bluuebunny/crossref_metadata_2025_split huggingface dataset:
Provision of Timely Alternative Multidisciplinary Protocols for Patients Refusing Blood or Blood Products
Authors: Melamed Naomi 
Published: December 2023

Blood components and products are life-saving therapeutics but with inherent, life-threatening risks. There are patients who do not accept blood products for different reasons, including fear of blood borne viruses, transfusion reactions and religious beliefs. It is important to determine the standard of care and outcomes for such patients, within any clinical setting. The aim of this audit was to evaluate adherence to the agreed standard of care for patients who do not accept blood transfusion.
Methods
All patients who refused transfusions between 2019 and 2021 were included. Scanned forms and Electronic Patient Records were used to gather data. Expected care standards were: (1) a multidisciplinary team (MDM) led alternative care plan, agreed at least 3 weeks prior to the intervention/ procedure, to prepare for blood loss, and (2) that the MDM should involve: either a surgeon or physician, anaesthetist (if the treatment is surgical or antenatal), haematologist or transfusion practitioner and the patient.
Results
There were 195 patients referred to MDMs, of which 105 were surgical (54%), 52 were interventional (27%) and 38 were antenatal (19%). Of these, 188 (96%) were sent before a procedure (or birth) with the remaining 7 (4%) referred for ongoing treatment of medical patients, i.e. with severe anaemia. In 72 patients (38%) the MDM did take place ≥3 weeks before the procedure (similar to the results from the first cycle of the audit, in 2017-18 = 40%). Almost 85% (165) of MDM included all relevant stakeholders.
Discussion
The delay in timely referral for MDM led alternative care plan was likely due to a lack of awareness of transfusion policies, and potentially could lead to cancellation of the procedure or unavailability of alternative protocols in an emergent scenario during surgery or intervention.
Conclusion
Improvement was required for safer procedures and outcomes, by investment in training, regular refreshers/ updates for staff and electronic protocols/ prompts.
Supporting Acute Neonatal and Paediatric Care Quality in Nepal
Authors: McQuaige Fiona , Shah Arvind 
Published: December 2023

The RCPCH Global Health programme has been working for over 20 years in many middle- and low-income countries to help improve the quality of child health worldwide. In 2021, RCPCH Global launched a new programme in Nepal working in partnership with Nepal Paediatric Society (NEPAS) the Nepal Ministry of Health and United Nations International Children’s Emergency Fund (UNICEF). This report outlines the component of the programs and highlights the success in improving neonatal and paediatric emergency care.
Distribution of Phlebotomus argentipes Annandale & Brunetti, 1908 in the Anuradhapura district, North Central Sri Lanka
Authors: Nayakarathna NMNG , Gunathilaka RAKM , Ganehiarachchi GASM 
Published: December 2023

Background & objectives:

Phlebotomus argentipes Annandale & Brunetti, 1908 (Diptera: Psychodidae) is the main vector responsible for the transmission of Leishmania donovani (Laveran & Mesnil, 1903) Ross, 1903 in the subcontinent of India. It is the potential vector of cutaneous leishmaniasis in Sri Lanka. The present study determined ecological factors that influence the abundance of P. argentipes in areas with high disease prevalence in the Anuradhapura district, North Central Sri Lanka.

Methods:
CDC light traps and yellow sticky traps were used for sampling, and abundance was recorded throughout 12 months with selected environmental parameters namely, relative humidity, wind speed, and temperature. The relationships between the abundance of P. argentipes with mean temperature, % relative humidity, and wind speed were tested with regression analysis. The temporal distribution of the vector population was tested with a time series analysis.

Results:
The study identified the most preferable microhabitats of P. argentipes: shrubs, unclear areas, gardening areas, wet soil areas with leaf litter, and termite hills. The results indicated that the abundance of P. argentipes was highly dependent on mean temperature (P = 0.00, R2 = 68%), and a high number of P. argentipes was recorded for a low mean temperature range of 24.7–27.3°C. Furthermore, the abundance of P. argentipes exhibited an increasing trend with high humidity levels of 72–88% (P = 0.00, R2 = 91.6%).

Interpretation & conclusion:
These findings may help predict the temporal variation of the potential vector population with studied ecological parameters and contribute to a successful vector management strategy with thorough knowledge of the behavioral pattern of P. argentipes.
A rapid method for DNA Isolation from blood, dried blood spots and rapid diagnosis test
Authors: Sharma Supriya , Sen Aparajita , Ahmed Naseem , Swarnkar Deendayal , Singh Himmat 
Published: December 2023

Background & objectives:
Malaria is a parasitic disease spread by Plasmodium parasite. Microscopy, lateral flow devices such as the Rapid Diagnostic Test (RDT), molecular methods such as Polymerase Chain Reaction (PCR), isothermal methods such as Loop-mediated isothermal amplification (LAMP), and other diagnostic methods are available for malaria. On the other hand, the accuracy of molecular diagnosis is dependent on genomic DNA isolation. A quick method for isolating and subjectively determining the presence of genomic DNA from blood, dried blood spot (DBS), and rapid diagnostic test (RDT), was identified.

Methods:
We have developed a protocol for isolating DNA from blood, DBS, and RDTs using the HUDSON Buffer (TCEP and EDTA). Isolated genomic DNA was seen with SYBR Safe DNA stain (1X) under a UV transilluminator without running in 0.8 percent gel electrophoresis or using a spectrophotometer.

Results:
The technique for DNA isolation was accurate for the presence of malaria parasite genomic DNA from positive samples confirmed by microscopy with a sensitivity of 76% and specificity of 78.67% and RDT with a sensitivity of 88% and specificity of 66%. The requirements were minimal, and the process took 30 minutes for a hundred sample processing.

Interpretation & conclusion:
Finding a fast and reliable method of separating nucleic acids from many samples is crucial. This approach extracts intact genomic DNA in under ten minutes, making it ideal for large-scale investigations.
Evaluation of the knockdown resistance locus (kdr) in Anopheles stephensi (Diptera: Culicidae) in southeastern Iran
Authors: Hajibeygi Ramtin , Hejripour Seyed Zia , Taghavi Nader , Shahali Hamzeh , Zarei Saeed , Nouri Majid , Mirahmadi Hadi , Tabatabaie Seyed Mahdi , Solgi Rahmat , Darvishi Mohammad 
Published: December 2023

Background & objectives:
The resistance to insecticide among Anopheles stephensi population due to insecticide selection pressure has been previously reported from Iran. The current study was performed to evaluate the susceptibility of different insecticide reagents against An. stephensi by bioassay and molecular methods in Saravan County, a malaria-endemic area in southeastern Iran.

Methods:

An. stephensi mosquitoes were collected from different larval habitats in Saravan City, southeastern Iran in 2022. At first, the susceptibility of collected samples for DDT, permethrin, and deltamethrin were evaluated by bioassay test. The collected mosquitoes were then evaluated for the presence of different kdr mutations.

Results:
Insecticide susceptibility tests were conducted on the field population of An. stephensi from Saravan, revealing its potential resistance to pyrethroids and DDT. Of the 150 An. stephensi samples, 4 % carried the kdr L1014F mutation as heterozygous and the rest of them were homozygous L1014 wild type.

Interpretation & conclusion:
The current study revealed the presence of L1014F mutation for the first time in Iran. So, further monitoring of kdr mutations in the VGSC gene and resistance phenotypes should be performed.
Prevalence of preoperative anxiety and depression in patients undergoing major oncologic surgeries: An analytical cross-sectional study
Authors: Opneja Sonali , Sureshan Roopesh , Abraham Jisha , Balasubramanian Satheesan , Malodan Riyas , John Mayan 
Published: December 2023

Background:
Depression and anxiety experienced before major cancer surgeries have been associated with postoperative morbidity and mortality.

Objectives:
This study aimed to estimate the prevalence of preoperative anxiety and depression in patients undergoing major oncosurgeries.

Materials and Methods:
This was a cross-sectional analytical study conducted between June 2021 and June 2022 at Malabar Cancer Center in Thalassery, Kerala, in South India. We enrolled patients aged 18–65 years undergoing major oncosurgeries with American Society of Anesthesiologists (ASA) Physical Status Grades I and II. Patients were administered a questionnaire (in the local language, Malayalam) by the anesthesiologist on their first preoperative visit after the preanesthetic checkup. The questionnaire was in two parts: part 1 consisted of the demographic data, and part 2 comprised the Patient Health Questionnaire-4 (PHQ-4) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS). On the PHQ-4, a score of ≥3 for the first two questions was the cutoff for anxiety, and a score of ≥3 for the last two questions was the cutoff for depression. APAIS is a six-item questionnaire; a score of ≥11 on the anxiety scale was considered positive for anxiety, and a score of >5 was considered to indicate the need for more information.

Results:
We enrolled 200 patients; 136 (68%) were women, and the median age overall was 52 (interquartile range [IQR], 42–60). Patients enrolled were planned for surgeries for head-and-neck cancers (n = 55, 27.5%), laparotomies or therapeutic laparoscopies (n = 70, 35%), breast cancers (n = 67, 33.5%), and bone and soft tissue surgeries (n = 8, 4%). Anxiety was noted in 49 (24.5%) patients by PHQ-4 and 23 (11.5%) patients by APAIS; depression was detected in 31 (15.5%). The presence of depression significantly contributed to anxiety. Patients who screened positive for depression had 79.6 times higher odds of screening positive for anxiety, as compared to those who screened negative for depression.

Conclusion:
Almost one in four patients undergoing major oncosurgeries experience preoperative anxiety, and one in six have depression. Patients have a substantial requirement for information concerning anesthesia and surgical procedures, which, if unmet, contributes to anxiety and/or depression. Preoperative counseling and providing more information to patients could reduce anxiety or depression. Other causative personal, familial, social, or economic factors should also be assessed and managed (Clinical Trials Registry of India number: CTRI/2021/07/034568).
The prevalence and correlates of comorbidities among patients with cancer attending a tertiary care cancer center in South India: An analytical cross-sectional study
Authors: Sebastian Divya , Joseph Jaison , Mathews Elezebeth 
Published: December 2023

Background:
Comorbidities in patients with cancer can affect treatment, and should, therefore, be prioritized and managed.

Objectives:
Our primary aim was to assess the prevalence of comorbidities among patients with cancer. The secondary objective was to identify the association of comorbidities with various sociodemographic and clinical variables.

Materials and Methods:
This was a cross-sectional study conducted between December 2019 and March 2020 among patients with cancer, seeking treatment at Malabar Cancer Center, in Kannur District of northern Kerala in South India. Semi-structured interviews were conducted, and comorbidities were assessed using the Charlson Comorbidity Index. The anthropometric measurements were recorded using a standardized instrument and protocol.

Results:
We enrolled 242 patients in this study. There were 148 (61.2%) female patients; 106 (43.8%) were aged between 41 and 50 years. Cancers of the head-and-neck and breast accounted for the majority of cases (23.1% each, n = 56), followed by the digestive system (18.6%, n = 45) and female reproductive system (11.2%, n = 27). The most common primary cancers in the head-and-neck, digestive, and female reproductive systems were oral, colorectal, and cervical, respectively. The prevalence of comorbidities among patients with cancer was 70.2% (n = 170). Common comorbidities were hypertension (n = 82; 33.9%), arthritis (n = 57; 23.6%), and diabetes (n = 53; 21.6%). After controlling for potential confounders, the factors noted to be independently associated with the presence of comorbidities were advanced age, family history of comorbidity, normal weight or underweight, and cancer treatment for more than 6 months' duration.

Conclusions:
The high prevalence of comorbidities among patients with cancer suggests the need for an integrated system of care and management as the comorbidities affect the overall management of cancer treatment and care.
TAFRO Syndrome Mimicking Solid Cancer and Successfully Treated by Tocilizumab: A Case and Literature Review
Authors: Fu Pei-An , Wu Chia-Chi , Hsu Ya-Ting 
Published: December 2023

Abstract
TAFRO syndrome, or now formally termed idiopathic multicentric Castleman disease (iMCD) with thrombocytopenia, anasarca, fever, renal insufficiency or reticulin fibrosis, and organomegaly (iMCD-TAFRO), describes a unique subtype of iMCD. Hypersecretion of pro-inflammatory cytokines, such as interleukin-6, plays a critical role in this disease. Several anti-inflammatory medications are used for treatment, such as tocilizumab, siltuximab, and rituximab, and they have demonstrated efficacy in some cases; however, the disease remains incurable. Here, we report a 56-year-old woman who presented with ileus and progressive ascites formation. She received several operations for suspected secondary peritonitis, but thrombocytopenia, lymphadenopathy, and anasarca progressed. It took 1 year to reach the diagnosis of iMCD-TAFRO, and tocilizumab was given soon after the diagnosis. After tocilizumab treatment, her symptoms improved dramatically. Due to the heterogeneous clinical manifestations of iMCD-TAFRO, awareness of iMCD-TAFRO and a multidisciplinary team approach are required for a timely and accurate diagnosis of iMCD-TAFRO.
A retrospective analysis of the 5-year trends of antimicrobial resistance in gram-negative bacterial isolates from an intensive care unit at a tertiary care hospital
Authors: Raj Nikhil , Agarwal Jyotsna , Singh Vikramjeet , Nath Soumya Sankar , Das Anupam , Sen Manodeep 
Published: December 2023

Background:
Intensive care units (ICUs) in developing countries constitute a high risk for patients acquiring infection by multidrug-resistant organisms (MDROs). The rise in antimicrobial resistance (AMR) threatens the effective prevention and treatment of an increasing range of infections. The present study analyzed the local trends of AMR in Gram-negative isolates of ICU patients from a tertiary care facility in North India.

Methods:
This retrospective study was conducted over 5 years (January 2018–December 2022). All bacterial isolates from patients admitted to ICU during the study period were included in the study, and their AMR pattern was analyzed. In addition, sensitivity trends of different antimicrobials against the common Gram-negative bacteria were analyzed, and AMR trends were analyzed over the study period.

Results:

Klebsiella spp. was the most common isolate in samples received from ICU. A rise of carbapenem-resistant microorganisms was observed over the study period. Escherichia
coli and Klebsiella spp. showed around 10% and a 17% decrease in susceptibility to carbapenems, respectively. In contrast, a marked 29% decrease in sensitivity to carbapenems was observed in Acinetobacter spp.

Conclusion:
The inception of integrated stewardship measures has shown a rising trend in susceptibility and is the need of the hour to prevent the spread of MDROs. Surveillance studies help us understand the impact of AMR in hospitals and help plan prevention programs.
A prospective observational study to correlate lung ultrasound with clinical severity and prognosis score in patients with primary pulmonary pathology on invasive ventilatory support
Authors: Basu Sulagna , Verma Rishiraj Narayan , Joshi Aditya , Dwivedi Deepak , Mateen Mohammad Abdul , Bhatia Jagdeep Singh 
Published: December 2023

Background:
Lung ultrasound (LUS) is a known imaging modality employed for monitoring patients in an intensive care unit. This study evaluates, LUS in assessing disease severity and prognosis, by correlating its score with the three commonly used clinical severity scoring systems (CSSS), namely, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE) II score, and simplified acute physiology score (SAPS) II.

Methods:
This single-center prospective observational study included 54 adult patients of primary lung disease-induced acute respiratory distress syndrome (ARDS), on invasive ventilation. The primary objective was to correlate LUS score with SOFA score. Secondary objectives were to correlate LUS score with APACHE II and SAPS II scores. LUS score was also correlated with the estimated mortality derived from the above-mentioned scores. A subgroup analysis on COVID-19-positive cases was also carried out. All scores were calculated on the initiation of mechanical ventilation, daily for 7 days or mortality, whichever was earlier.

Results:
A significant positive correlation (P < 0.001) was found between LUS and all three severity scores, as well as their corresponding estimated mortality percentages, for all days of the study period, in both non-COVID-19 ARDS patients and in COVID-19 patients. The merit of all four scores in differentiating between the survivor and mortality group for the duration of study also showed significant (P < 0.05) to very significant (P < 0.001) results.

Conclusion:
Point-of-care LUS in conjunction with CSSS is a reliable tool for assessing the severity and progression of primary lung disease.
Clinical utility of i-gel® and BlockBuster™ supraglottic devices for airway management in postburn injury contracture neck patients under general anesthesia: A randomized controlled trial
Authors: Tripathi Manish Kumar , Tiwari Tanmay , Naithani Bhavya , Upadhyaya Divya Narain , Singh Prem Raj , Tripathi Ila 
Published: December 2023

Background:
Post burn injury contracture (PBC) neck patients pose a unique challenge for the anesthesiologists. The use of supraglottic device (SGDs) for managing such patients is being increasingly used. We compared i-gel® and LMA BlockBuster™ in PBC adult patients under general anesthesia (GA).

Methods:
The study included 63 subjects with mild/moderate PBC neck of either sex with American Society of Anesthesiologists Physical Status I and II under GA. Patients with intraoral pathology, mouth opening <2.5 cm, and severe contracture were excluded. Patients were randomly assigned to i-gel® (I) and BlockBuster™ (B) groups. The primary objective of the study was the time for successful insertion. First attempt success rate, oropharyngeal leak pressures (OLP), and complications were also assessed.

Results:
Mean insertion time was significantly less in Group I as compared to Group B (17.35 ± 1.43 vs. 21.32 ± 1.10 s; P < 0.001), OLP in Group B was significantly higher as compared to Group I (34.03 ± 1.33 vs. 25.23 ± 3.04 cm of H2O; P < 0.001). Group I was found to be statistically easier to insert as compared to Group B (P = 0.011) with reduced requirement of airway maneuvering to insert the device (P = 0.017). Groups were similar in terms of complications.

Conclusion:
SGDs are attractive option for airway management in mild/moderate degree of PBC neck. i-gel® having shorter insertion time with easier insertion can be favorable at times of emergency while use of LMA BlockBuster™ can be preferred to reduce the risk of aspiration owing to higher OLP.
Comparative histomorphologic study of basement membrane side staining and additional epithelial side staining of the anterior lens capsule with Trypan Blue
Authors: Srinija Kommana , Bhat Subrahmanya K , Prasad Kishan H L 
Published: December 2023

Purpose:
To compare the histomorphologic changes on the anterior lens capsule by both epithelial and basement membrane side staining to those of only basement membrane side staining of the anterior lens capsule with Trypan Blue (TB).

Methods:
A cross-sectional study was done on 72 samples from patients who underwent cataract surgery between April 2021 and September 2022. After capsulorhexis of the TB-stained capsule, it was made into two halves externally and one half labeled as controls (sample A). The other half was immediately stained further with TB on the epithelial side and was taken as cases (sample B). Samples were analyzed for lens epithelial cells and basement membrane changes.

Results:
The loss of intactness of lens epithelial cells, partial or complete detachment of lens epithelial cells, degeneration of lens epithelial cells, and basement edema were significantly higher in cases compared to controls, whereas intactness of the basement membrane did not show any statistical significance between the two groups. There was a statistically significant decrease in cell density in cases compared to controls.

Conclusion:
Staining the epithelial side of the capsular bag with TB is more detrimental to lens epithelial cells and paves the way for a further study of staining the capsular bag before intra-ocular lens implantation to reduce the incidence of posterior capsule opacification.
Clinical profile, demographic distribution, and management of Posner–Schlossman syndrome: An electronic medical record-driven data analytics from an eye care network in India
Authors: Warjri Gazella B , Das Anthony V , Senthil Sirisha 
Published: December 2023

Purpose:
To describe the clinical profile, demographics, and management of Posner–Schlossman syndrome (PSS) in patients presenting to a multitier ophthalmology hospital network in India.

Methods:
This cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of PSS in at least one eye were included as cases. The data were collected using an electronic medical record system.

Results:
Overall, 130 eyes of 126 (0.004%) patients were diagnosed with PSS. The majority of the patients were male (81.75%) and had unilateral (96.83%) affliction. The most common age group at presentation was during the fourth decade of life, with 46 (36.5%) patients. The overall prevalence was higher in patients from a higher socioeconomic status (0.005%) presenting from the metropolitan geography (0.008%) and in professionals (0.014%). A significant number of patients (108; 83.08%) had a raised intraocular pressure of >30 mm of Hg. The majority of the eyes had mild or no visual impairment (better than 20/70) in 99 (76.15%) eyes. Keratic precipitates were found in 59 (45.38%) eyes, anterior chamber cells in 43 (33.08%) eyes, and iris atrophy in seven (5.38%) eyes. The majority of eyes (127; 97.69%) had open angles on gonioscopy. The average duration of use of topical steroids was 1.70 ± 0.76 months, and the average duration of use of topical antiglaucoma medications (AGMs) was 1.66 ± 0.81 months, with 35 eyes (26.92%) requiring continued AGMs. Among the surgical interventions, trabeculectomy was performed in nine (6.92%) eyes and cataract surgery in five (3.85%) eyes.

Conclusion:
PSS more commonly affects males presenting during the fourth decade of life from higher socioeconomic status and is predominantly unilateral. The majority of the eyes have mild or no visual impairment, open angles, and require surgical intervention in a tenth of the eyes.