bluuebunny/crossref_metadata_2025_split huggingface dataset:
Challenges faced by frontline health managers during the implementation of COVID-19 related policies in India: A qualitative analysis
Authors: Kundapur Rashmi , Aggarwal Sumit , Gaitonde Rakhal , Rashmi Anusha , George Leyanna Susan , Pandey Arvind , Bavaskar Yogita 
Published: August 2023

Background & objectives:
The COVID-19 pandemic exposed the strengths and weaknesses of the healthcare systems across the world. Many directives, guidelines and policies for pandemic control were laid down centrally for its implementation; however, its translation at the periphery needs to be analyzed for future planning and implementation of public health activities. Hence, the objectives of this study were to identify the challenges faced by frontline health managers in selected States in India during the pandemic with regard to implementation of the COVID-19-related policies at the district level and also to assess the challenges faced by the them in adapting the centrally laid down COVID-19 guidelines as per the local needs of the district.

Methods:
A qualitative study using the grounded theory approach was conducted among frontline district-level managers from eight different States belonging to the north, south, east and west zones of India. The districts across the country were selected based on their vulnerability index, and in-depth interviews were conducted among the frontline managers to assess the challenges faced by them in carrying out COVID-19 related activities. Recorded data were transcribed verbatim, manually coded and thematically analyzed.

Results:
Challenges faced in implementing quarantine rules were numerous, and it was also compounded by stigma attached with the disease. The need for adapting the guidelines as per local considerations, inclusion of components of financial management at local level, management of tribal and vulnerable populations and migrants in COVID context were strongly suggested. The need to increase human resource in general and specifically data managers and operators was quoted as definite requirement.

Interpretation & conclusions:
The COVID-19 guidelines provided by the Centre were found to be useful at district levels. However, there was a need to make some operational and administrative modifications in order to implement these guidelines locally and to ensure their acceptability.
Waardenburg Syndrome with Rare Ocular Features
Authors: Puri Neerja , Goyal Sheenu , Brar Balvinder Kaur 
Published: August 2023

Introduction:
Waardenburg syndrome (WS) is an uncommon autosomally inherited disease with four subtypes.

Case Report:
We report a case of a 5-year-old girl with molluscum contagiosum with features of Waardenburg syndrome with dystopia canthorum, synophrys, broad nasal root, and sensorineural hearing loss.

Discussion:
The association between Waardenburg syndrome and ocular albinism is rare and hence reported.
Is there a Role for Combined Therapy with Oral Corticosteroids and Propranolol in Patients with Infantile Hemangioma? A Retrospective Cohort Study
Authors: García-Valencia Claudia , Sáez-de-Ocariz Marimar , Orozco-Covarrubias Luz 
Published: August 2023

Introduction:
Infantile hemangioma (IH) is the most common benign tumor in infancy. Oral corticosteroids (OCs) still have an important role in the treatment of complex IH. In the present study, we provide our experience of oral propranolol + OCs treatment for IH.

Materials and Methods:
This was a retrospective cohort study of 26 IHs treated with propranolol, either alone or in combination with OCs, at the National Institute of Pediatrics, Mexico. Information on clinical and demographic data was collected. Data were summarized as mean (standard deviation) or median (minimum, maximum) or frequencies and proportions as needed. Comparative analysis between the group only treated with propranolol and the group treated with propranolol plus OCs was performed with Fisher’s exact test or Mann–Whitney U-tests.

Results:
All of our patients had a positive response to treatment. The comparison between both groups showed that the maximum and mean propranolol doses were significantly lower in the group of patients receiving combined treatment.

Conclusions:
Our findings support that the use of propranolol plus corticosteroids in IH allows the use of lower doses of both drugs for longer periods with less risk of adverse effects and fewer or no relapses.
A Clinical Study of Dermatoses in Neonatal Intensive Care Unit in a Tertiary Health-Care Center
Authors: Reddy Suga , Kavya K. B. , Guruprasad G. 
Published: August 2023

Introduction:
Neonatal period is defined as the first 4 weeks of extrauterine life. The skin and appendages of the newborn present different features compared to adults. The imperative knowledge of normal phenomena and their differentiation from the more significant cutaneous disorders of the newborn is critical for dermatologists for timely intervention, which could facilitate a better therapeutic outcome.

Materials and Methods:
We conducted a hospital-based, observational, cross-sectional study of a total of 128 neonates with cutaneous manifestation from May 2021 to November 2021. Results were analyzed statistically.

Results:
Of all neonates examined, i.e., 128, 77 (60.15%) were male and 51 (39.85%) were female, with a male: female ratio of 1.5:1. 87 (67.96%) neonates were term, 35 (27.34%) were preterm, and 6 (4.68%) were postterm. 33 (25.78%) neonates had more than one cutaneous lesion. Of all the cutaneous lesions, physiological skin lesions were most common, which accounted for 70% of skin lesions, followed by iatrogenic 8%, transient noninfective conditions 5%, eczema 5%, developmental defects 4%, birthmarks 4%, and others 4%.

Conclusion:
Neonatal skin lesions are often physiological. Both dermatologists and pediatricians have to be aware of the course of the disease. Nursing mothers have to be explained the natural course of the skin lesions to reduce unnecessary anxiety; whereas to reduce iatrogenic infections, nursing staff has to be explained to handle newborn’s skin with care as they are sensitive.
A cross-sectional study exploring the positive aspects of caregiving in opioid dependence and its relation with quality of life, social support, and caregivers’ burden
Authors: Saha Priyanka , Saha Sayan , Kaloiya Gauri Shanker , Sarkar Siddharth 
Published: August 2023

ABSTRACT

Background and Aims:
Despite a large body of research linking caregiver burden and social support in substance dependence, positive aspects of caregiving in these disorders have received very minimal attention. This exploratory observational study aimed to assess the positive aspects of caregiving for opioid dependence and evaluate the association of these positive aspects with caregiver quality of life, burden, and social support.

Methods:
This cross-sectional study included 199 caregivers of patients with opioid dependence recruited through purposive sampling. Participants were assessed using the Scale for Positive Aspects of Caregiving Experience (SPACE), World Health Organization Quality of Life–BREF version, Family Burden Interview Schedule (FBIS), and Social Support Questionnaire.

Results:
Of the 199 caregivers recruited, a majority of the caregivers were middle-aged women. About two-thirds of the patients were currently using opioids (n = 135, 67.8%), while the remaining were abstinent. Among the SPACE domain scores, the mean was highest for motivation for the caregiving role (2.07), which was followed by self-esteem and social aspect of caring (2.04), caregiving personal gains (1.76), and caregiver satisfaction (1.65). Caregivers of patients currently abstinent experienced greater positive aspects of caregiving (SPACE mean item score 2.57 versus 1.62, P < 0.001), and lesser burden (FBIS mean score 13.4 versus 29.3, P < 0.001).

Conclusion:
Positive aspects of caregiving can be potentially utilized for better caregiver engagement in treatment and improved caregiver outcomes.
Crestal sinus augmentation in a head back position: Retrospective case series
Authors: Zhang Yuhang , Zhang Chunyuan 
Published: August 2023

Objectives:
To evaluate the clinical efficacy of Crestal Sinus Augmentation (CSA) in a head back position (CSA-HBP) for maxillary sinus mucosa elevation.

Materials and Methods:
We enrolled 209 patients, 246 maxillary sinuses, 348 sites in this study. Complications, maxillary sinus mucosal perforation rate and cumulative survival rate (CSR) data were collected to evaluate the clinical efficacy of CSA-HBP. Maxillary sinus mucosal elevation height (EH) and new bone height (NH) were measured by cone-beam computerized tomography and standard periapical radiographs. The implantation sites of residual bone height (RBH) ≤5 mm and RBH >5 mm were marked as Groups A (n = 81) and B (n = 267), respectively. The implantation sites of the second and third molar sites were marked as Group C (n = 134), and the remaining sites were marked as Group D (n = 214).

Results:
The RBH before implant placement was 6.63 ± 2.10 mm (95% confidence interval [CI] 6.41– 6.85 mm). The mucosal EH was 4.04 ± 1.86 mm (95% CI 3.85 – 4.24 mm). The NH was 2.36 ± 1.20 mm (95% CI 3.85–4.24 mm). No other complications were found except three cases of postoperative swelling and one case of nasal blood secretions. The overall mucosal perforation rate was 1.44% (5/348, 95% CI 0.2%–2.7%) and the rate of RBH ≤ 5 mm (Group A) was 1.49% (2/134, 95% CI 0%–3.50%). The 8-year CSR was 99.71% (347/348, 95% CI 99.2%–100.0%). Mucosal EH and NH were higher in RBH ≤5 mm (Group A) than in RBH >5 mm (Group B) (P = 0.001 and P = 0.001, Mann–Whitney U-test). There were no significant differences in mucosal EH and perforation rate between second and third molar sites (Group C) and other sites (Group D) (P = 0.77, Mann–Whitney U-test, and P = 0.16, Yates’ Chi-square independence test).

Conclusions:
CSA-HBP is a minimally invasive and reliable technique.
Comparative clinical evaluation of a local drug delivery of cranberry and garcinia fruit gel with tetracycline fibers for amelioration of periodontitis: A split mouth study
Authors: Panda Vandana , Patidar Pragya , Gaikwad Rajesh , Borade Shrutika , Fernandes Lynette 
Published: August 2023

Background:
The present study formulates and evaluates a polyberry gel comprising extracts of cranberry (Vaccinium
macrocarpon) and brindle berry (Garcinia
cambogia) in patients suffering from chronic periodontitis.

Materials and Methods:
The polyberry gel was evaluated for various physicochemical parameters, in vitro permeability and stability, and the active phytoconstituents were quantified by High-performance thin layer chromatography (HPTLC). Total phenolic content, total antioxidants, and ascorbic acid were estimated in the two extracts by in vitro assays. Patients suffering from chronic periodontitis with probing pocket depth (PPD) up to 5 mm were divided into 3 groups of 21 patients each and treated with scaling and root planing (SRP) or SRP followed by subgingival placement of polyberry gel or tetracycline fibers (standard). Plaque Index (PI), Gingival Index (GI), PPD, Clinical Attachment Level (CAL), and the salivary aspartate aminotransferase (AST) and C-reactive protein (CRP) levels were recorded at baseline and after 1 month.

Results:
A significant (P < 0.01) reduction in the periodontic disease parameters was observed in the standard and gel-treated groups between their baseline and 1-month time-interval readings. The polyberry gel treatment significantly (P < 0.05 for AST and P < 0.01 for the rest) attenuated the periodontitis-elevated PI, GI PPD, CAL, AST and CRP levels when compared with SRP at the end of the study and was comparable with tetracycline.

Conclusion:
The amelioration of periodontitis and gingival inflammation may be attributed to the potent antioxidant activity of the polyphenolic phytoconstituents of the gel. The polyberry gel may thus be used as a safe adjunct to SRP/tetracycline in chronic periodontitis.
Clinical and radiographic assessment of periodontal status among patients with post-COVID mucormycosis: A cross-sectional study
Authors: Arunachalam Muthukumaraswamy , Natarajan Rajakumari , Krishnamurthi Malathi , Gopalakrishnan Ramesh Kumar 
Published: August 2023

Background:
An escalation in cases of rhinomaxillary mucormycosis among post-COVID patients is being reported. However, there is limited information about periodontal features in mucormycosis cases. This study explored the periodontal signs and symptoms among post-COVID mucormycosis individuals.

Materials and Methods:
This cross-sectional study was carried out with a total of 25 post-COVID mucormycosis patients attending tertiary care public teaching hospital. Clinical and radiographic assessments were done.

Results:
An elevation in mean probing pocket depth (PPD) up to 6.21 ± 2.7 mm was noted. Nearly 16%–40% of patients had Miller’s Grade III mobility in the affected site. Forty-four per cent had localized single or multiple abscess, 40% had palatal swelling, 32% had necrosis of soft tissue and bone exposure, and 52% had maxillary dentoalveolar segmental mobility in the affected site. Radiographic examination revealed varying stages of interdental bone loss.

Conclusion:
The present study observed an increase in mobility and mean PPD which did not commiserate with interdental bone loss in the affected maxillary region.
Effect of Nursing Care Regarding Postoperative Complications among Diabetic Patients after Hip Replacement Surgery
Authors: Tariq Mohammed , Natheer Munther , Allo Rami Ramadhan 
Published: August 2023

Background:
The total hip arthroplasty surgery is an effectiveness intervention to improve patients function with osteoarthritis. This surgery is usually done for patients who aged more than 60 years and are associated with uncontrolled pain or hopeless damage hip joints. The effect of diabetes disease at post-surgical time, influencing on wounds healing process and promoting sores formation which lead to a complex of nursing care performance for patients has a big challenge, to deal with patients and their family feeling to help them to promote independence.

Objective:
This study aimed to evaluate the nursing management for diabetic patients undergoing surgical total hip replacement.

Materials and Methods:
A case–control study design applied on diabetic patients with a hip operation after fractured hip at orthopedic wards at Al-Rabea and Ninevah private hospitals in Mosul city. The study was conducted from September 10, 2022 until December 10, 2022. Postoperative nursing care provided to the control group was the daily common nursing care management in our hospitals, whereas that provided to the study group depended on a special standard nursing care management protocol.

Results:
Evaluation of postoperative disorders and complications showed a positive direction in decreasing their occurrence after depending on a special standard nursing care management protocol.

Conclusions:
The study concludes that all the postoperative complication may be relieved after total hip replacement as any surgical intervention if the orthopedic nursing staff applied the standard tool for nursing care management.
Biofilm Formation and Virulence Factors among Multidrug Resistant Pseudomonas aeruginosa Isolated from Patients in Babylon Province
Authors: Almuttairi Ahmed Abdulkareem H. , Abdulla Anwar A. 
Published: August 2023

Background:

Pseudomonas aeruginosa is often multidrug resistant that is associated with hospital-acquired infections.

Objectives:
The objective of this study was to identify the patterns of antibiotic resistance, biofilm formation, the occurrence of multiple drug resistant (MDR), and virulence genes (Alg, OprL, and OprI) in P. aeruginosa isolated from patients.

Materials and Methods:
A total of 131 isolates from various sites including (burn, wound, and urine) were collected from different hospitals in Babylon province for both genders and ages. These isolates were identified using traditional techniques as well as the Vitek 2 system. Pseudomonas aeruginosa isolates were subjected to disc diffusion antimicrobial susceptibility testing. Alg, oprL, and oprI-specific primers were used in the polymerase chain reaction technique for the molecular identification of virulence factors genes.

Results:

Pseudomonas aeruginosa isolates that were one hundred thirty-one (100%) had oprL gene. On the other hand, Alg and oprI each have 129 (98.47%).

Conclusion:
Alarming factors for public health include the high rate of MDR among P. aeruginosa isolates and its capacity to form biofilm.
Tumor Size Assessment with Three Breast Imaging Modalities
Authors: Sediguli Sreenidhi , Gowda Raghu Srinivasa , Ranganathan Rupa , Kumar B Senthil 
Published: August 2023

Background and Objectives:
Diagnostic accuracy of breast MR is higher than the routinely used sonomammography and digital mammography. There are mixed reports regarding usefulness of breast MR imaging regarding the tumor size estimation. The objective of this study was to determine which modality can assess the exact tumor dimension in comparison with corresponding tumor dimension at pathologic examinations.

Materials and Methods:
In a prospective study, 68 patients who came for screening diagnostic mammogram and who had breast lesions of Breast Imaging Reporting and Data System (BIRADS) category 3 and more were evaluated. All patients underwent bilateral digital mammography and targeted high-frequency sonography of the primary lesion. Those patients who were thought to possibly have breast cancer and to be candidates for surgical management were offered bilateral contrast-enhanced breast MRI. Tumor size was evaluated by digital mammography, sonomammography, contrast-enhanced mammography, and compared with histopathology reports.

Results:
Size of the lesions as measured by DM or SM correlated well with the size determined through breast MR (r = 0.975, P < 0.01). There was a statistically significant difference between the measured sizes of lesions between breast MR and HPE (P = 0.76). Breast MR imaging, true size was overestimated in 28 breasts with range of 0–0.6 cm and underestimated in 25 breasts with range of 0–0.9 cm.

Conclusion:
Breast MR imaging depicts more accurate dimensions of the tumor and its extensions than digital and sonomammography.
Impact of Lipid-Lowering Drugs on Lipid Profile in Hyperlipidemia Patients
Authors: Shemran Khawla A. , Edin Sarah H. , Alta’ee Abdulsamie H. 
Published: August 2023

Background:
Hyperlipidemia is an umbrella term for any of the genetic or acquired disorders that result in an elevated level of lipids circulating in the blood. These lipids can enter the walls of arteries and increase the risk of developing hardening of the arteries, which can lead to atherosclerosis, stroke, and heart attack.

Objectives:
The present study tries to investigate the impact of lipid-lowering drugs on lipid profile in patients with hyperlipidemia and to determine the best drug of choice in such patients.

Materials and Methods:
Sixty hyperlipidemia patients with the mean age of 45.52 ± 13.24 years admitted to a private clinic in Hilla city, Iraq, during a period extant from October 2022 to November 2022 were subjected to the present cross-sectional study. Patients were categorized according to the type of drug used and gender. Group 1 (G1) patients treated with rosuvastatin, group 2 (G2) patients treated with atorvastatin, group 3 (G3) patients treated with ezetimibe, and group 4 (G4) patients treated with combination of ezetimibe + simvastatin. Lipid profile was determined using enzymatic method.

Results:
The combination of ezetimibe + simvastatin has a better effect to lower the body mass index. Ezetimibe alone reduces total cholesterol (TC), whereas combination of ezetimibe + simvastatin was found to reduce TC, low-density lipoprotein cholesterol (LDL-C) and triacylglycerol (TG). Rosuvastatin raises the high-density lipoprotein cholesterol (HDL-C).

Conclusions:
The combination of ezetimibe and simvastatin gives a good result in reducing the level of TC in the body, and this leads to a better reduction of LDL-cholesterol than using atorvastatin alone.
Comparison of ropivacaine (0.2%) and ropivacaine (0.125%) with 2 μg/ml fentanyl for epidural labor analgesia
Authors: Rapeti Kalyani Manasa , Mulam Santhisree , Sowbhagya Lakshmi B. , Sharma Ankur 
Published: August 2023

Aim:
The aim of this study was to determine the minimum effective local anesthetic concentration required to provide good analgesia with less consumption of opioids.

Objective:
Among various labor analgesic techniques, epidural analgesia is the most effective form of analgesia. This study aimed to determine the minimum effective local anesthetic concentration required to provide good analgesia with less consumption of opioids. The objective of this study was to evaluate the efficacy of 0.125% and 0.2% ropivacaine, both with fentanyl 2 μg/ml for epidural labor analgesia.

Materials and Methods:
A total of 50 term parturients of American Society of Anesthesiologists physical status Grade I and II with vertex presentation in active labor were randomly assigned to two groups, Group R1 and Group R2, which received 10 ml of 0.125% ropivacaine with injection fentanyl 2 μg/ml and 10 ml of 0.2% ropivacaine with fentanyl 2 μg/ml, respectively, as an initial bolus dose and intermittent top-up doses epidurally. Characteristics of the block, onset and duration of analgesia, and total analgesic requirements were noted. Pain and overall satisfaction scores were assessed with the Visual Analog Scale score. The maternal and fetal outcomes were recorded.

Results:
Maternal demographic characteristics were comparable. Although both the concentrations are effective in providing optimal labor analgesia, decreasing the concentration of ropivacaine has resulted in an increased number of repetition of doses and thus an increased consumption of fentanyl. There were no significant differences between the two groups regarding motor block, hemodynamic, and neonatal outcomes.

Conclusion:
We conclude that 0.2% ropivacaine was found superior in terms of faster onset, prolonged duration, lesser breakthrough pain requiring lesser top-ups, and hence a lesser consumption of opioids. Hence, we conclude that the use of 0.2% ropivacaine is superior to 0.125% ropivacaine with fentanyl.