bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective review of 188 cases of epistaxis presenting to the emergency department: Etiology and outcome
Authors: Raaj Prethesh , Hazra Darpanarayan , Chandy Gina M. , Jacob Christna R. , Ganesan Priya 
Published: November 2023

Background:
Due to a myriad of risk factors, epistaxis is a very frequent presentation to the emergency room (ER). This study aims to ascertain the prevalence of epistaxis in our population, risk factors, effectiveness of ER treatment, complications, and ER outcome.

Materials and Methods:
This was a prospective observational study performed in the ER of a referral tertiary care center in south India. Data were categorized, coded, and analyzed to determine the objective of the study.

Results:
During the study's six-month duration, 188 (0.6%) patients presented with epistaxis. The mean age was 42.9 (SD: 16.49) years, with a male preponderance of 143 (76.1%). A majority of these patients (n: 156; 82.9%) were triaged as priority II, with hypertension (n: 53, 28.2%) as the commonest comorbidities. Trauma-related epistaxis (n: 107, 56.9%) was the most frequent cause. Anterior nasal packing was carried out for 85 (45.2%) patients, posterior nasal packing was carried out for one (0.5%) patient, and bleeding had spontaneously resolved in the majority (n: 102; 54.3%) patients. Seven (3.7%; p-value: 0.001) patients had recurrent epistaxis, and of those, three (1.6%) required urgent resuscitation with crystalloid fluid and blood products. Two of these patients had bleeding dyscrasias, four had history of trauma, and one patient presented with uncontrolled hypertension. Two (1.1%) patients came back to us with recurrent bleeding within 12 h of discharge. Majority (69.2%; 130) were discharged stable, (23.9%; 45) were admitted for observation and (6.9%; 13) were discharged against medical advice. There was no mortality among these study populations.

Conclusion:
Middle-young, aged males most commonly presented with epistaxis. Most of them were secondary to trauma. Anterior nasal bleeding was the most common source and hemostasis could be obtained by anterior nasal packing. Majority could be discharged stable from the ER. However, this cohort had seen patients in life-threatening conditions, so the severity cannot be overlooked.
Awareness and perceptions regarding autism among school teachers in Jazan region, Kingdom of Saudi Arabia
Authors: Otaif Eman A. , Salih Sarah M. A. , Mahfouz Mohammed S. 
Published: November 2023

Background:
Identification of Autism Spectrum Disorder (ASD) especially at early stages is highly important to improve the quality of life and help to decrease the disease burden. This study was performed to assess the school teachers' level of knowledge and perception regarding Autism.

Materials and Methods:
An observational cross-sectional study was carried out in the Jazan region among a random sample of school teachers (males and females) who are working at the governmental primary Schools, throughout the scholastic year 2019–2020. A structured validated self-administered questionnaire was used for data collection. It includes three sections: sociodemographic information of the participants, the Autism Knowledge Questionnaire (AKQ), and statements exploring the teachers' attitudes toward children with autism.

Results:
The study included 403 primary school teachers. The age of 47.1% of them ranged between 35 and 44 years. Slightly more than half (50.9%) were males. Overall, the total autism knowledge score ranged between 2 and 26, out of a possible 30 with a median (interquartile range “IQR”) of 15 (12-18). Teachers who ever encountered a child with autism had higher significant knowledge scores about autism compared to their counterparts (mean ranks were 263.95 and 179.32, respectively), P < 0.001. Female compared to male teachers more significantly agreed that teachers not trained in special education should not be expected to deal with a child with autism, P = 0.018. Teachers aged between 35 and 44 years are more willing to have an autistic child in their class in compare to those ages ≥55 years that they would not want children with autism in their class, P = 0.036 and more interested in attending training in the area of childhood developmental and behavioral disorders, P = 0.010. Postgraduate teachers were more agreed than Bachelor holders that teachers not trained in special education should not be expected to deal with a child with autism, P = 0.001. Diploma-holder teachers were more agreed than postgraduates that children with autism are too impaired to benefit from activities of a general school, P = 0.019 and students with Autism should be given every opportunity to function in the regular education classroom whenever possible, P = 0.028.

Conclusion:
The knowledge about autism among primary school teachers is average in general, however, they expressed mostly positive attitudes towards autistic children.
Effect of COVID-19 pandemic on utilization of maternal healthcare services in a rural area of Haryana – A record-based comparative study
Authors: Singh Tejbeer , Kaur Ravneet , Kant Shashi , Mani Kalaivani , Yadav Kapil , Gupta Sanjeev Kumar 
Published: November 2023

Background:
The COVID-19 pandemic posed a challenge for the public health system, as all the health facilities and manpower were diverted for the delivery of COVID-19-related services. This affected the provision of routine health services, including maternal healthcare services. There is a paucity of data from rural and primary healthcare settings, as the earlier studies were either modelling-based or from tertiary care centres.

Materials and Methods:
This record-based study was conducted in 12 subcentres in the district Faridabad of Haryana. Data of pregnant women registered during 1 April to 30 September in the years 2017–2020 were retrieved. The utilization of maternal healthcare services among women registered during 1 April 2020 to 30 September 2020 was compared with those registered in the same period during the preceding 3 years (2017–2019).

Results:
There was a significant decline in utilization of maternal healthcare services. Services like minimum four antenatal visits declined from 67.8% to 48.3% (P < 0.0001), at least 100 iron-folic acid tablets (45.4–20.9%; P < 0.001), and examination at each visit (90.8–72.3%; P < 0.001). The proportion of pregnant women who received full antenatal care decreased from 26.0% to 10.7% (P < 0.001). There was a significant increase in delivery in private health facilities (40.9–49.9%) and delivery by caesarean section (21.6–27.3%; P = 0.002).

Conclusion:
COVID-19 pandemic had an adverse effect on utilization of maternal healthcare services. Effective planning and coordination between different levels of government health facilities and primary care providers, including family physicians, can ensure uninterrupted provision of essential services during similar emergencies in future.
Raised Hematocrit at High Altitude: Its Relation to Sensorineural Hearing Loss
Authors: Gupta Atul , Raj Poonam 
Published: November 2023

Abstract

Background:
Military troops deployed in high altitude areas (HAAs) may suffer from illnesses peculiar to the terrain which are usually due to hypoxia. The physiological dynamics at high altitude (HA) are different from those in the plains and hence environmental factors play an important role at HA. The effect, if any, of hemodynamic changes in terms of raised hemoglobin (Hb) levels in HA on otological disorders is not very well researched and needs to be explored further. This study was undertaken to study the clinical manifestations, if any, of the hemodynamic alterations in the inner ear and their correlation with the Hb levels after 1 year deployment at HA.

Methods:
A longitudinal descriptive study was conducted over 1 year duration at a Military Hospital located at HAA on 99 soldiers who were <40 years of age with no history of prior ear complaints/ear surgery and with normal pure tone audiometry (PTA) thresholds and Hb levels at initial evaluation. Each soldier underwent PTA and Hb estimation twice: initially, at the time of induction, and later after completion of 1 year deployment at HAA. Statistical analysis was done using simple paired t-test.

Results:
On data analysis, no hearing loss was found in any participant of the study cohort at frequencies 500 Hz and 1 kHz in either ear on second evaluation. At 2 kHz, for left ear, the mean Hb level for the group with hearing thresholds greater than 25 dB was 17.07 g% with a standard deviation of 0.66, and for right ear, it was 16.95 g% with standard deviation of 0.64. At 4 kHz, the mean Hb level was 16.50 g% and 16.49 g% for hearing thresholds below and up to 25 dB for left and right ear, respectively. It was 16.99 g% and 16.96 g% for hearing thresholds above 25 dB. The results were statistically significant for both right and left ear at 4 kHz.

Conclusion:
A statistically significant deterioration of hearing thresholds for 4 kHz frequency with corresponding increase in Hb levels was observed in our study. Hb levels can therefore be used as a marker to ensure no further exposure to other risk factors like loud noise exposure, further deployment at higher altitudes to prevent deterioration, and progression of hearing loss.
Distribution of COVID-19 Cases According to Environmental Pollutants and Meteorological Factors in Districts of Maharashtra
Authors: Madhu B. , Biswas Brototi , Karegam Dhivya , Yadav Arun Kumar 
Published: November 2023

Abstract

Introduction:
Environmental factors such as temperature, precipitation, and various other pollutants in the air like nitrogen dioxide (NO2), CO2, etc., have been studied for sustenance and transmission of Coronavirus disease-19 (COVID-19). Studies from India are lacking about the distribution of COVID-19 cases according to air pollutants and meteorological factors. Hence, the present study was conducted to study the relationship between COVID-19 and environmental factors with the objectives of Cluster mapping of the COVID-19 cases district-wise for the state of Maharashtra.

Methodology:
The air pollution variables NO2 column density (mol/m2), sulfur dioxide column density (mol/m2), Aerosol absorbing index (Ai), Carbon monoxide (CO) column density (mol/m2), and Ozone column density (mol/m2) were extracted from Sentinel-5P datasets available in Google Earth Engine (GEE) (https://code.earthengine.google.com/). The meteorological variables precipitation (m), temperature (t), and humidity (k) were extracted from the European Environmental Agency 5-Land reanalysis dataset in GEE, which provides data at a resolution of 1113.2 m. The preprocessing and retrieval of data were carried out in GEE. These values were correlated with daily cases, density, and other demographic factors.

Results:
The study identified a cluster of cases in few districts of Maharashtra. These districts were Pune, Ahmednagar, Mumbai, Nashik, and Nagpur. Population density and NO2 were important factors in most of the monthly data.

Conclusion:
The present study used data available on public platforms to assess the association between COVID-19 and environmental factors. The study found that various environmental factors such as NO2, CO, and Ai may be associated with increase cases of COVID-19 in the district. However, ecological bias may be kept in mind.
Risk Factors and Functional Outcome of Ischemic Stroke Vis-à-vis Hemorrhagic Stroke at a Tertiary Care Hospital in North India
Authors: Gupta Anirban , Mukherjee Arindam , Gupta Aditya , Shashikala Tirulapati Padmavathi , Barki Satish , Dhull Pawan 
Published: November 2023

Abstract

Background:
Worldwide, stroke is the most common cause of death after coronary artery disease (CAD). The risk factor stratification and prognostication of stroke patients are vital in planning and allocating health-care resources.

Methods:
We conducted a prospective, comparative observational study. Fifty age- and sex-matched cases each of ischemic stroke (IS) and intracerebral hemorrhage (ICH) stroke were enrolled, and baseline demographic, risk factor profile, Glasgow Coma Scale, modified Rankin scale (mRS), and Barthel Index (BI) were recorded, and the cases were followed up for 90 days or till death. We looked at the risk factors associated with IS and ICH and functional outcome of IS vis-à-vis ICH using mRS and BI at 90 days postenrollment. We also compared the mortality of IS vis-à-vis ICH.

Results:
The presence of hypertension (100% vs. 88%) and smoking (50% vs. 26%) was significantly higher in ICH (P < 0.05). The presence of diabetes mellitus (40% vs. 18%) and CAD (12% vs. 2%) was significantly more in IS cases (P < 0.05). Consumption of alcohol was more prevalent in ICH patients compared to IS patients (30% vs. 24%). Based on mRS and BI at 90 days, ICH cases had significantly poorer functional outcome compared to IS cases (P < 0.0001). Mortality of IS cases (4%) was also significantly less compared to ICH cases (30%).

Conclusions:
A combination of hypertension, smoking, and history of alcohol consumption had a higher predilection for the occurrence of ICH, whereas a combination of hypertension, diabetes mellitus, and CAD favored the occurrence of IS. The functional outcome of cases of ICH 90 days poststroke was significantly poorer compared to IS cases. The most important factors for poor outcome of ICH cases were more stroke severity at baseline compared to IS cases and the presence of intraventricular hemorrhages in some cases. Mortality was also found to be more in patients with ICH compared to IS.
A Clinicoradiological Profile of H3N2 Outbreak in Western India
Authors: Harikrishnan P. , Duche Suraj Gautam , Vashisht Rohit , Mishra Yogendra , Kumar Abhinav , Samadarshi Samir 
Published: November 2023

Abstract

Introduction:
Although H3N2 outbreaks were once rare, they have become more common in recent years. With a significant toll on health-care resources and the ability to cripple any society, the epidemiological significance of this disease is paramount. While most of the previous studies on influenza outbreaks have reported H1N1 disease, there is a scarcity of literature regarding the H3N2 clinicoradiological profile. Hereby, we present the clinicoradiological profile of a series of H3N2 cases from western India.

Materials and Methods:
This is a retrospective chart-based review of clinicoradiological profile of a series of cases that were reported to a tertiary care center in western India between February 2023 and March 2023.

Results:
A total of 10 patients had tested positive for H3N2. All patients had a history of fever lasting an average of 4.7 days, and six had varying degrees of dyspnea. One patient had gastrointestinal symptoms, and six developed tachypnea with hypoxemia requiring oxygen supplementation. One patient with multiple comorbidities required invasive mechanical ventilation and had a complicated course with a superadded bacterial infection. Out of the four patients with radiographic findings, two had atypical pneumonia/acute infective etiology.

Conclusion:
This study provides valuable insights into the clinical presentation and management of H3N2 infections. The findings highlight the importance of influenza vaccination and early detection of H3N2 infections to prevent severe complications. The successful outcomes of the patients in this study demonstrate the effectiveness of prompt intervention and appropriate treatment in managing H3N2 infections.
A Prospective Study on the Prevalence of Coronavirus Disease 19 Infection in Antenatal Patients at Term and Its Effects on Maternal-fetal Health and on Early Childhood Development
Authors: Mustajib Ali , Arunav Sharma , Abdul Sheik R. , Bhargava Harshit , Sunil Agrawal 
Published: November 2023

Abstract

Background:
Coronavirus disease 19 (COVID-19) has become a global pandemic; its unparalleled speed of spread has left us all in a worldwide alarming situation.

Aims:
The aim was to study the prevalence of COVID-19 infection in asymptomatic antenatal patients at term and its maternal and fetal outcomes and neonates being followed up till 18 months for developmental assessment. This was a prospective observational study carried out from September 1, 2020, to March 31, 2023.

Materials and Methods:
This prospective observational study was conducted on 250 pregnant women attending the antenatal care outpatient department in a Zonal Hospital in Northeastern India expected to undergo delivery in the next 5 days, and all suspected COVID-19 pregnant women were included in the study. Asymptomatic pregnant women not expecting delivery in the next 5 days were excluded. All neonates born to these 250 mothers were followed till 18 months of age and were then assessed for the impact of COVID-19 on the developmental milestones. The prevalence of COVID-19 was calculated in the study population. The Chi-square test was used to compare categorical variables in COVID-19-positive and -negative groups. P <0.05 was considered significant.

Results:
The prevalence of COVID-19 infection in term pregnancies was found to be 4%. The findings of the study showed no immediate impact on maternal and fetal health from COVID-19 infection. However, on follow-up of these babies (born during the pandemic) at 18 months of age, there was a delay in social and language domains of development in 18.8% of children. Most women were discharged without any significant problems, and there were no signs that COVID-19 had been transmitted vertically.

Conclusion:
COVID-19 infection was found to have no immediate impact on maternal and neonatal health. However, follow-up at 18 months of babies born during the COVID-19 era revealed a delay in social and language milestones in 18.8% of children. Further multicentric studies with a larger population base need to be done to substantiate this claim.
Unusual Inflammatory Clinical Presentation After Cataract Surgery and that Thought-provoking Question: Is this Infection or Toxic Anterior Segment Syndrome?
Authors: Kaplan Anil , Tas Muhammed D. , Selver Ozlem B. 
Published: November 2023

Abstract:

PURPOSE:
Toxic anterior segment syndrome (TASS) is a noninfectious anterior chamber reaction caused by ocular surgeries. It usually develops within the first 12–48 h after surgery. In case of clinical suspicion of TASS, endophthalmitis as a devastating disease should always be excluded. However, the fact that TASS and endophthalmitis can look the same, but the treatment for each is different. Therefore, distinguishing between the two conditions is an important factor in coping with both diseases. It was aimed to describe the features and clinical management that are considered when distinguishing the cause of unexpected inflammatory response after cataract surgery.

METHODS:
A retrospective review of medical records of 13 patients who developed TASS in our clinic at Ege University Ophthalmology Department on three different days between July 2022 and December 2022 were included in this study. Anterior segment photographs of those 13 patients and the records of ophthalmological examinations of those patients, including best-corrected visual acuity (BCVA), ocular pressure, biomicroscopic, and fundoscopic examination, were collected. Medical data were evaluated retrospectively.

RESULTS:
The mean time to onset of clinical symptoms was 27.6 h. The main complaint was pain in nine patients. The primary symptom in the remainder of the patients was blurred vision. Severe hypopyon was seen in 5 cases. Despite the presence of pain and hypopyon, patients who were treated with topical steroids were closely followed up (every 2 h) because they were consecutive patients and had relatively acute onset complaints. Inflammation was regressed after an average of 4 h. No factor causing TASS was found. The BCVA was at the minimum level of 8/10 on the 5th day of surgery.

CONCLUSION:
When distinguishing TASS from endophthalmitis, severe pain, relatively late onset, hyperemia, and the presence of severe hypopyon usually lead ophthalmologists to the clinical diagnosis of endophthalmitis. However, in this study, most of the patients diagnosed with TASS had severe pain, a significant portion of them had hypopyon, and the onset of the symptoms was relatively late. Close follow-up immediately after suspicion plays a vital role in clinical diagnosis and management accordingly.
Incident management system comparison: Hospital Incident Command System versus Major Incident Medical Management and Support
Authors: Mzahim Bandr , Alzahrani Abdulrahman , Alzahrani Abdullah Ahmed , Aldharman Sarah , Alkhamis Wala , Almutairi Bandar S. , Sabbagh Abdulrahman Y. , Khan Anas 
Published: November 2023

ABSTRACT
The Hospital Incident Command System (HICS) and Medical Major Incident Management System (MMIMS) are incident management systems that any hospital may utilize to deal with threats, scheduled events, or emergencies. Both are valuable systems since they provide an organizational framework for incident management and include planning, developing, and adjusting that structure. HICS is used in the United States and MMIMS in the United Kingdom. The aim of this study is to find and show the difference, elements, and concepts of MIMMS and HICS. A scoping review of relevant papers and documents for the HICS was conducted. Medical Incident Command System, HICS, Healthcare Incident Command System, MMIMS, and Major Incident Management System are all referred to the same definition of HICS that was mentioned in the introduction. This research took place from March through June of 2022. From January 1, 1995, to June 15, 2022, all publications, books, guidelines, and manuals were extracted. We searched PubMed, Ovid, Springer, Scopus, Web of Science, and Google Scholar for articles. In conclusion, the main principles, strengths and weak points, and characteristics of the HICS and MMIMS appear to be the same. The differences were specified in the elements and chain of commands, which were designed to the geographic and governmental factors. Both systems are efficient and competent to achieve the goal of HICS but should be applied within the country’s borders as it is an integrated system.