bluuebunny/crossref_metadata_2025_split huggingface dataset:
Facial Diplegia as Initial Manifestation of Acute, Myelomonocytic Leukemia with Isolated Trisomy 47, XY,+11[14]/46, XY[6]
Authors: Finsterer Josef , Panny Michael 
Published: June 2017

ABSTRACTBilateral peripheral facial palsy (facial diplegia) has been repeatedly reported as a neurologic manifestation of acute myeloid leukemia but has not been reported as the initial clinical manifestation of myelomonocytic leukemia. A 71-year-old male developed left-sided peripheral facial palsy being interpreted and treated as Bell’s palsy. C-reactive protein (CRP) and leukocyte count 4 days later were 2.5 mg/l and 16 G/l, respectively. Steroids were ineffective. Seven days after onset, he developed right-sided peripheral facial palsy. Three days later, CRP and leukocyte count were 234.3 mg/l and 59.5 G/l, respectively. Cerebrospinal fluid investigations revealed pleocytosis (62/3) and elevated protein (54.9 mg/dl). Two days later, pleocytosis and leukocytosis were attributed to myelomonocytic leukemia. Leukemic meningeosis was treated with cytarabine and methotrexate intrathecally. In addition, cytarabine and idarubicin were applied intravenously. Under this regimen, facial diplegia gradually improved. Facial diplegia may be the initial clinical manifestation of myelomonocytic leukemia, facial diplegia obligatorily requires lumbar puncture, and unilateral peripheral facial palsy is not always Bell’s palsy. Patients with alleged unilateral Bell’s palsy and slightly elevated leukocytes require close follow-up and more extensive investigations than patients without abnormal blood tests.
Delayed Facial Palsy after Microvascular Decompression: Report of Two Cases
Authors: Prasad G. Lakshmi , Kumar Vinod , Menon Girish 
Published: June 2017

ABSTRACTMicrovascular decompression (MVD) is a novel surgical procedure predominantly performed for treating trigeminal neuralgia (TN) and hemifacial spasm (HS). Multiple studies have proven the long-term success of MVD for both these conditions. The most common complications of MVD reported include chemical meningitis, facial hypesthesia, cerebrospinal fluid leak, facial paresis, and hearing loss. Delayed facial palsy (DFP) is an uncommon complication mostly noted in MVD for HS and after the removal of acoustic tumors. We report two cases of DFP occurring after performing MVD, one each for HS and TN. This is also the first case of DFP to be reported after MVD for TN. Both were young females who developed DFP 2 weeks after surgery. They were managed with oral steroids and acyclovir for 2–3 weeks and achieved excellent outcome at an average of 4.5 weeks from the onset. We conclude that although majority of the cases improve spontaneously, steroids and acyclovir might assist in faster recovery.
Mental Health Orientation for Self-Help Group Members: A Feasibility Study
Authors: Shrinivasa Basavaraj , Janardhana Navaneetham , Nirmala Bergai Parthsarathy 
Published: June 2017

ABSTRACT
Background: Treatment gap for mental health care in low- and middle-income (LAMI) countries is very large, and building workforce using the locally available resources is very much essential in reducing this gap. The current study is a preliminary work toward this direction. Materials and Methods: A single group pre- and post-design was considered for assessing the feasibility of Mental Health Orientation (MHO) Program for Self-Help Group members. Assessment of participants’ MHO using Orientation Towards Mental Illness (OMI) scale was undertaken at three levels: baseline assessment before the intervention, after completing 2 days orientation program, and 6 weeks later. Results: Analysis of data resulted in statistically significant mean scores in the domains of areas of causation (F[1.41, 40.7] = 21.7, P < 0.000, ηp
2 = 0.428), perception of abnormality (F[1.27, 36.8] = 15.8, P< 0.000, ηp
2 = 0.353), treatment (F[1.42, 41.3] = 34.8, P < 0.000, ηp
2 = 0.546), and after effect (F[1.36,39.4] = 26.7, P < 0.000, ηp
2 = 0.480). Although the overall mean scores of all the domains of OMI were found to be statistically significantly different, there was no significant difference in the mean scores between post and follow-up assessments on areas of causation (µd = 1.27, P = 0.440) and treatment (µd = 1.00, P = 0.156). Conclusion: Overall, the findings of our study demonstrate that brief MHO program can exert a beneficial effect on bringing about significant change in the orientation of the participants toward mental illness but need to be refreshed over time to make the impact of the program stay longer.
Environmental Arsenic Contamination and Its Effect on Intelligence Quotient of School Children in a Historic Gold Mining Area Hutti, North Karnataka, India: A Pilot Study
Authors: R. Manju , Hegde Amitha M. , Parlees Paul , Keshan Anisha 
Published: June 2017

ABSTRACT
Context: Arsenic is a rare crystal element that naturally occurs in all environmental media. A combination of regional and site-specific biogeochemical and hydrological factors governs its dispersion in the environment. It has far reaching consequences on human health. Exposure to arsenic in drinking water has been associated with a decline in intellectual function in children. Aim: The aim of this study is to assess the relationship between exposure to arsenic by drinking water and children’s intelligence in Karnataka state, India. Settings and Design: Twenty school children of age 10–14 years from Sandur, Bellary, Karnataka, and from Hutti, Raichur, Karnataka, were categorized as control and study group, respectively. Subjects and Methods: Water samples were collected from both the villages for the analysis of arsenic and fluoride levels. Hair and nail samples were collected from the participants, and the arsenic levels were determined. Intelligence quotient (IQ) assessment was done using the Raven’s Standard Progressive Matrices. Statistical Analysis Used: Chi-square test, Mann–Whitney U-test, and Fisher’s exact test. P < 0.05 was considered statistically significant. Results: There was a significant increase in the arsenic content in the hair and nail samples of children in the study group. The mean IQ tests score in the control group and study group was 30.55 and 17.95, respectively, and this difference was statistically significant. Conclusion: Chronic arsenic exposure could be a possible cause for the reduced IQ scores seen in children residing in Hutti, Raichur District, North Karnataka.
Junctional Chiasmatic Syndrome Due to Large Anterior Communicating Artery Aneurysm
Authors: Kesani Maruthi , Pelluru Pavan Kumar , Bhattacharjee Suchanda , Alugolu Rajesh , Purohit A. K. 
Published: June 2017

ABSTRACTEven though aneurysm involving the anterior communicating artery (A Com A) was common in clinical practice, producing compressive symptoms such as visual loss was rare. We report a case, in which patient had gradually progressive visual loss with features of the junctional chiasmatic syndrome, imaging revealed partially thrombosed large A Com A aneurysm. Intraoperatively, aneurysm was found compressing the optic chiasm and right optic nerve, following clipping and decompression of the optic nerve and chiasm there was gradually improvement in the vision over 2 weeks postoperatively.
Cognitive and Functional Outcomes following Inpatient Rehabilitation in Patients with Acquired Brain Injury: A Prospective Follow-up Study
Authors: Patil Maitreyi , Gupta Anupam , Khanna Meeka , Taly Arun B. , Soni Amit , Kumar J. Keshav , Thennarasu K. 
Published: June 2017

ABSTRACT
Objectives: To study the effects of cognitive retraining and inpatient rehabilitation to study the effects of cognitive retraining and inpatient rehabilitation in patients with acquired brain injury (ABI). Design and Setting: This was a prospective follow-up study in a neurological rehabilitation department of quaternary research hospital. Patients and Methods: Thirty patients with ABI, mean age 36.43 years (standard deviation [SD] 12.6, range 18–60), mean duration of illness 77.87 days (SD 91.78, range 21–300 days) with cognitive, physical, and motor-sensory deficits underwent inpatient rehabilitation for minimum of 14 sessions over a period of 3 weeks. Nineteen patients (63%) reported in the follow-up of minimum 3 months after discharge. Type of ABI, cognitive status (using Montreal Cognitive assessment scale [MoCA] and cognitive Functional Independence Measure [Cog FIM]®), and functional status (motor FIM®) were noted at admission, discharge, and follow-up and scores were compared. Results: Patients received inpatient rehabilitation addressing cognitive and functional impairments. Baseline MoCA, motor FIM, and Cog FIM scores were 15.27 (SD = 7.2, range 3–30), 31.57 (SD = 15.6, range 12–63), and 23.47 (SD = 9.7, range 5–35), respectively. All the parameters improved significantly at the time of discharge (MoCA = 19.6 ± 7.4 range 3–30, motor FIM® = 61.33 ± 18.7 range 12–89, Cog FIM® =27.23 – 8.10 range 9–35). Patients were discharged with home-based programs. Nineteen patients reported in follow-up and observed to have maintained cognition on MoCA (18.8 ± 6.8 range 6–27), significantly improved (P < 0.01) on Cog FIM® (28.0 ± 7.7 range 14–35) and motor FIM® =72.89 ± 16.2 range 40–96) as compare to discharge scores. Conclusions: Cognitive and functional outcomes improve significantly with dedicated and specialized inpatient rehabilitation in ABI patients, which is sustainable over a period.
Single Parietal Burr-hole Craniostomy with Irrigation and Drainage for Unilateral Chronic Subdural Hematoma in Young Adults <40 Years: A Rationale behind the Procedure
Authors: Chandran Raj S. , Nagar Milesh , Sharmad M. S. , Prabhakar Rajmohan B. , Peethambaran Anil K. , Kumar Shailesh , Sharma Saurabh , Jain Sourabh K. 
Published: June 2017

ABSTRACT
Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. It is mostly a disease of elderly population with very little data about the young patients. There is also the debate regarding treatment strategies. We decided to determine the overall efficacy of the single burr-hole craniostomy (SBHC) for unilateral CSDH in young adults <40 years. Subjects and Methods: We performed a retrospective study of young patients undergoing SBHC for unilateral CSDH between January 2013 and June 2016 at our institution. Medical records were assessed based on patient characteristics in the form of sex of the patient, etiology, presenting symptoms, comorbidities, and signs including Glasgow Coma Scale, computed tomography (CT) brain findings (site and thickness of SDH with midline shift), and intraoperative presence of chronic/subacute component. Results: Mean age of the patient was 33.69 years (range 18–40 years), mean thickness of SDH was 15.47 mm, and mean midline shift was 11.26 mm. 61.54% patients were male, trauma being the most common etiology (92.31%) with most common presenting complaint being headache (90.38% patients). 69.23% patients presented within 1 day of onset of symptoms. On CT scan, most of the patients were having SDH thickness between 11 and 20 mm (67.31%) with midline shift of 6–10 mm (53.85%). Right-sided SDH was present in 53.85%. Intraoperatively, 63.46% patients had subacute SDH whereas 34.61% had chronic component. There were total 2 recurrences (3.85%). Conclusions: Young adults who present with unilateral CSDH usually have a history of trauma. They have shorter duration of symptoms and present mainly with the features of raised intracranial pressure such as headache and vomiting. SBHC with irrigation and drainage has excellent result for unilateral CSDH in young adults compared to other methods of drainage and should be considered treatment of choice unless contraindicated.
Electronic Health Record Effects on Work-Life Balance and Burnout Within the I3 Population Collaborative
Authors: Robertson Sandy L. , Robinson Mark D. , Reid Alfred 
Published: June 2017

ABSTRACT

Background
Physician burnout is a problem that often is attributed to the use of the electronic health record (EHR).

Objective
To estimate the prevalence of burnout and work-life balance satisfaction in primary care residents and teaching physicians, and to examine the relationship between these outcomes, EHR use, and other practice and individual factors.

Methods
Residents and faculty in 19 primary care programs were anonymously surveyed about burnout, work-life balance satisfaction, and EHR use. Additional items included practice size, specialty, EHR characteristics, and demographics. A logistic regression model identified independent factors associated with burnout and work-life balance satisfaction.

Results
In total, 585 of 866 surveys (68%) were completed, and 216 (37%) respondents indicated 1 or more symptoms of burnout, with 162 (75%) attributing burnout to the EHR. A total of 310 of 585 (53%) reported dissatisfaction with work-life balance, and 497 (85%) indicated that use of the EHR affected their work-life balance. Respondents who spent more than 6 hours weekly after hours in EHR work were 2.9 times (95% confidence interval [CI] 1.9–4.4) more likely to report burnout and 3.9 times (95% CI 1.9–8.2) more likely to attribute burnout to the EHR. They were 0.33 times (95% CI 0.22–0.49) as likely to report work-life balance satisfaction, and 3.7 times (95% CI 2.1–6.7) more likely to attribute their work-life balance satisfaction to the EHR.

Conclusions
More after-hours time spent on the EHR was associated with burnout and less work-life satisfaction in primary care residents and faculty.
A Study to Analyze the Efficacy of Levonorgestrel Intrauterine System in the Management of Abnormal Uterine Bleeding among Urban Indian Women
Authors: Chowdhury Bijit , Sanyal Poushali , Gupta Anshu , Roychoudhury Bidisha , Zoha MMS 
Published: June 2017

ABSTRACT
Objective
The study tried to analyze the efficacy of levonorgestrel intrauterine system (LNGIUS) for the treatment of heavy menstrual bleeding in the urban and suburban Indian women.

Materials and methods
The present study was conducted in the Department of Gynecology and Obstetrics, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata, over a period of 1 year. A total of 20 patients suffering from abnormal uterine bleeding in the age group of 20 to 45 years were recruited in this study. The LNGIUS was inserted in all the women and they were followed up at the end of 3, 6, and 12 months. All subjects completed 1 year duration of follow-up. We used the Student’s paired t-test to evaluate the reduction in the menstrual blood loss, passage of clots, and increase in hemoglobin concentration at each point from the baseline.

Results
At the end of 6 months, most (90%) of the women had an acceptable bleeding, with 10% having amenorrhea (pictorial blood-loss assessment chart score 0). Statistically significant improvement in the hemoglobin level was observed at the end of 3, 6, and 12 months postinsertion. The level of satisfaction increased steadily with time.

Conclusion
Levonorgestrel intrauterine system is an effective reversible treatment for menorrhagia. Levonorgestrel intrauterine system can be used as an effective alternative to hysterectomy in the future in the urban and suburban affluent Indian women.

How to cite this article
Gupta A, Roychoudhury B, Sanyal P, Chowdhury B, Zoha MMS. A Study to Analyze the Efficacy of Levonorgestrel Intrauterine System in the Management of Abnormal Uterine Bleeding among Urban Indian Women. J South Asian Feder Menopause Soc 2017;5(1):19-22.
Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country
Authors: Khan Erum S , Irfan Sheikh , Khalid Natasha 
Published: June 2017

ABSTRACT
Introduction
Surgical site infections (SSIs) are among the most common complications in surgical patients and have serious consequences for outcomes and costs. There is a dearth of information on risk factors for developing SSI in patients undergoing gynecologic cancer surgery, and this has not been studied using national data.

Objectives
The objectives of this study were to estimate the prevalence, preoperative and operative risk factors associated with the higher risk of SSIs in gynecologic cancer patients undergoing surgery in a tertiary care facility in a developing country.

Setting
Department of Obstetrics and Gynaecology, Aga Khan University Hospitals, Karachi, Sindh, Pakistan.

Materials and methods
Retrospective record review of gynecologic oncology patients admitted for surgery from January 2015 to December 2015 was performed.

Results
A total of 100 patients met the inclusion criteria. Of these, 15 were identified with SSIs, which were all found to be of the superficial type. Approximately, 44, 40, and 7% were diagnosed with endometrial, ovarian, and cervical cancers respectively. The mean time from surgery to developing SSI was 12.9 days. Among endometrial cancer, 22.7% (10/44) had SSI compared with 7.5% (3/40) for ovarian cancer and 14.2% (1/7) for cervical cancer. The significant predictors of SSI were body mass index ≥35 (p-value <0.004), endometrial cancer diagnosis, the American Society of Anesthesiologists class more than 3, modified surgical complexity scoring system 3 to 4, and blood sugar levels more than 180 mg/dL within 48 hours after surgery in known diabetics.

Conclusion
About 15% of patients undergoing laparotomy for gynecologic malignancy developed SSIs. In this study, we identified several risk factors for developing SSI among gynecologic cancer patients. These findings may contribute toward identification of patients at risk for SSIs, and the development of strategies to reduce SSI rate and potentially reduce the cost of care in gynecologic cancer surgery.

How to cite this article
Khan ES, Irfan S, Khalid N. Rate and Risk Factors for Surgical Site Infection in Gynecologic Oncology Surgeries at a Tertiary Care Facility in a Developing Country. J South Asian Feder Menopause Soc 2017;5(1):23-27.
Knowledge and Awareness of Cervical Cancer and Human Papilloma Virus Vaccine among Medical Students: A Cross-sectional Study
Authors: Rathod Setu , Samal Sunil K , Samal Sunita 
Published: June 2017

ABSTRACT
Aim
Cervical cancer is still one of the most common cancers affecting females in India, leading to a lot of mortality and morbidity. Since it is a preventable cancer, the study is aimed to assess the knowledge and awareness of cervical cancer and human papilloma virus (HPV) vaccine among medical students.

Materials and methods
This is a cross-sectional study conducted among the medical students in a tertiary care center in Mahatma Gandhi Medical College & Research Institute, Puducherry, India. Three hundred students were administered a validated 53-point questionnaire regarding knowledge of cervical cancer, its risk factors, preventive measures, HPV vaccine, and screening tests. Data were kept confidential and the results were analyzed by Statistical Package for the Social Sciences software version 16.

Results
The results show 93.3% of students were aware that cervical cancer is caused by HPV, but only 61.4% knew that HPV vaccine was available. Majority of the students were uncertain about age group, number of doses, and side effects of vaccine. Only 11.74% felt the need to get vaccinated in future; 96.64% of students knew that pap smear was used to screen for cervical cancer, but only 57.72% opted to screen themselves or family members in future as they believed that they were not at risk. The common obstacle against vaccination was worry about complications, inadequate information, and efficacy of vaccine.

Conclusion
The study showed that there were misconceptions among medical students regarding cervical cancer, vaccine, and screening, which have to be cleared. Creating awareness among health care workers on risk factors, vaccination, and current methods for cervical cancer screening is a necessary step toward implementing effective prevention programs in the society.

How to cite this article
Rathod S, Samal SK, Samal S, Ghose S. Knowledge and Awareness of Cervical Cancer and Human Papilloma Virus Vaccine among Medical Students: A Cross-sectional Study. J South Asian Feder Menopause Soc 2017;5(1):41-44.
Application of Environmental Conflict Resolution to Public Interest Issues in Water Disputes
Authors: Jeffrey QC Michael , Craig Donna 
Published: June 2017

This article examines the role of environmental conflict resolution (ECR) in the public interest issues of water disputes. The article endeavours to illustrate the strengths and weaknesses of a range of alternative dispute resolution (ADR) and negotiation approaches in the context of decision-making. Although many embrace ECR as the cheaper and more effective alternative to more formalistic and entrenched judicial processes before courts of law and quasi-judicial tribunals, the authors argue that there is an urgent need for a more critical, contextual and issue-oriented approach. In particular, the article highlights the significant difficulties associated with representing the full range of stakeholders who should be involved in an ADR process, and the lack of transparency and procedural safeguards associated with ADR in complex public interest disputes. The strength of ADR in smaller project-specific disputes involving a very limited number of stakeholders is well understood. The authors argue that ADR may have a significant role in scoping the issues and associated research as well as facilitating agreement on procedural aspects of large, complex public interest water disputes. However, ADR has severe limitations as a decision-making process. For example, water conflicts necessarily involve the concept of sustainability that in turn touches on a complex maze of social, political, economic and ecological values. The probability of reaching a mediated settlement in such a context is severely curtailed. A preferable approach may be one that is entirely transparent, capable of being both monitored and enforced, and is binding on all stakeholders whether or not they are parties to the mediation.
‘Placing’ the other: final year law students’ ‘imagined’ experience of rural and regional practice within the law school context
Authors: Mundy Trish Karen 
Published: June 2017

This paper discusses the partial findings from a research study involving a narrative analysis of in-depth interviews with twelve final year law students. The research explored student attitudes to, and perceptions of, legal practice in rural, regional and remote (RRR) communities – that is, their ’imagined experience’. The research findings suggests that, at least in the context of the non-regional law school, the rural/regional is both absent and ‘other’, revealing the ‘urban-centric’ nature of legal education and its failure to adequately expose students to rural and regional practice contexts that can help to positively shape their ‘imagined’ experience. This paper argues that all law schools must take up the challenge of rural inclusiveness by integrating a sense of ‘place-consciousness’ into the law curriculum.