bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of role of HPLC (Merits & Pitfalls), in the diagnosis of various hemoglobinopathies & thalassemic syndromes
Authors: Baig Mirza A. , Swamy KB , Baksh Ameen D. , Bahashwan Ahmed , Moshrif Yasser , Al Sawat Abdullah , Al Mutairi Nabeel , Alharbi Nader 
Published: July 2021

Background:
HPLC is one of the most important tools for accurate diagnosis of hemoglobinopathies and thalassemias. The advantage of the HPLC system is the excellent resolution, reproducibility &quantification of several normal and abnormal hemoglobin.

Results:
BIO RAD Variant II analyzer was used. Sickle cell syndromes including double heterozygous states accounted for 56.13% of total cases. HbSS, HbS/β0-th, HbS/β+–th β-thal trait comprises 29%, 6.5%, 5.1%& 10% of total cases respectively with mean MCV (fl) = 84, 68,71,64 respectively. The Mean HbA2 for β-thal trait, HbE trait &HbE-β thal showed 5.1 ± 1.1, 19 ± 9 & 24 ± 8 respectively. HbF is increased in 8.6% case (excluding SC syndromes & β-thal disorders), of these 5.5% were infants & 12 cases of Aplastic Anemias. Peak P2 >7% (2.4% cases) was seen in uncontrolled diabetes mellitus which on quantification showed HbA1C = 8 ± 2.1 mmol/L.

Discussion:
HPLC in correlation with CBC parameters & family studies can aid in the diagnosis of majority of Hemoglobinopathies and thalassemic syndrome. The CBC & HPLC parameters of the present study are in good correlation with the research conducted by Tejinder Sing, RiouJ & Alla Joutovsky. Present study showed HPLC comprehensively characterizing HbS, A, A2, F, S, C, D from each other & was also applicable for the quantification of HbA1c for the monitoring of Diabetes Mellitus.

Conclusion:
The merits of HPLC are small quantity of sample required, economical, less TAT, accurate categorization of HbS, HbA2 & F. But one has to be aware of the limitations and problems associated with this method due to variant hemoglobin within the same retention windows. The present findings show HPLC as an excellent & powerful diagnostic tool for the direct identification of hemoglobin variants with a high degree of precision in the quantification of normal and abnormal hemoglobin fractions.
Acute Diarrhoeal Disease in Children Aged 6 Months to 24 Months
Authors: Mathew Mathews Marian , Kaimal Resmi S. , Goodwill Jose 
Published: July 2021

Introduction:
Diarrheal disease comes second among the causes of death in children under 5 years of old. We are well aware that this common disease is preventable and treatable. But the practice of preventive strategies is not as efficient as it should be.

Aims and Objectives:
1. To determine the frequency of acute diarrheal disease in children aged 6 months to 24 months attending the immunization clinic of Lourdes Hospital, Kochi, Kerala. 2. To assess the associated factors and practices involved with acute diarrheal disease in the study group.

Material and Methods:
A cross-sectional study was done in children above 6 months attending immunization clinic in Lourdes hospital during the period from 1st October 2017 to 31st March 2019. After receiving their informed consent, a pretested, semistructured, and validated questionnaire was given to the mothers/caregivers to gather data on socio-demographic characteristics and practices. In order to assess the prevalence of diarrhea, details of the diarrheal episode after the 6 months of age were included in the questionnaire. To eliminate repeats, caution was taken not to include previously recorded data on the diarrheal episode.

Discussion and Conclusion:
The proportion of children with diarrhea in the study population was 38.7% which was high compared with other studies in the same age group. Many of the practices associated were found faulty and needing rectification which is a Family Physician's area of expertise. The study concludes that there is a need for identifying novel risk factors for diarrhea and educating the caregivers regarding the prevention of diarrhea. Primary Care Physicians/Family Physicians can play an effective role in educating the caregivers.
Maternal and neonatal outcomes in extra hepatic portal vein obstruction
Authors: Jacob Smitha Elizabeth , Shankar Ravi , John Anoop , Eapen C.E. , Yadav Bijesh , Rathore Swati 
Published: July 2021

Background:
Women with Extra hepatic portal vein obstruction (EHPVO) are mostly young and belong to Asian countries. In the Indian subcontinent, 20–30% variceal bleeds are caused by EHPVO. Hence pregnancy is a concern in such patients. The objective of this study is to observe the maternal and neonatal outcomes in women with EHPVO.

Materials and Method:
Extra hepatic portal vein obstruction was studied retrospectively in 28 pregnancies in 20 women from Jan 2011 to July 2018 at a tertiary hospital in South India and the pregnancy outcomes were observed during this period. Institutional Review Board approval obtained.

Results:
The mean age of the women was 24.3 years and the mean age of diagnosis was 18.5 years. Splenomegaly, thrombocytopenia and anaemia were seen in 22 (78.5%), 17 (60.7%) and 8 (28.5%) of pregnancies, respectively. Rate of abortions and preterm deliveries were 2 (7.1%, n =28) and 10 (35.7%, n =28). There was one stillbirth (3.6%) in the study group. EHPVO was diagnosed in 25 (89.3%) women prenatally in our series. During pregnancy only one woman had variceal bleed, which was managed conservatively. Blood and blood product transfusion was required in 7(25%) of women and there was no maternal mortality.

Conclusion:
Pregnancies in EHPVO have good maternal and neonatal outcomes, provided they are taken care of by a multidisciplinary approach in a tertiary care centre.
Diagnostic value of intravenous oxygen saturation compared with arterial and venous base excess to predict hemorrhagic shock in multiple trauma patients
Authors: Taherinia Ali , Saba Ghazal , Ebrahimi Mohsen , Ahmadi Koorosh , Taleshi Zabihollah , Khademhosseini Peyman , Soltanian Ali , Safaee Atie , Bahramian Mehran , Gharakhani Shahin , Nodoshan Mohammad Ali Jafari 
Published: July 2021

Introduction:
In this study, with the help of peripheral vein sampling, Spvo2, and peripheral artery and vein sampling, we examined base excess (BE) in trauma patients and determined its diagnostic value for hemorrhagic shock.

Methods:
In this cross-sectional study, from 64 patients with abdominal, pelvic and chest Blunt trauma who have a score of 2 or higher trauma during treatment, blood samples were taken from peripheral vein to measure oxygen saturation and peripheral vein and artery for BE measurements and were compared in order to assess their diagnostic value in predicting the occurrence of hemorrhagic shock.

Results:
Out of 60 examined patients, 43 (71.67%) patients were diagnosed with hemorrhagic shock. The correlation for the percentage of oxygen saturation of the peripheral blood and the rate of arterial and venous BE for these r
2
patients were 17.0 and 09.0, respectively, with a P value greater than 0.005. In the case of the percentage of oxygen saturation of the peripheral blood, the sensitivity and specificity were 93.03 and 11.76%, respectively. The positive and negative likelihood ratios were 1.05 and 0.59, respectively. The positive and negative predictive values were 72.73 and 40%, respectively.

Conclusion:
In general, the results of this study showed that arterial and venous excess base levels had a proper correlation, specificity and sensitivity for diagnosing and predicting hemorrhagic shock, while the percentage of oxygen saturation of peripheral blood and BE arterial and venous levels had not proper correlation to detect and predict hemorrhagic shock.
Impact of the COVID-19 pandemic on residents’ clinical training and psychosocial well-being in Saudi Arabia's Western region
Authors: Alshareef Reem , Al Zahrani Abdullah , Alzhrani Meshari , Suwaidi Abdulaziz , Alamry Bander 
Published: July 2021

Background:
The novel COVID-19 pandemic has imposed a significant burden on healthcare systems. Similarly, it has also affected the performance and well-being of the medical staff working during the pandemic. This study aims to evaluate the negative effect of COVID-19 pandemic on medical training and psychological well-being of resident doctors practicing in the Western region of Saudi Arabia.

Methods:
This is a quantitative cross-sectional study that included a survey distributed to resident physicians working in the western region in Saudi Arabia. The survey included questions on demographic data and factors influencing the academic training, attitude, and daily habits of the residents during the pandemic. Psychological impact was assessed using the Kessler Psychological Distress Scale. Data analysis was executed using IBM SPSS version 26.

Results:
A total of 121 residents responded to this survey. Of all respondents, 71.1% were junior residents, 66.9% had a medical specialty; and 33% were family medicine physicians, followed by 17% from general surgery. In regard to work amid the pandemic, 36.1% were in contact with confirmed COVID-19 patients, and 35.5% had to work overtime during the pandemic. There was a non-significant difference detected between the residents regarding the factors negatively affecting their psychological well-being.

Conclusion:
Residents working during the pandemic in the Western area of Saudi Arabia were significantly affected by the pandemic from both professional and psychological perspectives. Further research on how the pandemic is affecting physicians in other areas in Saudi Arabia is needed.
Prevalence and associated factors of stress among primary health care nurses in Saudi Arabia, a multi-center study
Authors: Abdoh Duoaa Seddiq , Shahin Mohammed Adeeb , Ali Ahmed Khalid , Alhejaili Shumukh Mohammed , Kiram Osama Madani , Al-Dubai Sami Abdo Radman 
Published: July 2021

Background:Nursing practice has been identified as one of the most stressful professions within the healthcare systems. The current study aimed to determine the prevalence of stress and its associated factors among primary healthcare nurses.Materials and Methods:This analytical cross-sectional study was conducted among 200 Saudi nurses in the government primary health care centers in Medina city, Saudi Arabia. Stress was measured by the stress subscale of the 21-Item Depression, Anxiety and Stress Scale. Sources of stress were assessed by 15 items.Results:The majority were females (68.0%) and aged less than 40 years (72.5%). Thirty percent had severe or very severe stress. Stress was associated significantly with the presence of chronic diseases (P= 0.037) and with working in night shifts (P= 0.042). All sources of stress in the workplace were associated significantly and positively with stress (P< 0.01).Conclusion:About one-third of the participants had stress. Improving work conditions and minimizing stress in the workplace should be a priority in the primary health care setting.
Utility of Panfungal PCR in the diagnosis of invasive fungal infections in febrile neutropenia
Authors: Srinivas Sujay , Kumari Pushpa , Gupta Dipendra Kumar 
Published: July 2021

Background:
The prevalence of invasive fungal infections (IFIs) is increasing due to the increasing population of immunocompromised patients. Fungal culture is the gold standard for diagnosis but not sensitive and the turnaround time is long. Samples for histopathology are difficult to obtain because of profound cytopenias. We conducted this study with the aim to evaluate panfungal PCR for the diagnosis of IFIs in patients of febrile neutropenia.

Methods:
This was a single-centre, cross-sectional observational study. Patients of febrile neutropenia suspected of having IFI were included in the study. Panfungal PCR was performed on the blood of included patients along with other investigations for diagnosis of IFI. The sensitivity, specificity, positive predictive value, and negative predictive value of panfungal PCR were calculated using EORTC/MSG 2008 criteria as the gold standard.

Results:
Fifty patients of febrile neutropenia were included in the study, of which 52% were diagnosed positive by panfungal PCR assay. The sensitivity, specificity, positive predictive value, and negative predictive value of panfungal PCR assay was found to be 82.76%, 90.48%, 92.31% and 79.17% respectively.

Conclusion:
Panfungal PCR is a promising and highly sensitive diagnostic test for screening at-risk patients suspected to have IFIs. The use of panfungal PCR assay in combination with other diagnostic modalities and clinical judgment can be very helpful in the early diagnosis of IFI.
Seroprevalence trends of Scrub typhus among the febrile patients of Northern India
Authors: Singh Sweta , Patel Sangram Singh , Sahu Chinmoy , Ghoshal Ujjala 
Published: July 2021

Background:
Rickettsial infections remain one of the most neglected and underdiagnosed tropical diseases in the developing countries. Scrub typhus can prove to an important diagnosis in pyrexia of unknown origin (PUO) patients and is transmitted by a species of trombiculid mites (“chiggers”). The disease leads to a plethora of symptoms like fever, rash, headache, nausea, abdominal pain, thrombocytopenia, etc. The current study was aimed to assess the seroprevalence as well as other demographic parameters of scrub typhus among patients diagnosed with PUO in the northern part of India.

Materials and Methods:
This study was undertaken for a period of 3 years from September 2017 to September 2020. Serum samples of suspected cases were tested for IgM Scrub typhus along with other common febrile illnesses like Malaria, typhoid, dengue, leptospirosis, chikengunya, etc. Additional testing for COVID-19 was also planned for samples received after February 2020.

Results:
The overall seroprevalence of Scrub typhus during the 3 year study period was noted to be 18.6% in the PUO patients. Typhoid was noted in 39.5%, malaria in 9.2%, Dengue in 13.5%, leptospirosis in 4.8%, and chikungunya in 5.3% of the patients. No cause was identified in 9.1% of the PUO cases. 3.9% of the samples were positive by RT-PCR for COVID-19. No mortality was noted in the scrub typhus positive cases.

Conclusion:
Scrub typhus is an emerging tropical rickettsial disease in the Indian subcontinent. The present study highlights the importance of screening of PUO cases for this important infection as timely institution of simple empirical treatment can prove to be life saving in such positive cases.
Dynamic profile and clinical implications of hematological and immunological parameters in COVID-19 patients. A retrospective study
Authors: Suryawanshi Shekhar Yashwant , Priya Shrishtee , Sinha Sandarbh Saumya , Soni Srinath , Haidry Naqoosh , Verma Shilpi , Singh Supriya 
Published: July 2021

Background:
Ever since the World Health Organization (WHO) announced the SARS-CoV-2 or nCOVID-19 infection (a pandemic), continuous spread of the virus has been observed which has continuously seen to affect and kill multitudes of individuals all over the world. An understanding of the pathophysiology of this disease is necessary for an effective treatment. Laboratory investigations play an important role in the diagnosis as well as treatment of this infectious disease. Hematological parameters demonstrate alterations during the progression of nCOVID-19 infection. Of these, many are indicative of extremely poor clinical outcome. Hematological findings like leukopenia, lymphopenia, thrombocytopenia and coagulation-related abnormalities are the most common manifestations. The aim of this study was to assess the dynamic profile and clinical implications of hematological and immunological parameters among nCOVID-19 infections.

Materials and Methods:
This retrospective study was designed after categorizing patients suffering from COVID-19 into three groups: (a) Group I; (b) Group II and (c) Group III or severe critical patients. Hematological and immunological parameters of neutrophilic and white blood cell counts, d-dimer levels, hemoglobin levels, immunoglobulin G (IgG) and M (IgM) levels and interleukin-6 (IL-6) levels were assessed. Statistical analysis using Kruskal–Wallis test was used.

Results:
Normal white blood cell and neutrophil count among COVID-19 patients was seen. However, median values in Group II (P < 0.01) and Group III (P < 0.0001) were found to show significantly higher values when compared to Group I. A significant (P < 0.01) decrease in lymphocytic counts was found among severe and critical patients. Hemoglobin level was found to demonstrate higher decrease (P < 0.01) among severe and critical patients. Platelet count was found in normal range in all COVID-19 patients. Routine coagulation tests revealed increased fibrinogen (P < 0.01) and d-dimer levels (P < 0.0001) in severe and critical patients. Normal proportions of total CD3+ and CD4 + T lymphocytes were observed in COVID-19. However, CD8 + T lymphocytes proportion was found to be decreased (P-value < 0.05). Immunoglobulin G levels among Groups II and III patients were found to be lower when compared with Group I (P < 0.001). No statistical significance was observed between the groups in IgM levels. Plasma IL-6 levels were found to show progressive rise among Groups II and III patients (P < 0.05).

Conclusion:
Analysis of hematological and immunological parameters profiles in COVID-19 patients may help in deciphering the clinical progression of patients suffering from COVID-19 disease. Thus, regular monitoring of the hospitalized patients may help in planning the management of these cases.
Prevalence and predictors of prehypertension and hypertension in adult population of rural Southern India—An epidemiological study
Authors: Udayar Sharvanan Eshwar , Thatuku Srinivas T. , Jevergiyal Devika Pandurang , Meundi Anand M. 
Published: July 2021

Introduction:
Hypertension is considered as one of the major health problem worldwide and the most important risk factor for non-communicable diseases.

Aims:
To estimate the prevalence and the risk factors of prehypertension and hypertension.

Methods and Material:
A community-based cross-sectional study was conducted among adult population of rural area of Chittoor District. WHO STEPS was applied for data collection from 1,742 study participants aged 18 years and above. Chi-square test, Fisher exact, and ANOVA test applied to find out the intragroup and intergroup variable association with raised blood pressure.

Results:
The overall prevalence of hypertension and prehypertension in our study was 21.5% [95% CI: (19.6–23.5)] and 42.8% [95% CI: (39.5–46.3)], respectively. Males had higher prevalence when compared to females. The mean systolic and diastolic blood pressure was 118.7 ± 17.6 mmHg and 77.1 ± 9.7 mmHg, respectively. The odds of being hypertensive was higher among older age group (OR: 3.83), male study participants (OR: 1.83), either widowed or separated (OR: 2.03), unemployed (OR: 1.51), and those who belonged to upper socioeconomic status (OR: 2.01). Those who were overweight (OR: 3.15), obese (OR: 2.55) and having central obesity (OR: 1.74), and also tobacco smokers (OR: 1.53) were having higher odds of hypertension. Significant association was found between hypertension and age, gender, marital status, body mass index, abdominal obesity, tobacco smoking, and physical inactivity.

Conclusion:
The prevalence of prehypertension and hypertension in this study was found to be high in rural area of Andhra Pradesh. There is a need to develop a community-based program, which would aim at minimizing the risk factors of hypertension.
Prevalence and reasons behind use of injectable contraceptive among the women of reproductive age group
Authors: Bairagya Anwesha , Basu Gandhari , Mondal Reshmi , Roy Suman Kumar 
Published: July 2021

Context:
Estimated 42 million reproductive age group women currently use injectable contraceptive, fourth most prevalent contraceptive worldwide.

Aims:
To find out the prevalence, reasons and the associated factors for using injectable contraceptive among the women of reproductive age group.

Settings and Design:
A sub-centre-based observational, cross sectional survey was conducted among 212 reproductive age group women living in the rural areas of a district, West Bengal.

Methods and Material:
A multi-stage cluster random sampling technique was done considering villages as the cluster to get the required sample. Totally, 212 reproductive age group women were chosen from a total of 16 villages, selected by simple random sampling. Information regarding study variables was collected by direct interview of the respondents by visiting individual houses with help of a pre-designed, semi-structured proforma. Strict confidentiality and anonimousity were maintained throughout the study.

Statistical Analysis Used:
Data were analysed with SPSS 22.0 (licensed). Mean, median, proportion were used for quantitative variables whereas qualitative attributes were presented by proportion. Associations between dependent and independent variables were tested by Chi-square test.

Results:
The proportion of teenage marriage was unexpectedly high. More than half mothers were unwilling to have babies in future. One-third of study population used injectable contraceptive, ASHA was the main suggestion provider in choosing the method. The major reasons of use were discomfort in previous method and suggestion of service provider. Irregular menstrual problem and easy maintenance was the commonest cause of dissatisfaction and satisfaction, respectively.

Conclusions:
Use of injectable contraceptive must be sincerely promoted through social marketing and the front line health workers should motivate the women to use it by providing correct information.
Development and validation of a nomogram for predicting varices needing treatment in compensated advanced chronic liver disease
Authors: Wang Jitao , Wei Wenxin , Duan Zhihui , Li Jinlong , Liu Yanna , Liu Chuan , Zhang Liting , Zhang Qingge , Zhou Shengyun , Zhang Kunpeng , Gao Fengxiao , Wang Xiaojuan , Liao Yong , Xu Dan , Huang Yifei , Wang Shuai , Hu Weiling , Mao Hua , Xu Ming , Dang Tong , Wu Bin , Yang Li , Liu Dengxiang , Qi Xiaolong 
Published: July 2021

Background:
Only a small proportion of patients with compensated advanced chronic liver disease (cACLD) had varices needing treatment (VNT) after recommended esophagogastroduodenoscopy (EGD) screening. We aimed to create a non-invasive nomogram based on routine tests to detect VNT in cACLD patients.

Methods:
The training cohort included 162 cACLD patients undergoing EGD in a university hospital, between January 2014 and September 2019. A nomogram was developed based on the independent predictors of VNT, selected using a multivariate logistic regression analysis. Thirty-three patients from eight university hospitals were prospectively enrolled as validation cohort between December 2018 and December 2019.

Results:
The prevalence of VNT was 32.7% (53/162) and 39.4% (13/33) in training and validation cohorts, respectively. The univariate analysis identified six risk factors for VNT. On the multivariate analysis, four of them, i.e., gallbladder wall thickness (odds ratio [OR]: 1.23; 95% confidence interval [CI]: 0.98-1.56), spleen diameter (OR: 1.02; 95% CI: 1.00-1.04), platelet count (OR: 0.98; 95% CI: 0.97-0.99), and international normalized ratio (OR: 0.58; 95% CI: 0.06-5.84) were independently associated with VNT. Thus, a nomogram based on the four above - mentioned variables was developed, and showed a favorable performance for detecting VNT, with an area under receiver operating characteristic curve of 0.848 (95% CI: 0.769-0.927) in training cohort. By applying a cut-off value of 105 in validation cohort, 31.0% of EGD were safely spared with 3.4% of missed VNT.

Conclusion:
A nomogram based on routine clinical parameters was developed for detecting VNT and avoiding unnecessary EGD in cACLD patients.