bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beard Reconstruction
Authors: Yaseen Ummer , Ahmed Shabir , Ahmed Muzaffar 
Published: November 2021

Introduction:
Loss of beard can occur due to many reasons. As beard has huge cosmetic importance, loss of beard can be psychologically traumatic. Beard can be absent from puberty, called as congenital absence of beard. Beard loss can be secondary to dermatological conditions such as nodulocystic acne. In our setting, the most common cause of loss of beard is burn injury. There are many treatment options such as surgical excision of scar, flaps Z/W plasty, and hair transplantation to reconstruct the beard. We present the follicular unit extraction (FUE) method of beard reconstruction.

Aim:
The aim of our study was to describe the evaluation of the results using FUE method for beard reconstruction.

Materials and Methods:
We did a study in twenty male patients. Any patient having alopecia areata were ruled out of the study. Fifteen patients had postburn loss, three had postacne scarring, and two patients had congenital absence of beard. We evaluated all patients thoroughly by calculating the density of beard over the normal areas of beard, evaluating the elasticity of skin, preoperative photography, and doing dermatoscopy. Areas were marked. FUE was used for harvesting the grafts as a limited number of grafts were needed to complete the surgery. In the recipient area, adrenaline was avoided in patients of scarring alopecia. In cases of congenital absence of hair, 1:200,000 adrenaline was used to minimize bleeding. Grafts were placed. Results were noted after 1 year.

Results:
All patients followed up properly for 1 year. Growth started 3 months postoperatively and continued till 1 year postoperatively. Density was good in cases with congenital absence of hair. In cases of scarring alopecia, multiple sessions were needed to provide adequate density. Results were graded as “very good,” “good,” and “poor.” Eleven patients had “very good” result, eight had “good,” and one had “poor” result. Nineteen patients were satisfied with the final result, and one patient was dissatisfied with the result.

Conclusion:
FUE is the ideal method of reconstructing beard loss. Proper preoperative evaluation, preparation, planning, and proper surgical technique produce the best possible result.
Impact of COVID-19 on psychological and academic performance of medical students in Saudi Arabia
Authors: Allah Ahmad A , Algethami Nada E. , Algethami Rahma A. , ALAyyubi Raghad H. , Altalhi Wahaj A. , Atalla Aymen A. Ahmed 
Published: November 2021

Background and Objectives:
The COVID-19 pandemic affected the mental health and psychosocial conditions of everyone worldwide according to the WHO. Public health emergencies affect college students and are expressed as anxiety, worry, and fear. The aim of this study was to assess the impact of COVID-19 on the psychological health and performance of medical students.

Design and Settings:
A cross-sectional study using an online survey was done.

Participants and Methods:
Participants were 1591 Saudi medical students. A predesigned questionnaire included questions on demographic characters, GPA, having a relative got COVID-19, how to face sad news and stressors, and satisfaction with online lectures. The Generalized Anxiety Disorder (GAD-7) scale was used that included seven items asking about the degree the participant was bothered by feeling anxious in the last 2 weeks.

Results:
A total of 59.4% of students had various degrees of anxiety. Participant age, unsteady family income, high grade point average (GPA,) satisfaction with the online lectures, and being female were associated with higher GAD-7 scores.

Conclusion:
Mental health of medical students was significantly affected by the COVID-19 pandemic. Psychological support programs for medical students during the pandemic and provision of high-quality distance learning is essential for psychological well-being during the pandemic.
Prevalence of alopecia and its contributing factors among primary healthcare attendees in the Jazan region, Saudi Arabia
Authors: Alomaish Abeer R. , Gosadi Ibrahim M. , Dallak Fatimah H. , Durayb Amjad A. , Dallak Ali H. , Hakami Jubran A. , Hakami Ayman M. , Alshamakhy Arar E. , Mleeh Nouf T. 
Published: November 2021

Background:
Alopecia is a common health condition that can be associated with social and psychological consequences.

Aims:
This study aims to estimate the prevalence of hair loss and its associated risk factors among primary healthcare center (PHC) attendees in the Jazan region.

Methods:
This investigation was a cross-sectional study conducted in the Jazan region of southwest Saudi Arabia. A total of 23 PHCs were randomly selected from five governorates in the region. Data were collected via interviewing PHCs attendees and were asked about their demographic characteristics, presence of hair loss, and among attendees who confirmed having hair loss, they were further asked about associated clinical features, healthcare-seeking behavior, and factors that might contribute to the development of their condition.

Results:
A total of 729 participants consented to be involved in this study. The number of respondents who reported having hair loss was 483, representing 66.3% of the whole sample. Gender appears to have the highest level of variability, with the majority of participants reporting hair loss being female (P < 0.001). The most frequently reported type of hair loss was telogen effluvium, followed by androgenic alopecia. A total of 185 respondents reported taking medications to treat their hair loss, of whom 108 (58.3%) did not seek any medical advice to identify the cause of their condition.

Limitations:
The main weakness of this investigation is related to relying on a reported presence of hair loss without having it confirmed with a clinical diagnosis.

Conclusion:
A minority of participants who reported suffering from hair loss were further evaluated by healthcare professionals to learn the cause of their hair loss. This may indicate the presence of poor hair care and the probability of a higher risk of hair loss requiring the development of suitable preventive strategies.
Epidemiological study to assess the impact of COVID-19 pandemic on the occurrence of monsoon-related diseases in the city of Mumbai
Authors: Chavhan Smita S. , Kashyap Vandana , Gokhale Chinmay N , Adsul Balkrishna B. , Gomare Mangala , Kumbhar Maharudra , Kadam Neelam , Dhikale Prasad T. , Kinge Kirti V. 
Published: November 2021

Background:
The onset of monsoons in Mumbai poses an additional health disease burden in the form of rising vector-borne and water-borne diseases such as dengue, malaria, leptospirosis, hepatitis, typhoid, chikungunya, and acute gastroenteritis. These monsoon-related illnesses are preventable with hygienic and sanitation measures that are likely to have been adopted during COVID-19 pandemic.

Aim:
To assess the impact of COVID-19 pandemic on the occurrence of monsoon-related diseases in the city of Mumbai and find out determinants of variations if any.

Material and Methods:
This was a retrospective descriptive study. Universal sampling was done using secondary data collected from the Epidemiological Cell of Municipal Corporation of Greater Mumbai (MCGM). Data mining was performed to obtain the trends of the monsoon-related diseases in Mumbai.

Results:
COVID-19 pandemic has remarkably affected the city of Mumbai with approximately 3 lakh cases till December 2020. MCGM has taken a lot of efforts resulting in a recovery rate of close to 95% with less than 3% mortality. With the effective use of social behavior change communication, which focused on masks, frequent hand washing, and social distancing, there seems to be a decline in monsoon-related illnesses in the year 2020 as compared to the previous two years of 2018 and 2019.

Conclusion:
Monsoon-related illnesses are impacted by behavior and lifestyle modifications like hygiene and environmental sanitation practiced during the COVID-19 pandemic. This study highlights the importance of these universal hygienic practices and their utility in the long-term reduction of monsoon-related illnesses.
Implementing a “convergent” framework of action against childhood malnutrition in urban informal settlements of Mumbai
Authors: Ramani Sudha , Sridhar Rama , Shende Sushma , Manjarekar Shreya , Patil Sonali , Pantvaidya Shanti , Fernandez Armida , Jayaraman Anuja 
Published: November 2021

Context:
The National Nutrition Mission (POSHAN Abhiyaan) intends to “converge” nutrition-related program components across sectors (nutrition, health, water, and sanitation). In this study, we have examined the perspectives of Anganwadi workers (AWWs), the frontline workers of the Integrated Child Development Services, on working in convergence with the public health sector.

Methods:
This exploratory qualitative study was done between June 2018 and June 2019 in two urban informal settlements in Mumbai. We conducted in-depth interviews with 26 AWWs and their supervisors, purposively sampled and diversified in terms of age, education, and years of experience. We used the software NVivo version 12 to aid analysis.

Results:
Most AWWs acknowledged that a convergent framework of action between “nutrition” and “health” was likely to be beneficial to the community. However, they also shared that cross-sector convergence was currently limited due to technical unfamiliarity with “health-sector” issues in the frontline, discomfort with data sharing, and lack of meaningful incentives for joint work. Broader organizational challenges such as poor infrastructure and lack of supervision, as well as challenges in the urban context (migration and cultural barriers) further hindered joint activities.

Conclusions:
The findings indicate that critical structural gaps in the urban setup of ICDS need to be addressed and AWWs need to be better familiarized with the changing roles expected from them under POSHAN Abhiyaan. To work better with the health sector, the work timings of AWWs need to be aligned with those of the health sector and meaningful financial incentives need to be put in place for cross-sector activities.
Effects of oxybutynin in children with posterior urethral valves post fulguration
Authors: Norris Joshua Jonathan , Raj Jeffrey Pradeep , Thomas Tia Teresa , Maleperambil Tijo Thomas , Shubha Attibele Mahadevaiah 
Published: November 2021

Objectives:
Posterior urethral valves (PUV) is the commonest obstructive uropathy with varied consequences. Though valve fulguration is the treatment of choice, appropriate bladder management modifies outcome and includes rational use of anticholinergics. Here, we aim to evaluate the effects of oxybutynin on the bladder and urinary tract morphology and function. Concurrently, we document adverse effects encountered, patient compliance, and medication adherence.

Methods:
A retrospective study of children below 5 years of age (2012–2017) post fulguration and on oxybutynin for at least 6 months. Patient demographics, clinical features, renal ultrasound, micturating cystourethrogram, dimercaptosuccinic acid scan, adverse effects, and pill count for medication adherence were collated.

Results:
48 children below the age of 5 years were included, and 12 were excluded either due to the presence of concomitant problems or were not on oxybutynin. Of the 36, four were lost to follow-up and one had died due to an unrelated condition. Thus, a total of 31 children were analyzed. At follow-up, 28/31 patients were asymptomatic, two had daytime incontinence, and one had recurrent urinary tract infection. All patients except one have preserved renal function tests. On ultrasonography, hydroureteronephrosis worsened in only 1/25 children and two showed significant post void residues. The resolution of vesicoureteral reflux was noted in almost 50%. 4/31 renal units had progressive scars. Only two parents defaulted medication. Urodynamic study done in half of these children showed stable bladder pressures except in two.

Conclusion:
Oxybutynin therapy following adequate valve fulguration aids upper tracts preservation by stabilizing deranged bladder dynamics. The medication is well tolerated with minimal or no side effects.
Altered pro-inflammatory and anti-inflammatory plasma cytokines levels in children with Down’s syndrome
Authors: Nigam Nitu , Singh Prithvi K. , Raizada Neena , Singh Balendra P. , Tripathi Shalini , Agrawal Monica , Gupta Harish , Singh Sharad , Fatima Ghizal , Nigam Sanjay K. , Saxena Shailendra K. 
Published: November 2021

Background:
Down syndrome (DS) is the commonest chromosomal anomalies at birth. DS is portrayed by the event of extra complete/deficient duplicate of chromosome number 21 (trisomy 21). Around the world, this disordered influencing roughly 1 out of 1000 infants. Pro-inflammatory and anti-inflammatory cytokines engaged with a few physiological procedures involving the guideline of inflammatory reactions. In DS kids, the creation of few important inflammatory and anti-inflammatory cytokines is altered. Different investigations shows that the cytokines are dysregulated in patients with DS. In this study, we led a meta-analysis to evaluate the connections of pro-inflammatory and anti-inflammatory cytokine changes in youngsters with DS patients.

Methodology:
We searched PubMed, Google and Web of Science for studies in exploring the association of pro-inflammatory and anti-inflammatory serum level with DS patients. Total 10 studies were included in the meta-analysis. The random effects were used to analyze the pooled data. All statistical tests were two-sided.

Results:
High circulating level of serum MCP-1 was significantly associated with DS [Cohen’s d = 143.91 95% confidence interval (CI) =110.38-177.43]. However, the other circulating cytokines IL-2 and IL-17 level were lower whereas IL-13 level was higher but not significantly different in DS as contrasted to healthy controls. The heterogeneity level was higher in IL-2, IL-13 and IL-17 cytokines.

Conclusion:
This meta-analysis shows that the higher circulating level of MCP-1 was associated with DS.
Emoqol 100, an ultra ultra-brief mood case-finding tool
Authors: Arroll Bruce , Mulcahy Connor F. , Roskvist Rachel P. , Mount Vicki 
Published: November 2021

Background:
Case-finding for low mood in primary care can be time-consuming using current depression inventories.

Aim:
To assess the diagnostic accuracy, of a single verbally administered question on the emotional quality of life (Emoqol 100), for low mood in patients with symptoms of distress in an ambulatory care setting.

Design and setting:
Eligible patients were consecutive patients seen by one of the authors over 13 months with possible distress/low mood. The index test was the verbally asked Emoqol 100, which is the patient’s emotional quality of life now, with 100 being perfect emotional health and 0 being the worst imaginable. The reference standard is the written version of the PHQ-9 with a cut point of ≥10.

Methods:
A retrospective audit of consecutive consultations in a single primary care clinic.

Results:
One hundred two patients were seen during the study period, of which 76 met the eligibility criteria for this audit, and there were 215 test results. For a cut point of <50 on the Emoqol 100 and the PHQ-9 ≥10 the sensitivity was 47% (95% CI 39-54), and the specificity was 93% (95% CI 86-100). The positive predictive value was 95%, and the negative predictive value was 37%.

Conclusion:
This is the first accuracy estimation of the Emoqol 100. It appears to have a high specificity which means when it is positive (<50) it is a good estimate of a high PHQ-9, i.e. a mood issue probably exists. The test will be helpful for busy primary care clinicians as it takes less than 15 seconds to verbally administer.
Clinical profile, outcomes and predictors of mortality in elderly patients admitted to the emergency medicine intensive care unit of a teaching hospital – A single-center registry
Authors: Wilson William , Ravindra Prithvishree , Khasage Udaykumar J. , Raj Jeffrey Pradeep , Jain Vinayak , Bose Bijoyini , Kosuri Sreenidhi 
Published: November 2021

Aim:
Emergency intensive care of the elderly is often complicated and multifaceted. Understanding the clinical profile of elderly patients admitted in an emergency department-intensive care unit (ED-ICU) is crucial in planning health policies in geriatric emergency medicine. Thus, the aim of the study was to create a local registry of elderly people utilizing the ED-ICU services and to understand the rate and predictors of mortality.

Methods:
A retrospective chart analysis was performed including all patients aged ≥60 years who had an ED-ICU admission during a 6-month period (August 2018–January 2019). A structured case record form was used to capture information such as basic demography, clinical profile, and outcomes.

Results:
Total number of records considered for final analysis were 503. Mortality was seen in 21.07% (n = 106/503). The most common presenting complaint and cause of death was breathing difficulty (n = 48/503; 29.42%) and pneumonia (n = 41/106; 38.67%), repectively. The significant predictors of mortality [adjusted odds ratio; 95% confidence intervals; P value] were hypertension (2.195; 1.255, 3.840; 0.006), chronic liver disease (CLD) (4.324; 1.170, 15.979; 0.028), malignancy (2.854; 1.045, 7.796; 0.041), requiring noninvasive ventilation (NIV) (2.618; 1.449, 4.730; 0.001), requiring intubation (6.638; 3.705, 11.894; <0.001), and requiring vasopressors (3.583; 1.985, 6.465; <0.001).

Conlusion:
Approximately one in every five elderly patients getting admitted in ED-ICU died, and respiratory illness was the common diagnosis leading to death. Those with comorbidities such as hypertension, CLD, or malignancy and those requiring NIV, intubation, or vasopressors had higher mortality.
The attitude and awareness of contact lens use among medical students of King Faisal University, Al Ahsa, Saudi Arabia
Authors: Boqursain Saad K. , Al-Hussain Ahmed S. , Al Mubarak Adeeb A. , Al-Bujays Dawood S. , Al-Mustahi Manayer 
Published: November 2021

Background:
Not many studies have investigated the knowledge outcomes among medical students with regards to contact lenses (CL). Thus, in this study, we aim to assess the attitude and awareness of CL use and the associated factors among medical students of King Faisal University (KFU), Al Ahsa, Saudi Arabia.

Methods:
This a cross-sectional study that based developed based on a designed questionnaire that was composed of 31 questions with a maximum score of 57 points. We have also conducted a linear regression model to explore the possible important factors that may affect the level of knowledge and awareness about contact lenses care.

Results:
A total of 208 participants were included in this study, with a mean age of 21.0 ± 1.9, and 56.3% (n = 117) of them being females. The total mean knowledge score in our study was 30.1 ± 7.74, which was higher in females (31.5 ± 7.09) than in male participants (28.7 ± 7.69). The results of the linear regression model showed that being female (E = -0.37; 95%CI = -0.65— -0.10; P = 0.007), using contact lenses (E = 0.56; 95%CI = 0.29 — 0.82; P < 0.001), and in the third year (E = 0.66; 95%CI = 0.19— 1.13; P = 0.007) is significantly correlated with having higher knowledge scores about using CLs.

Conclusion:
Female participants had higher total mean knowledge scores than males. We recommend that further educational campaigns should be inaugurated to raise awareness about taking care of CLs and enhancing the related practices of wearing them.
Why parents bring their children with minor health problems to their family practitioners
Authors: Serour Maleka , Al-Weqayyan Adnan , Almazeedi Hind , Al-Fedhala Hanan , Bahroh Ahmed , Aljadi Fatma , AlHilali Mohammed 
Published: November 2021

Background:
Parents’ of young children who frequently attend primary health care (PHC) services for mild health problems (MHPs) can present a complex and difficult challenge for staff. This phenomenon can expose the child to inappropriate overprescribing, unnecessary medical interventions and may impair the quality of life of parents and children.

Aim:
To define driving factors for frequent attenders (FAs) preschool children in PHC services in Kuwait.

Design and Setting:
An unmatched case-control study was conducted in the PHC setting in Kuwait.

Method:
A sample comprised of 300 parents from 10 PHC centres was selected. The top third children with higher frequency (FAs) visits to their family practitioners (FPs) were compared with the lower third with lower frequency (NFAs) visits to their FPs during the same duration. The Brief Illness Perception Questionnaire (Brief IPQ) was used to assess parents’ response to their children’s illness. The sociodemographic data for both groups were collected. Culture and background heath status for child and family were collected (order of the child in the family, if the family is living with the extended family and additional help received regarding childcare). The previous medical history of parent, child, and siblings was also included.

Results:
The mean number of consultations in FAs versus NFAs within the previous year was 15.5 ± 7.6 and 4.3 ± 2.1, respectively. There was no significant difference in means between the two groups of parents in responses to the questions of the adapted Brief IPQ. FAs were more likely to be the first-order child (odds ratio (OR) 2.4; 95% confidence interval (CI) =1.2–4.6), have chronic disease (OR 4.7; 95% CI = 2.1–10.6), and live with the extended family (OR 1.8; 95% CI = 1.1–3.3). They experienced an acute, potentially life-threatening episode previously (OR 2.6; 95% CI = 1.1–6.4), with the same applying to a sibling (OR 72.6; 1.2–6.2) or parent (OR 2.6; CI = 1.1–6.4).

Conclusion:
Identification of the hidden reasons that affect parents’ decisions to consult their FPs frequently for their children’s MHPs were important predictors for defining preschool FAs children in the PHC centres and can help the staff provide effective management plans to help them.
Evaluation of changes in corneal volume, volume and angle of anterior chamber in keratoconus patients using Pentacam after CXL
Authors: Ostadian Farshad , Nickkhah Sona , Farrahi Fereydoun , Rad Atefeh Mahdian 
Published: November 2021

Introduction and Objective:
Corneal collagen cross-linking (CXL) with riboflavin and ultraviolet-A (UVA) is a new technique of mechanical stability of the cornea and prevention of keratoconus progression. The present study aimed at the evaluation of the changes in the corneal volume (CV), volume, and the angle of anterior chamber in keratoconus patients using the Pentacam after CXL.

Methods:
This prospective study was performed on 48 eyes of 24 patients (including 12 men, 17–33 years old) with progressive keratoconus undergoing CXL treatment at collagen cross-linking Imam Khomeini Hospital in Ahvaz in 2019. The CV (CV) and anterior chamber parameters such as anterior chamber volume (ACV) and anterior chamber angle (ACA) were measured using the Pentacam before CXL and at 6 and 12 months after CXL. Also, all of the patients were evaluated in terms of best-corrected visual acuity (BCVA), during the follow-up.

Results:
The pre-CXL values of BCVA was significantly lower than the post-CXL values in 6 and 12 months (0.18 ± 0.11, 0.15 ± 0.10, and 0.11 ± 0.10, respectively, P < 0.0001). In general, there was a significant improvement in the BCVA (P < 0.0001), a significant decrease in the CV (P = 0.001), and a significant increase in the ACV (P < 0.0001), and angle (P < 0.0001) 6 and 12 months after CXL.

Conclusion:
It seems that CXL has a positive effect on the anterior chamber parameters (ACV and ACA) and CV after 6 months and 1 year in the treatment of keratoconus patients. In addition, the visual acuity improves after CXL. Finally, further studies with a higher sample size and longer follow-up periods are recommended.