bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is embracing metaphysical determinism or free will a better response to suffering?
Authors: Antombikums Aku S. 
Published: December 2024

Metaphysical determinism argues that God divinely predetermines everything, including human suffering. Contrary to metaphysical determinism, free will or libertarianism argues that not everything is predetermined by God. Therefore, evil does not serve any divine purpose. Libertarianism argues that metaphysical determinism is simply incoherent because it holds that God can predetermine an action and, at the same time, holds that He could stop such an action. This study seeks to find out which of these two views might be promising in responding to the problem of suffering. Contrary to these two positions, this study argues that suffering must be understood contextually. The above-stated responses do not always provide viable answers to the problem of suffering because they are often generalised and conceived from the God-eye view without considering the sufferers’ perspectives.Contribution: Although there are a plethora of publications on metaphysical determinism and freewill, this study re-examined both and sheds a nuance for a further development of these two competing views. The article argues that none of these two responses offers the best response to the problem; rather, each has its strengths and weaknesses because they seem to focus on God rather than the sufferer.
Access and utilisation of leprosy healthcare services in high-burden districts in Ethiopia
Authors: Marrye Solomon S. , Shakwane Simangele 
Published: December 2024

Background: A lack of awareness, poor quality of care, and gender inequalities are factors associated with access and utilisation of leprosy services.Objectives: This study aimed to identify factors affecting community access and utilisation of leprosy services in high-burden districts of Ethiopia.Method: A community-based cross-sectional study design was utilised and a simple random sampling technique was used to recruit study respondents. One hundred and sixty-one respondents completed the self-administered structured questionnaire. Data were analysed using SPSS version 26. A logistic regression model was used to identify predictors associated with leprosy services. A p-value 0.05 was considered statistically significant.Results: More than 75% (n = 123) of study respondents had limited knowledge about leprosy. However, respondents who reside in urban areas were knowledgeable about the disease (adjusted odds ratio [AOR] = 8.2; 95% confidence interval [CI] = 1.6, 42.0). Men were most likely to use health care facilities (AOR [95% CI] = 2.9 [1.2, 7.2]). In addition, those who had better household income were more likely to have examined their family members for leprosy compared to low-income families (AOR [95% CI] = 4.5 [1.6, 12.9]).Conclusion: General knowledge about leprosy was low in communities. However, persons infected with leprosy who resided in the urban areas had a better understanding of leprosy. Male persons infected with leprosy were more likely to utilise leprosy services.Contribution: The results of this study provide early insights into the factors associated with leprosy service utilisation to provide community-centred leprosy care.
Emergence of dengue in tribal villages of Mandla district, Madhya Pradesh, India
Authors: Barde P.V. , Shukla M.K. , Kori B.K. , Chand G. , Jain L. , Varun B.M. , Dutta D. , Baruah K. , Singh Neeru 
Published: December 2024

Background & objectives:
Dengue (DEN) is a rapidly spreading arboviral disease transmitted by Aedes mosquitoes. Although it is endemic in India, dengue virus (DENV) infection has not been reported from tribal areas of Madhya Pradesh. Investigations were conducted to establish the aetiology of sudden upsurge of cases with febrile illness in June 2013 from tribal villages of Mandla district of Madhya Pradesh, India.

Methods:
The rapid response team of the National Institute for Research in Tribal Health, Jabalpur, conducted clinical investigations and field surveys to collect the samples from suspected cases. Samples were tested using molecular and serological tools. Collected mosquitoes were identified and tested for the presence of virus using semi nested reverse transcriptase-polymerase chain reaction (nRT-PCR). The sequences were analysed to identify serotype and genotype of the virus.

Results:
Of the 648 samples collected from 18 villages of Mandla, 321 (49.53%) were found to be positive for dengue. The nRT-PCR and sequencing confirmed the aetiology as dengue virus type 2. Eighteen per cent of patients needed hospitalization and five deaths were attributed to dengue. The virus was also detected from Aedes aegypti mosquito, which was incriminated as a vector. Phylogenetic analysis revealed that the dengue virus 2 detected belonged to cosmopolitan genotype of the virus.

Interpretation & conclusions:
Dengue virus serotype 2 was detected as the aetiological agent in the outbreak in tribal villages of Mandla district of Madhya Pradesh. Conducive man-made environment favouring mosquitogenic conditions and seeding of virus could be the probable reasons for this outbreak. Urgent attention is needed to control this new threat to tribal population, which is already overburdened with other vector borne diseases.
Pulmonary tuberculosis - a health problem amongst Saharia tribe in Madhya Pradesh
Authors: Rao V.G. , Bhat J. , Yadav R. , Muniyandi M. , Sharma R. , Bhondeley M.K. 
Published: December 2024

Background & objectives:
The information on tuberculosis (TB) situation amongst Saharia, one of the particularly vulnerable tribal groups (PVTGs) in Madhya Pradesh, is not available from Gwalior division of the State. Hence, this study was undertaken to estimate the prevalence of pulmonary tuberculosis (PTB) disease amongst them.

Methods:
A community based cross-sectional TB prevalence survey was undertaken among Saharia PVTG in Gwalior district of Madhya Pradesh. A random sample of villages predominated by Saharia tribe was selected from all the blocks in proportion to the size of Saharia population in each block of the district. All eligible individuals were questioned for chest symptoms relating to TB. Two sputum samples were collected from each of the eligible individuals, transported to the laboratory, and were examined by Ziehl-Neelsen(ZN) smear microscopy and solid media culture methods.

Results:
Of the total 10,259 individuals eligible for screening, 9,653 (94.1%) were screened for symptoms. Overall prevalence of PTB was found to be 3294 per 100,000. The prevalence increased with age and the trend was significant (P<0.001). The prevalence of TB was significantly higher amongst males (5497/100,000) as compared to females (1376/100,000) (P<0.001).

Interpretation & conclusions:
The study results provide vital information on the current situation of pulmonary TB disease among the Saharia tribal community in Gwalior district of Madhya Pradesh. In view of high PTB disease prevalence among this PVTG, there is an urgent need to improve and further intensify TB control measures in this area.
Declining prevalence of pulmonary paragonimiasis following treatment & community education in a remote tribal population of Arunachal Pradesh, India
Authors: Narain Kanwar , Devi K. Rekha , Bhattacharya S. , Negmu K. , Rajguru S.K. , Mahanta Jagadish 
Published: December 2024

Background & objectives:
In India, human pulmonary paragonimiasis is an important public health problem in the northeastern (NE) region. In 2005 we reported a hyperendemic focus of paragonimiasis in a remote tribal village in the hills of Changlang district in Arunachal Pradesh. The community was made aware of the disease and all active cases were treated. This study was aimed to assess the decline in the prevelance of paragonimiasis in the same area after a re-survey done in 2011 after a gap of six years.

Methods:
Re-surveys were carried to determine the reduction in the prevalence of paragonimiasis. Community education was given to the villagers to raise their awareness about paragonimiasis. A total of 624 individuals including 301 children (age < 15 yr) were included in the study. Sputum and stool samples were examined for eggs of lung flukes. Serum samples were screened for IgG antibodies against lung fluke antigen by ELISA.

Results:
A significant (P<0.001) decline in the prevalence of paragonimiasis was found. There was decline in both ELISA positivity and egg positivity. Antibody positivity against excretory-secretary (ES) antigen in children (age ≤ 15 yr) fell down from earlier 51.7 to 15.9 per cent and in individuals 16 - 30 yr of age the serological prevalence fell down from 22.4 to 8.2 per cent and in individuals aged ≥ 31 yr, the decline in prevalence was from 15.3 to 3.7 per cent. Gender-wise analysis revealed that the decline in ELISA positivity was similar in both genders and fell down from 33.9 to 11.5 per cent in males and from 29.8 to 10.7 per cent in females. Similarly, there was a significant decline rate in egg positivity also.

Interpretation & conclusions:
The strategy of hotspot targeted active paragonimiasis case detection and treatment of infected cases together with community education appears to be feasible methods to achieve control of paragonimiasis in this region.
F wave index
Authors: Sathya G. R. , Krishnamurthy N. , Veliath Susheela , Arulneyam Jayanthi , Venkatachalam J. 
Published: December 2024

Background & objectives:
Each skeletal muscle is usually supplied by two or more nerve roots and if one nerve root is affected and the other is spared, the clinically used F wave minimum latency can still be normal. An F wave index was constructed taking into consideration the other parameters of the F wave such as persistence, chronodispersion, latency, arm-length to determine its usefulness in the diagnosis of peripheral neuropathy. This study was undertaken to construct the F wave index in the upper limb for the median nerve in normal healthy adult males and in patients with peripheral neuropathy and to compare the values obtained in both groups.

Methods:
This hospital-based study was carried out on 40 males who were diagnosed to have peripheral neuropathy and on 40 age matched healthy males who served as the control group. The F wave recording was done using a digitalized nerve conduction/electromyography/EP machine in a quiet and dimly lit room. All recordings were done between 0900 and 1100 h at an ambient temperature of 22°C. The F wave recording was obtained from a fully relaxed muscle by stimulating the median nerve.

Results:
The median value for F wave index obtained from median nerve (abductor pollicis brevis) in patients with peripheral neuropathy [right arm - 35.85, interquartile range (IQR) - 35.26; left arm - 39.49, IQR - 39.49] was significantly lower (P=0.001) as compared to the control group (right arm - 102.62, IQR - 83.76; left arm - 77.43, IQR - 58.02).

Interpretation & conclusions:
Our results showed that F wave index in upper limb was significantly lower in patients with peripheral neuropathy than the healthy controls, and could be used for early detection of peripheral neuropathy.
Ethyl pyruvate improves skin flap survival after ischaemia reperfusion injury
Authors: Kayiran Oguz , Cuzdan Suat Sedat , Uysal Afsin , Kocer Ugur 
Published: December 2024

Background & objectives:
Reperfusion after ischaemia is detrimental to the tissues. The oxidative stress created and cytokines released are mostly responsible in this process. In this study, ethyl pyruvate, a known agent for its anti-inflammatory and antioxidant properties, was used to investigate the effects on ischaemia/reperfusion injury on skin island flaps in rats.

Methods:
Sixty rats were randomly distributed in three groups (non-ischaemic, ischaemic and medication groups). Ethyl pyruvate was administered in the medication group with a dose of 50 mg/kg. After 24 h and one week, the animals were sacrificed, and the flaps were analyzed macroscopically, histopathologically, biochemically (total nitrite, malondialdehyde and myeloperoxidase).

Results:
Biochemical markers indicating oxidative stress, were found elevated in ischaemic group, whereas medication with ethyl pyruvate significantly reduced these values. There was a significant reduction (P<0.05) in the levels of these markers between ischaemic and medication groups. Ethyl pyruvate improved all the parameters significantly.

Interpretation & conclusion:
Ethyl pyruvate showed strong scavenger activity against reactive oxygen species. It could be a potential candidate to improve the flap viability in reconstructive microsurgery, especially in free tissue transfers. However, more studies are warranted in experimental models to confirm these findings.
In vitro susceptibility of Indian Plasmodium falciparum isolates to different antimalarial drugs & antibiotics
Authors: Agarwal Pooja , Anvikar A. R. , Pillai C. R. , Srivastava Kumkum 
Published: December 2024

Background & objectives:
The in vitro assays for susceptibility of Plasmodium falciparum to antimalarial drugs are important tools for monitoring drug resistance. During the present study, efforts were made to establish long-term continuous in vitro culture of Indian field isolates of P. falciparum and to determine their sensitivity to standard antimalarial drugs and antibiotics.

Methods:
Four (MZR-I, -II, -III and -IV) P. falciparum isolates were obtained from four patients who showed artemisinin-based combination therapy (ACT) from Mizoram, a north-eastern State of India, and characterized for their in vitro susceptibility to chloroquine diphosphate (CQ), quinine hydrochloride dehydrate, mefloquine, piperaquine, artemether, arteether, dihydro-artemisinin (DHA), lumefantrine and atovaquone and antibiotics, azithromycin and doxycycline. These patients showed ACT treatment failure. Two-fold serial dilutions of each drug were tested and the effect was evaluated using the malaria SYBR Green I fluorescence assay. K1 (chloroquine-resistant) and 3D7 (chloroquine-sensitive) reference strains were used as controls.

Results:
Growth profile of all field isolates was identical to that of reference parasites. The IC50 values of all the drugs were also similar against field isolates and reference parasite strains, except K1, exhibited high IC50 value (275±12.5 nM) of CQ for which it was resistant. All field isolates exhibited higher IC50 values of CQ, quinine hydrochloride dihydrate and DHA compared to reference strains. The resistance index of field isolates with respect to 3D7 ranged between 260.55 and 403.78 to CQ, 39.83 and 46.42 to quinine, and 2.98 and 4.16 to DHA, and with respect to K1 strain ranged between 6.51 and 10.08, 39.26 and 45.75, and 2.65 and 3.71. MZR-I isolate exhibited highest resistance index.

Interpretation & conclusions:
As the increase in IC50 and IC90 values of DHA against field isolates of P. falciparum was not significant, the tolerance to DHA-piperaquine (PPQ) combination might be because of PPQ only. Further study is required on more number of such isolates to generate data for a meaningful conclusion.
Evaluation of 75 g glucose load in non-fasting state [Diabetes in Pregnancy Study group of India (DIPSI) criteria] as a diagnostic test for gestational diabetes mellitus
Authors: Tripathi Reva , Verma Divya , Gupta Vinod Kumar , Tyagi Shakun , Kalaivani M. , Ramji Siddarth , Mala Y.M. 
Published: December 2024

Background & objectives:
There is no consensus regarding optimal standard for diagnosis of gestational diabetes mellitus (GDM). In this study, use of 75 g glucose load in non-fasting state [Diabetes in Pregnancy Study Group of India (DIPSI) criteria] as a diagnostic test for GDM in pregnant women was compared with different oral glucose tolerance tests (OGTTs).

Methods:
This prospective study included 936 pregnant women, who underwent plasma glucose evaluation two hours after the challenge of 75 g glucose load irrespective of the timing of last meal (DIPSI criteria for GDM). After three days, standard 75 g OGTT was done in all women irrespective of previous plasma glucose value. Accuracy of the first result was compared to OGTT using cut-offs as per the World Health Organization (WHO) and International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for the diagnosis of GDM.

Results:
Of the total 936 pregnant women, 73 (7.8%) patients had plasma glucose value ≥140 mg/dl when measured two hours after glucose load. When comparing with the WHO and IADPSG criteria, the sensitivity values were 65.1 and 74.1 per cent, respectively, and the corresponding specificity values were 96.3 and 96.9 per cent, respectively. On comparing with the WHO OGTT, only 41 of the 73 (56.2%) were true positives, whereas when IADPSG criteria were used, true positives were 46 (63%). False negative cases were also present when classified by the WHO and IADPSG criteria though in lesser numbers than false positives. The positive predictive values (PPVs) for the WHO and IADPSG criteria were 56.1 and 63 per cent, respectively, and their corresponding negative predictive values were 97.7 and 97.9 per cent, respectively.

Interpretation & conclusions:
Our findings showed that when 75 g glucose load in non-fasting state was used as a diagnostic test for GDM, almost one quarter of patients with GDM escaped diagnosis as sensitivity values were low. On the other hand, some GDM cases were falsely labelled as normal as this test did not account for cases of fasting hyperglycaemia. In addition, comparison with other OGTTs showed low PPVs. Hence, use of DIPSI criteria for diagnosing GDM must be reconsidered till further validation.
Safety, immunogenicity & effectiveness of the COVID-19 vaccine among healthcare workers in a tertiary care hospital
Authors: Kataria Sushila , Sharma Pooja , Singh Manish Kumar , Deswal Vikas , Kumar Kuldeep , Alam Sazid , Gupta Vaibhav , Phogat Rashmi , Sarma Smita , Patil Nipun , Dutt Rohit , Singh Padam , Saxena Renu , Trehan Naresh 
Published: December 2024

Background & objectives:
The COVID-19 pandemic has caused significant global morbidity and mortality. As the vaccination was rolled out with prioritization on healthcare workers (HCWs), it was desirable to generate evidence on effectiveness of vaccine in prevailing real-life situation for policy planning. The objective of the study was to evaluate the safety, effectiveness and immunogenicity of COVID-19 vaccination among HCWs in a tertiary care hospital.

Methods:
This prospective observational study was undertaken on the safety, immunogenicity and effectiveness of the ChAdOx1 nCoV- 19 coronavirus vaccine (Recombinant) during the national vaccine roll out in January-March 2021, in a tertiary care hospital, New Delhi, India.

Results:
The vaccine was found to be safe, with local pain, fever and headache as the most common adverse events of milder nature which generally lasted for two days. The adverse events following vaccination were lower in the second dose as compared to the first dose. The vaccine was immunogenic, with seropositivity, which was 51 per cent before vaccination, increasing to 77 per cent after single dose and 98 per cent after two doses. Subgroup analysis indicated that those with the past history of COVID-19 attained seropositivity of 98 per cent even with single dose. The incidence of reverse transcription (RT)-PCR positive COVID-19 was significantly lower among vaccinated (11.7%) as compared to unvaccinated (22.2%). Seven cases of moderate COVID-19 needing hospitalization were seen in the unvaccinated and only one such in the vaccinated group. The difference was significant between the fully vaccinated (10.8%) and the partially vaccinated (12.7%). The hazard of COVID-19 infection was higher among male, age >50 yr and clinical role in the hospital. After adjustment for these factors, the hazard of COVID-19 infection among unvaccinated was 2.09 as compared to fully vaccinated. Vaccine effectiveness was 52.2 per cent in HCWs.

Interpretation & conclusions:
ChAdOx1 nCoV-19 coronavirus vaccine (Recombinant) was safe, immunogenic as well as showed effectiveness against the COVID-19 disease (CTRI/2021/01/030582).
Red cell alloimmunization & role of advanced immunohaematological support in liver transplantation
Authors: Makroo Raj Nath , Agrawal Soma , Chowdhry Mohit , Bhatia Aakanksha , Thakur Uday Kumar 
Published: December 2024

Background & objectives:
Transfusion support forms an integral part of liver transplantation programme. Advanced immunohaematology services are required to deal with complex serological problems that can complicate transfusion therapy in these patients. Here, we report on red cell alloimmunization and presence of alloimmunization in donors and patients undergoing liver transplantation in a tertiary care hospital in north India.

Methods:
Records of 1433 liver transplants performed from January 2009 to March 2015 were retrieved and reviewed. Antibody screening was performed both for liver donors, and recipients and antibody identification was performed for the screen-positive patients.

Results:
Of the 1433 liver recipients, 32 (2.3%) developed antibodies. Seventeen patients had one or more alloantibodies, five had autoantibodies with an underlying alloantibody and 10 had only autoantibodies in their plasma. The overall alloimmunization rate was 1.5 per cent with 25 alloantibodies identified in 22 patients. Anti-E was the most common specificity identified.

Interpretation & conclusions:
The presence of alloantibodies can complicate transfusion therapy in patients undergoing liver transplantation, who are already at a high risk of being heavily transfused owing to the nature of surgery and the haemostatic dysfunction from chronic liver disease. Therefore, screening for irregular red cell alloantibodies combined with a rational blood transfusion policy may be essential for these patients.
Immediate neonatal outcomes of preterm infants born to mothers with preterm pre-labour rupture of membranes
Authors: Dannapaneni Niveditha , Oleti Tejopratap , Surapaneni Tarakeswari , Sharma Deepak , Murki Srinivas 
Published: December 2024

Background & objectives:
With the use of early and appropriate use of antibiotics, outcomes have improved in the mother-infant dyads exposed to preterm pre-labour rupture of membranes (PPROM). This study was undertaken to evaluate immediate neonatal outcomes in infants born before 33 completed weeks of gestation to mothers with PPROM versus without PPROM.

Methods:
During the study period from January 2013 to December 2013, a total of 182 mother-infant dyads were prospectively included in the study. Among the enrolled, 69 were in the PPROM group and 113 in the control group (no PPROM). Mother-infant dyads in PPROM group were covered with antibiotics. The primary outcome was the combined adverse neonatal outcome consisting of sepsis, necrotizing enterocolitis >Stage II or pneumonia or oxygen at day 28 or cystic periventricular leucomalacia or mortality before discharge.

Results:
Baseline maternal and neonatal variables were comparable across the two groups, except for higher incidence of singletons, maternal pregnancy-induced hypertension (PIH) in the control group and higher proportion of males, complete steroid coverage and oligohydramnios in the PPROM group. The proportion of infants with combined adverse neonatal outcome was similar between the two groups [odds ratio (OR): 1.43; 95% confidence interval (CI): 0.77-2.6]. Both the groups were comparable for most other neonatal morbidities and outcomes, except screen-positive sepsis (OR: 3.7; 95% CI: 1.17-11.5) which was higher in PPROM group.

Interpretation & conclusions:
Mothers with PPROM and their newborns when treated with timely and appropriate antibiotics had neonatal outcomes similar to those not exposed to PPROM.