in the management of symptomatic patients with temporomandibular joint disorders. The present review has been registered with PROSPERO – An international prospective register of systematic review (CRD42021233019). An electronic search was done in PubMed, Cochrane Library, Science Direct, Google Scholar, Latin American and Caribbean Health Sciences Literature (LILACS), ClinicalTrial.gov, and sci-hub.se. Manual electronic searches were also carried out and articles were handpicked. The assessments of articles were done using selection criteria. There are a vast number of studies done in this subject of interest and hence, only prospective clinical trials like Randomized clinical trials (RCTs) and controlled clinical trials (CCTs) were included in this review. A total of three studies were included in this review, which consisted of prospective RCTs and CCTs. Two studies have been reported for meta-analysis. The included studies show TENS is proven to be effective in the management of TMD. The currently available evidence was insufficient to conclude the effectiveness of transcutaneous electric nerve stimulation and systemic pharmacotherapies in temporomandibular joint disorders. Based on the results of the meta-analysis, we can conclude that there was a significant reduction in pain encountered due to TENS.
Aggressive Fibromatosis
Authors: Khare Saumya , Ramachandra Reddy G.V. , Pillai Ajay K. , Khare Pooja
Published: October 2021

Fibromatosis develops in the soft tissue and is the proliferation of well-differentiated fibroblasts and myofibroblasts. It is present most commonly in the abdominal region. Aggressive fibromatosis (AF) of the oral or para oral structures has been reported occasionally but, it is quite uncommon in the maxilla. We report a case of AF in a 68-year- old male in the maxilla, who came with a chief complaint of swelling in his upper left back tooth region which extended to the retromolar region and was clinico-histopathologically diagnosed as AF. All proliferative indurated growths are not always clear-cut malignancies.
A Comparative Evaluation of Effectiveness of InGaAsP Laser and Therapeutic Ultrasound Administration Before the Induction of Muscle Fatigue on Healthy Young Individuals
Authors: Saini Roopam , Ahuja Upasana Sethi , Puri Nidhi , Ram Chinthalapalli Siva , Dhillon Manu , Rathore Akshay
Published: October 2021

Background:

Muscle fatigue or the inability to maintain muscle strength is a protective mechanism to prevent muscle injury. Phototherapy or low-level laser therapy (LLLT) and therapeutic ultrasound are non-invasive and non-pharmacological forms of treatment modalities that have demonstrated effective and affirmative results when used to prevent muscle fatigue. Aim: The study evaluated the effect of phototherapy and therapeutic ultrasound in reducing muscle fatigue when administered before the induction of fatigue.

Methodology:

The study design was a blind, randomized, and sham-controlled clinical trial on laser and therapeutic ultrasound. The study sample consisted of 100 healthy young participants randomly allocated to four different groups of lasers, sham laser, therapeutic ultrasound, and sham ultrasound. All the individuals were subjected to clinical examination to record the bite force by the bite force dynamometer, maximum interincisal distance (MID) by using digital vernier calipers, and muscle fatigue by using EMG Retrainer's Device. The laser and therapeutic ultrasound were given on the masseter and anterior temporalis muscle on both sides and both sham groups were submitted to the same procedure but with the devices in the switch-off mode. All the individuals were instructed to chew two pieces of gum (one on each side) for 6 min to induce muscle fatigue and MID, the bite force and muscle fatigue were re-evaluated.

Results:

Statistically significant improvement was observed between the pre-and post-bite force, MID, and muscle fatigue in both the laser and Therapeutic ultrasound group as compared to the sham control groups with the P-value equal to 0.000. No, statistically significant difference was observed in the improvement of the muscle fatigue when both the treatment groups, i.e., laser and therapeutic ultrasound were compared with a P value >0.05.

Conclusion:

Muscle fatigue can be effectively reduced if any one of the physical modalities, either laser or therapeutic ultrasound is administered before the long-duration treatments; enabling administration of treatment comfortably and effectively in one appointment.
To Compare the Effect of Conventional Radiotherapy versus Concurrent Chemoradiotherapy on the Thyroid Gland after External Beam Radiotherapy in Head-And-Neck Carcinoma
Authors: Gupta Surabhi , Upadhyay Shashi Bhoosan , Yadav Sarvesh , Singh Hari , Tyagi Anuj Kumar
Published: October 2021

Introduction:

Radiotherapy-induced hypothyroidism has remained underestimated and under reported ailment, because of noninclusion of routine assessment of thyroid function test in baseline workup and during follow-up protocol, which results in failure to detect and treat a reversible cause of morbidity in significant proportion of surviving patients. Greater magnitude and duration of thyroid-stimulating hormone elevation increase the probability of progression to clinical hypothyroidism and therefore increase the potential benefit of treatment of subclinical hypothyroidism. Hence, recognizing subclinical hypothyroidism at an early stage can prevent clinical hypothyroidism and its associated morbidities.

Aims and Objectives:

The aim of the present prospective study was to evaluate the functional and anatomical changes in thyroid glands in patients with head-and-neck cancer treated with conventional radiotherapy (external beam radiotherapy) and concurrent chemoradiotherapy and to assess the necessity of inclusion of routine thyroid function test in the workup and follow-up protocol of these patients.

Materials and Methods:

A total of 98 patients were randomly allocated in two arms. In arm I, 50 patients received concurrent chemoradiotherapy and in arm II, 48 patients underwent radical conventional radiotherapy alone. Baseline thyroid function test and ultrasonography of neck along with thoroughly clinical evaluation were done for every patient and these investigations were repeated in the middle of radiotherapy treatment (after 17 #), at the end of radiotherapy treatment, 3 months after completion of radiotherapy, and after that, at every 3rd-month follow-up to determine late changes in thyroid function test and echotexture.

Results:

In arm I, total 60% patients developed acute hyperthyroidism while in arm II, 68.75% patients developed acute hyperthyroidism. A total of 18.36% patients were found to have subclinical hypothyroidism. At the 9th month of follow-up, 55 out of 98 patients (56.12%) developed hypothyroidism. Among 55 patients, 37 were having clinical hypothyroidism while 18 patients were having subclinical hypothyroidism (P ≤ 0.0001). Maximum number of patients, i.e. 26/98 (47.27%) developing hypothyroidism were between 51 and 60 years of age group. Addition of surgery and chemotherapy had shown no difference in thyroid dysfunction. Patients with clinical hypothyroidism required medical management while patients with subclinical hypothyroidism were kept on close monitoring.

Conclusion:

Recognizing hypothyroidism (clinical or subclinical) early and treating it timely can prevent associated complications which are often ignored. Hence, thyroid function tests should be done routinely that is before starting of radiotherapy, on completion of radiotherapy, and during follow-up as well.
Elbasvir/Grazoprevir Treatment in a Hemodialysis Patient with Hepatitis C Virus Genotype 2a Infection, not Responded to Sofosbuvir/Daclatasvir Combination Therapy
Authors: Elmelodi Marwa Belgasem , Shaibani Badreddin , Ayad Khairi
Published: October 2021

Since 2017, direct-acting antivirals (DAAs) are the first-line treatment for patients with chronic hepatitis C virus (HCV) infection. In hemodialysis (HD) patients, however, a small percentage of patients failed to respond, and the data for the treatment of DAAs for such patients with HCV are lacking. Herein, we report a 57-year-old Libyan female patient on regular HD therapy for 18 years who did not achieved HCV clearance 12 weeks after the treatment with sofosbuvir/daclatasvir. Later, she was treated with elbasvir/grazoprevir (EBR/GZR) for 12 weeks and achieved a sustained virological response at the end of the treatment (12 weeks) and 12 months after the end of the treatment. No obvious side effects were reported during the treatment. Thus, EBR/GZR was effective and safe in this hemodialyzed patient with HCV genotype 2b infection who was failed to respond to12 week-treatment with sofosbuvir/daclatasvir combination.
Nasal Colonization and Antibiotic Resistance of Staphylococcus Species Isolated from Healthy Veterinary Personnel at Veterinary Medical Care Facilities in Tripoli
Authors: Ahmed Mohamed Omar , Othman Aesha A. , Abbassi Mohamed Salah , Elnageh Hiam R. , Almshawt Nariman F. , Abouzeed Yousef M. , Hiblu Murad A.
Published: October 2021

Background/Aim:

Veterinary medical personnel may carry important antibiotic-resistant organisms playing important role in their dissemination and emergence. The purpose of the study was to investigate nasal colonization and antibiotic resistance of Staphylococcus species isolated from veterinary personnel (VP).

Methods:

A total of 47 VP were sampled, whereby nasal samples were subjected to selective and typical laboratory protocols. Presumptive isolates were further confirmed and fully characterized by the Phoenix automated microbiological system then further tested by polymase chain reactions for mecA and panton-valentine leukocidin (pvl) genes.

Results:

A total of 34 (72%) VP were colonized with various species, mostly coagulase-negative staphylococci. A collection of 34 staphylococci isolates were collected of which 21% and 6% were, respectively, positive for mecA and pvl genes expressed exclusively by Staphylococcus aureus and S. epidermidis.

Conclusion:

VP may carry various staphylococci species of public health importance expressing multidrug resistant and virulent traits. Preventative measures and continuous monitoring are required to control the spread of methicillin-resistant staphylococci in veterinary clinics.
A classic case of ischemic central retinal vein occlusion with macular edema
Authors: Mantha Mani Kruthika , Suvvari Tarun Kumar , Kotipalli Lakshmoji Naidu , Kota Tejaswi
Published: October 2021

Central retinal vein occlusion (CRVO) is a significant cause of marked or total loss of vision in the middle-aged and elderly population. The patient was a 54-year-old man with a history of uncontrolled diabetes and was given seven intravitreal bevacizumab (Avastin) injections as treatment. The patient was advised to follow-up during the next 6 months, including gonioscopy and undilated examination of the iris to look for the iris/disc neovascularization. We presented a classic case of unilateral ischemic CRVO with macular edema, in whom diabetes is the leading risk factor. Close follow-up and diabetes control are advisable to prevent a similar scenario.
Altered leukogram and hematological parameters among leukemia patients
Authors: Yashim Andrew Nuhu , Obazee Dorcas Yetunde , Ajani Olumide Faith , Adewole Opeyemi Matthew , Swem Collins , Abiodun Paul Olaiya , Sanni Olaniyi Felix
Published: October 2021

Background:

The incidence of leukemia is increasing in developing countries, particularly in Africa. Cancer-associated inflammation is a significant factor in the improvement and survival of people with cancer. This study aimed to evaluate changes in leukogram and other hematological parameters among leukemia patients in Abuja, Nigeria.

Materials and Methods:

The study comprised 30 leukemia patients attending the Oncology Department of National Hospital Abuja, Nigeria, from July 2019 to August 2020, and 20 healthy people. Three milliliters of blood was collected from each participant into an ethylene diamine tetra-acetic acid bottle and analyzed for full blood and differential counts using the Mythic 22 (Orphee, Switzerland) five-part differential hematology analyzer. CD4 and CD8 T cells were analyzed by flow cytometry. Data analysis was done using IBM-SPSS software, SPSS Inc., Chicago, IL, version 25.0. T-test was used to compare means between groups, and the significant value was set as P < 0.05.

Results:

All hematological parameters were significantly lower (P < 0.05) in leukemia patients than those in controls except for monocytes and basophils. In addition, white blood cell count was significantly higher in leukemia patients (13.0 ± 0.57 × 109/L) than that in controls (6.11 ± 1.14 × 109/L) (P < 0.05). CD4 (775.40 ± 82.91 cells/µL) and CD8 counts (634.40 ± 101.43 cells/µL) were significantly higher in controls than those in leukemia patients. Furthermore, CD4/CD8 ratio was significantly higher (P < 0.05) among controls (1.24 ± 0.15) than that in leukemia patients (1.17 ± 0.09).

Conclusion:

The study found that changes in hematological parameters and leukogram are significantly associated with leukemia. The use of therapies to boost immune response in patients with leukemia is recommended.
Knowledge and awareness of ethics among phase 1 medical students
Authors: Sidhu Jaspreet K. , Chopra Deepti , Bhandari Bharti , Singh Surjit , Rai Jayant
Published: October 2021

Background:

The increasing incidence of disconnect between doctors and patients in India makes it imperative to teach principles and practice of ethics to medical graduates before they move into substantive clinical practices. The competency-based medical education (CBME) curriculum was recently introduced in India. The CBME curriculum encompasses teaching ethics at the beginning of the undergraduate medical curriculum. The study was planned to assess the knowledge and awareness of ethics among first-year undergraduate medical students at the beginning of the foundation course and after 40h of ethics training during the course.

Materials and Methods:

A standard 35-item questionnaire was administered to the first-year medical students at the beginning of the foundation course and after 40h of ethics training/teaching scattered throughout the foundation course. No personal information was recorded on the questionnaire to ensure the confidentiality and anonymity of participants.

Results:

There was a significant increase in the knowledge regarding some of the items in the questionnaire, such as “patient’s wishes must always be adhered to,” “if the patient refuses to be treated on religious grounds, they should be instructed to find another doctor.” Similarly, there was an improvement in the students’ knowledge of the practice of ethics. The students generally agreed that an awareness of ethics is important and should be an integral part of the MBBS curriculum.

Conclusion:

To prevent ethical erosion, ethics education should be introduced early during the undergraduate years, and continuous reinforcement is vital. We should strive to promote discussions about real occurrences directly involving students.
Novel method of tuboplasty using a thread stent
Authors: Palnitkar Anuradha , Palnitkar Devdatt
Published: October 2021

Background:

Women who have undergone tubectomy for sterilization seek reversal of sterilization for various reasons. The success rate of the traditional method used for recanalization has been compared to our novel method of using a stent.

Objective:

The aim of this article is to evaluate the success rate of a novel method of tuboplasty using a threaded stent.

Materials and Methods:

Twenty-one tuboplasty surgeries for reversal of sterilization done at our center were reviewed. All the patients underwent open abdominal tuboplasty using 4× Loupes for magnification. 6-0 Prolene (Johnson & Johnson) suture was used for tubotubal anastomosis with seromuscular sutures. In 11 patients operated on after the year 2010, a 1-0 Ethilon (Johnson & Johnson) thread was used as a “stent.” Before the year 2010, we used to do the anastomosis similarly but without a stent. Eight such patients operated upon before 2010 without stent were evaluated. Two patients operated upon after 2010, in whom the stent could not be placed satisfactorily, were also included in this group of unstented patients.

Results:

Of the 11 patients who could be stented successfully, 8 (72.7%) conceived a uterine pregnancy. Two patients (18.2%) from the stented group did not conceive. From the group of patients who were not stented or could not be stented (n = 10), only two (20%) conceived.

Conclusion:

Our novel method of tuboplasty using a thread stent can improve the pregnancy rate to 72.7%.
DRESS syndrome
Authors: Gudi Shreya , Biswas Tushar Kanti , Kane Sriraj
Published: October 2021

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare adverse drug reaction. We report a rare case of DRESS syndrome secondary to antitubercular treatment (ATT). A 65-year-old male patient with pulmonary tuberculosis (TB) presented with fever, cough and breathlessness, flushing of the face, and itchy erythematous maculopapular rashes over the abdomen, thorax, upper and lower extremities for 3 days, about 4 weeks after starting fixed-dose combination (FDC) of antitubercular drugs-intensive phase therapy as recommended under the Revised National TB Control Programme (RNTCP). Investigations revealed eosinophilia, severe thrombocytopenia, cholestatic hepatitis, and acute kidney injury (AKI) with metabolic acidosis. FDC was withheld and the patient was managed as DRESS syndrome fulfilling diagnostic criteria. The patient showed gradual improvement with progressive return of laboratory parameters towards normal levels. DRESS syndrome following ATT is very rare with fewer case reports from India. Physicians prescribing ATT need to be aware of this severe hypersensitivity reaction to anti-TB drugs.
Cost of medical management of patients in intensive care unit in a tertiary care teaching hospital, Pune, India
Authors: Mathew Achsah Anna , Karsiya Jainam Narendra , Patel Neel Kiran , Limbachiya Dharmik Anil , Shah Jignesh Navinchandra , Pawar Atmaram P. , Deshpande Prasanna R.
Published: October 2021

Aims and Objectives:

The aim of this study was to assess the cost of illness of the patients admitted to the intensive care unit (ICU).

Materials and Methods:

A prospective observational study was conducted on patients admitted and discharged from ICU above 18 years of any medical illness for 6 months in ICU in a tertiary care teaching hospital, Pune. Data such as demographic details, diagnosis, disease class, cost of drug therapy, and medical care cost were obtained. The cost was analyzed using the bottom-up method and statistical analysis of data was done using Pearson’s correlation coefficient and Mann–Whitney U test.

Results:

Of 400 patients, the average age was 54.27 years with a length of stay of 3.69 days and mortality rate of 12.25%. The average total cost per patient accounted for Rs. 52,840 and the per day cost was Rs. 14,319. Amongst various diagnoses, the cost incurred in alcoholic liver disease (ALD) accounted for Rs. 75,060 of the total cost, whereas the average per day cost observed in myocardial infarction (MI) was Rs. 15,495. The cost of drug therapy per patient was Rs. 5204.33 and total drug therapy accounted for 12.08%. The average number of drugs prescribed per patient was 8.44. Antimicrobial costs were observed as 28% of the total cost. The cost of antimicrobials was Rs. 1473 per patient. Medical care costs, including consultant and investigation charges per patient, were found to be Rs. 632 and Rs. 6861, respectively.

Conclusion:

The study reveals that ICU bed charges, miscellaneous charges, and drug therapy costs have more contribution to the direct medical cost of hospitalization.
The Effect of Training and Provision of Logistic Support on Disease Surveillance and Notification System in Private Health Facilities in Enugu State, Nigeria
Authors: Ibiok Ntat Charles , Aniwada Elias Chikee , Ossai Edmund Ndudi , Nwobi Emmanuel Amechi , Uzochukwu Benjamin S. C.
Published: October 2021

Introduction:

Rapid notification of infectious diseases is essential for prompt public health actions and monitoring disease trends at local, state and national levels. Disease surveillance is the backbone of Health Management Information system (HMIS). The study assessed the effect of training and provision of IDSR forms on disease surveillance and response in selected private hospitals in Enugu state.

Methodology:

The study was a quasi-experimental study that compared the study and control groups “before and after” an intervention (training and provision of IDSR forms). The intervention group received training and supplies if IDSR forms while the control group did not. A multistage sampling technique was used to select 400 participants from one hundred and four private hospitals in eight selected LGAs in Enugu East and Enugu North Senatorial Districts. Baseline data were collected followed by intervention. After six months waiting period post-intervention data were collected. A Questionnaire and observational checklist were used. Pearson and McNemar chi-square tests were employed. The level of statistical significance was set at p < 0.005.

Result:

At baseline, most knowledge and practice variables were poor (< 50%). The mean score of knowledge and practice between the groups at baseline was not significant (knowledge p=0.203 and practice p= 0.138). However, six months post-intervention there were significant increases in proportion for both knowledge and practice for study (McNemarχ2 p < 0.001) but not so control group. There was no statistically significant association of knowledge and practice with socio-demographic characteristics for both groups.

Conclusion:

Training of HCWs and provision of IDSR forms caused significant improvement in both knowledge and practice of disease notification and reporting in the private healthcare sector.
Myomectomy During Laparotomy for Ruptured Tubal Pregnancy in a Low-Resource Setting
Authors: Adeniyi Adebayo Augustine , Adeyemo Olabisi Timothy , Ayankunle Mojisola Olumide , Okunlola Abiodun Idowu
Published: October 2021

The traditional management of ruptured ectopic pregnancy has been limited to the removal of the gestational sac, securing hemostasis, and restoring hemodynamic stability with no room for the performance of other procedures such in myomectomy at the same setting. We present a case of a 37-year-old nulliparous woman who was referred for myomectomy on account of symptomatic uterine fibroids but was found to have coexisting ectopic pregnancy at presentation. She had successful total salpingectomy and myomectomy at the same laparotomy. This case demonstrated that myomectomy can be safely performed during the surgery for ruptured ectopic pregnancy in well-selected patients.
Antepartum Depression among Women Attending Antenatal Clinic in a Nigerian Teaching Hospital
Authors: Sulyman Dauda , Aminu Muhammad Baffah , Ayanda Kazeem Ayinda , Dattijo Lamaran Makama
Published: October 2021

Background:

Antepartum depression is a clinical depression occurring at any stage of pregnancy. The cause of antepartum depression might be a combination of hormonal changes and psychological factors. Antepartum depression can affect the course and outcome of pregnancy.

Objectives:

This study aimed to find the prevalence rate of antepartum depression and its determinant among women attending antenatal clinics.

Methodology:

The study was a cross-sectional questionnaire-based survey conducted among pregnant women at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria. With the use of the Edinburgh Postnatal Depression Scale, depression was screened among the respondents with the cutoff point of 13.

Results:

The study comprised 320 pregnant women. The majority (64.4%) of the respondents were below the age of 30 years. The predominant religion was Islam (58.7%). Twenty of the respondents were unmarried (6.2%). Only 2.5% had no formal education. Eighty-five of the respondents reported not having adequate support from their partners. Only 30% of the respondents were in their first pregnancy, and more than 66% were in their third trimesters. The prevalence rate of severe depression was 18.4%. Factors associated with antepartum depression were lack of support, first pregnancy, and third trimesters.

Conclusion:

This study found that a sizeable proportion of pregnant women attending antenatal clinics suffered from depression and highlighted factors associated with this. There is a need for screening for depression among pregnant women.
Analgesic and Opioid Sparing Effects of Preoperative Thoracic Paravertebral Block
Authors: Okoye Nnaemeka Ugonna , Majekodunmi Adetinuwe A. , Ilori Iniabasi U.
Published: October 2021

Background:

Various regional anaesthetic techniques are used for post-mastectomy pain relief; however, thoracic paravertebral block (TPVB) has shown some advantages over other methods. This study sought to demonstrate the post-operative benefit of pre-operative TPVB in patients scheduled for simple mastectomy.

Methods:

The study was carried out on 60 adult female patients with the American Society of Anesthesiologists physical status Class I to III scheduled for unilateral mastectomy. Pre-operatively, a nerve stimulator was used to locate the paravertebral space thereafter bupivacaine with adrenaline or saline was injected into the space. Post-operatively, intravenous morphine patient controlled analgesia was commenced in the two groups for 24 h after the surgery. In addition, intravenous paracetamol 15 mg/kg was administered 6 hourly for 24 h in both groups.

Results:

The 24 h morphine consumption was significantly reduced in the bupivacaine group compared to the control group (P = 0.000). The Numerical pain rating score was significantly lower in the bupivacaine group than in the control group in the 1st 6 h; P = 0.001. The time to first request for analgesia was significantly longer in the bupivacaine group than the control group (P = 0.000). Nausea was the major side effect detected and this was significantly higher in the control group (P = 0.024). The morphine sparing effect was 65.7% in the bupivacaine group.

Conclusion:

The study showed that bupivacaine-based TPVB provided an effective post-operative analgesic and opioid-sparing effect for simple mastectomy when compared with a saline-based control group that received only intravenous morphine patient controlled analgesia and paracetamol.
Role of Histopathology in Diagnosis of Ovarian Neoplasms
Authors: Chakrabarti Preeti Rihal , Chattopadhyay Monideepa , Gon Sonia , Banik Trisha
Published: October 2021

Context:

Ovarian tumours are known to be diverse biologically, varying from non-malignant to malignant tumours having implication on course of the management and prognosis. To address the paucity of such study on ovarian neoplasm from our region of West Bengal, we planned and executed this study. The aim of the study was to analyse the distribution of various ovarian tumours and classify them according to the biological behaviour, age, laterality, and mode of the presentation.

Setting and Design:

It was a retrospective study done in a tertiary care center of Kolkata, India.

Methodology:

A retrospective data of 4 years comprising 84 cases were included in the study from January 2016 to December 2019. All the slides were retrieved from the archives and re-evaluated and cross-checked with patients' clinical history, demographic, and macroscopic findings.

Results:

Out of these 84 tumours, maximum cases were of surface epithelial neoplasms (69%) followed by germ cell tumours (26.1%). Age interval of 19–40 years accounted for the highest number of individuals with equal predominance of both sites of the ovary. Serous cyst adenocarcinoma was the most common malignant tumour.

Conclusion:

Histological examination remains the mainstay in the early diagnosis of ovarian tumours and facilitates timely appropriate management of patients, and hence, reduces overall mortality in women.
Variant Neurovascular Relations of the Sphenoid Sinus in Adult Nigerians
Authors: Ominde Beryl Shitandi , Igbigbi Patrick Sunday
Published: October 2021

Background:

With the advent of endoscopic sinus surgery, the variant neurovascular relations of the sphenoid sinus are important to surgeons to minimise the iatrogenic complications. This study elucidates the variant neurovascular relations of the sphenoid sinus in adult Nigerians.

Materials and Methods:

This study was conducted at the Radiology Department of Delta State University Teaching Hospital after institutional approval. Brain computed tomography images of 336 patients, aged ≥20 years and spanning over 5 years' duration were utilised. We evaluated the sphenoid sinus for protrusion and dehiscence of neurovascular structures bilaterally. The position of the optic nerve in relation to the sinus was classified from Type 0–4. The Statistical Package for the Social Sciences software version 23 was used for the data analysis. The Chi-square test was used to probe for the association between the variants with regard to side and gender. P < 0.05 was considered statistically significant.

Results:

Dehiscence and protrusion of the internal carotid artery (ICA) occurred in 34, 10.1% and 83, 24.7% patients correspondingly. The dehiscence of optic, maxillary and Vidian nerves was (26, 7.7%), (60, 17.9%), and (53, 15.8%), whereas the frequency of their protrusion was (50, 14.9%), (76, 22.6%) and (87, 25.9%), respectively. All these variants except the ICA and maxillary nerve dehiscence showed a significant association with the side of occurrence (P = 0.001). Out of the 672 optic canals evaluated bilaterally, a preponderance of Type I (534, 79.5%) was observed followed by II (96, 14.3%), IV (35,5.2%), III (7, 1.0%) and Type 0 (0, 0%).

Conclusion:

Our study has shown that the neurovascular relations of the sphenoid sinus vary from previously documented reports, thus confirming the need for pre-operative evaluation.
Clinical Characteristics, Treatment Modalities and Outcome of Coronavirus Disease 2019 Patients Treated at Thisday Dome Isolation and Treatment Centre, Federal Capital Territory Abuja, Nigeria
Authors: Okogbenin Sylvanus Akhalufo , Erameh Cyril Oshomah , Egbuta Ola Chikerendu , Iraoyah Kelly Ohis , Onyebujoh Joy Thelma , Erohubie Christian Ehigbor , Jaggu Akolo Yohanna , Onovo Raymond , Avbuluimen Mercy , Odewale Modupeola Ajibike , Enigbe Elizabeth Ebosebhanlen , Ifada Ehinomen Cordilia , Okogbenin Esther Osemudiamen
Published: October 2021

Introduction:

Coronavirus disease 2019 (COVID-19), a highly transmissible viral infection has spread worldwide causing exponential increase in morbidity and mortality. But so far, there is limited information available to describe the presenting characteristics, outcomes and treatment modalities of COVID-19 patients in Nigeria. This study aimed to describe the demographic and clinical characteristics, underlying comorbidities, treatment modalities and outcomes of patients isolated and treated in a repurposed COVID-19 isolation and treatment centre in Abuja, Nigeria.

Materials and Methods:

A retrospective study which reviewed the medical records of 300 confirmed COVID-19 patients isolated and treated according to the World Health Organisation and Nigeria Centre for Disease Control guidelines between 22nd July and 26th October, 2020 in ThisDay Dome Isolation and Treatment Centre. Data collected from the medical records include demographics, clinical features, treatment measures and outcomes.

Results:

Out of 300 patients studied, 61.0% were male. The mean age of the participants was 38.2 ± 14.7. Less than half of the patients (40.3%) had one or more underlying comorbidities with hypertension the most common co-morbidity. Majority (62%) of patients were mildly symptomatic, 33% were asymptomatic while only 2% were severely symptomatic. The most common presenting symptoms include cough 34.0%, fever 30.3%, anosmia 28.7% and dysgeusia 22.7%. Older age (P < 0.001), tertiary education and the presence of underlying comorbidity (P < 0.001) were significantly associated with symptomatic presentation of COVID-19. The median duration of time between positive laboratory testing and presentation for treatment was 5 days (0–29). All patients were treated with a combination of Ivermectin, Azithromycin, Zinc and Vitamin C with no recorded death. The median length of stay at facility was 9 days.

Conclusion:

Close attention should be given to patients with co-morbidities as an inefficient management of such co-morbidities could lead to mortalities which may not be directly attributable to COVID-19.