bluuebunny/crossref_metadata_2025_split huggingface dataset:
Studies on the “Toxins” of Hemolytic Streptococci
Authors: Ando K. , Nishimura H. 
Published: December 2022

Summary and Conclusions
The specific toxin has been almost completely precipitated by the addition of 2 volumes of alcohol both from culture filtrate and from the broth culture itself, and easily obtained in a form of solution by simple saline extraction of this precipitate. The specific toxin is not easily dialyzable. No precipitation occurred when 2 volumes of alcohol were added to one volume of dialyzed culture filtrate, but abundant precipitate of the specific toxin was observed when in addition to alcohol a small amount of saturated salt solution was added to the dialyzed filtrate. A small portion of the specific toxin may be precipitated by acid from a culture filtrate, dialyzed filtrate and crude specific toxin (solution of alcoholic precipitate). When the alcoholic precipitate of specific toxin was dissolved in a small amount of saline solution, an insoluble part remained. The suspension and the washings from this insoluble part caused positive skin reactions on white pigs, while the washings from an acid precipitate of the culture filtrate or crude specific toxin gave no skin reaction on the same animals even in a higher concentration. Accordingly, the acid precipitate seems to contain the specific toxin not merely by adsorption, but perhaps in a form of chemical combination, probably, with nucleoprotein.
Hypersensitiveness to Diphtheria Bacterial Products
Authors: Neill James M. , Sugg John Y. , Richardson Lurline V. 
Published: December 2022

Summary
This paper reports the anaphylactic reactions of guinea pigs immunized with toxoid and subsequently injected intravenously either with phenolized filtrate containing the toxin antigen or with formolized filtrate containing the toxoid antigen. It was proved that the acute death of the antitoxic immune animals represented true anaphylactic reactions specific to bacterial products contained in diphtheria filtrate.
While it was recognized that other constituents participate to some extent, the evidence as a whole indicated that the toxin or toxoid antigen is the principal agent of the anaphylactic reaction of antitoxic immune guinea pigs to unheated filtrates containing a relatively large proportion of toxin or toxoid. The complications due to the substances other than toxin or toxoid are least prominent if one uses both for the immunization and for the intravenous test, minimal amounts of unheated filtrate in which toxoid is the dominant antigen, and finally selects for intravenous test the individual guinea pigs that had been “earliest” in antitoxin production. As might be expected, the complications become more prominent if either the immunization or the intravenous anaphylaxis test is made with diphtheria filtrate in which toxin or toxoid is not the dominant antigen (e.g., filtrates of weakly toxicogenic strains or heated filtrates of toxicogenic strains).
Most of the experiments were made with toxoid-immunized guinea pigs, but after a proper rest period animals immunized with toxin-antitoxin gave anaphylactic reactions to intravenous injection of formolized toxoid-containing filtrates.
Could mid-upper arm circumference be a valid proxy to the body mass index for elderly persons?
Authors: Goswami Anil Kumar , Sathiyamoorthy Ramadass , Mani Kalaivani , Kant Shashi , Gupta Sanjeev Kumar 
Published: December 2022

Introduction:
In elderly persons, due to physiological, anatomical, and functional changes, body mass index (BMI) may not be suitable for the assessment of nutritional status. Mid-upper arm circumference (MUAC) can be a proxy indicator to identify underweight and overweight/obesity among elderly persons. This study aimed to estimate the correlation between MUAC and BMI, and the cutoffs for MUAC using receiver operating characteristic (ROC) analysis.

Material and Methods:
This survey was carried out in a resettlement colony of Delhi. The participants were residents of the area who were aged 60 years or older, and selected by a simple random sampling technique. The arm span, weight, and MUAC of the participants were measured. The correlation between MUAC and BMI for gender and age group was calculated. The ROC curve was also constructed.

Results:
A total of 946 eligible participants were enrolled. The correlation between MUAC and BMI was 0.67 (P < 0.001) and 0.76 (P < 0.001) among men and women, respectively. The MUAC cutoff for underweight was <25 cm with a sensitivity of 68.8% and specificity of 84.9%. The area under the curve (AUC) was 0.84 (0.80–0.88). The MUAC cutoff for overweight/obesity was ≥27 cm with a sensitivity of 83.9% and specificity of 64.9%, and AUC was 0.78 (0.75–0.82).

Conclusion:
The MUAC of the participants increased as the BMI of the participants increased. MUAC cutoff was determined using the ROC curve for underweight and overweight/obesity among elderly persons.
Assessment of sleep quality among postgraduate residents of a tertiary care hospital in Kashmir
Authors: Yousuf Awhad Mueed , Qazi Tanzeela Bashir 
Published: December 2022

Introduction:
The Postgraduate medical training is long and emotionally taxing. These occupations are associated with stress and good workload along with night shifts which effects the sleep quality. Studies have documented that high levels of stress among medical residents have been associated with sleep problems. Our study aims to investigate sleep quality among the postgraduate residents of a tertiary care hospital using Pittsburgh Sleep Quality Index.

Material and Methods:
It was a cross sectional study that was conducted from 1 November 2021 to 31 December 2021. Study participants included Postgraduate medical residents working at a tertiary care hospital in district Srinagar of Kashmir valley. A total of 400 participants took part in the study.

Results:
The mean age of the participants was 33.4 years (S.D 4.9). Majority of the participants (54%) were females. The mean global Pittsburgh Sleep Quality Index score (±SD) for sleep quality was 8.46 (±4.5) with a median score of 6 and Inter Quartile Range of 6.5.

Conclusion:
Poor sleep quality was reported in 75% of the residents. This highlights the need for awareness about this problem. There is a need for early interventions in order to introduce flexible working hours for medical residents and to provide shifts of manageable durations.
Utilization of modern family planning methods among women of reproductive age group in North-Central Nigeria; rural – urban comparison
Authors: Hassan Ikrama , Lucky Changkat , Michael Anazodo , Caleb Odonye Eselema , Hellen Kwakipi , Adaku Ezeala , Ahmed Lawal Abdulmumuni , Ezekiel Tomen , Anna Joshua , Oyeleke Bello Surajudeen 
Published: December 2022

Introduction:
Contraception is one of the most successful developmental interventions, unique in women empowerment and population control. Family planning (FP) reinforces the right to determining the number and spacing of children. Hence, we determine the utilization of modern FP methods among urban and rural dwellers.

Material and Methods:
This is a cross-sectional study of reproductive age women in Lafia, Nigeria. Ten primary healthcare centers (PHCs) each were selected from the urban and rural locations over 6 months using multi-staged sampling technique. Questionnaire was administered, and the data were analyzed using SPSS V 23. P < 0.05 was considered significant.

Results:
Most participants were aged between 20 and 29 years. The prevalence of using modern methods of FP was 17.3%. More than three quarters of urban women are using contraceptives compared with one quarter of rural women. There was a difference between those who ever used measures to delay pregnancy and their locations, P = 0.049. Women in the rural areas use the cycle beads, while those in the urban areas use the injectables. Need for more children was the most common reason for discontinuing FP, others are FP failure, absence of spouse, and fear of side effects. Age of the participants was found to be a good predictor of using modern FP method, P = 0.022.

Conclusion:
There is low prevalence of modern FP utilization in this study despite knowing where to access the services (PHCs). Three of four urban women are using FP compared with one out of four among rural women. The cycle beads and the injectables were the most common methods. Age is a major determinant of using FP.
Morbidity profile and dynamics of determinants of health-seeking behaviour in geriatric population of Chandigarh, India
Authors: Puri Sonia , Bhandari Praizy , Goel N. K. , Sharma Munish Kumar , Lehl Sarabmeet Singh , Gupta Monica 
Published: December 2022

Introduction:
Aging is a natural process that usually results in physiological, biological, emotional, and financial decline. As a result, a robust health system is required to meet their escalating health needs. Through this study, we got an opportunity to study the morbidity profile of the elderly and to assess their health-seeking behavior and its determinants in urban areas of Chandigarh.

Material and Methods:
The sample consisted of 360 participants. Multistage and proportionate sampling techniques were used to recruit study subjects. A structured interview was carried out to get information on the different parameters of health-seeking behavior of the elderly population.

Results:
The most pervasive determinant of health-seeking behavior was perceiving health issues related to age, no family support, and health-care expenditure.

Conclusion:
The elderly had a positive behavior toward seeking help with regard to health care. Multiple morbidities were evident among the elderly, and modern medication was the greatest choice. Improved perspective toward health, easy accessibility, and awareness regarding the disease may contribute to the willingness of seeking help for the health-care needs.
An observational study on health-related quality of life and persistent symptoms in COVID-19 patients after hospitalization at a tertiary care centre
Authors: Shah Chirali , Keerthi B. Y , Gali Jayasri Helen 
Published: December 2022

ABSTRACT

Aim:
The study aims to determine persistent symptoms and effects of COVID-19 infection on the quality of life (QOL) at 1 and 3 months after the acute phase of the disease in mild, moderate and severe cases.

Methods:
The prospective observational study was conducted among patients with confirmed COVID-19 who had been treated and discharged after hospitalization from February 2021 to June 2021. All patients were interviewed at 1 and 3 months post discharge to assess persisting symptoms and health-related QOL. QOL was assessed using European Quality Of Life 5-Dimensions 3-Levels (EQ-5D-3L) and EuroQol-visual analogue scales (EQ-VAS).

Results:
In total, 388 out of 479 discharged following COVID-19 infection were included. The median age of patients was 48 years, with 62.6% male predominance. Most of the COVID-19 cases were mild (67.01%). Most common presenting symptom was fever (69.8%). EQ-5D-3L showed that the problems reported at 3-month follow-up were significantly less when compared to 1-month follow-up (p < 0.001), and QOL significantly improved after 3 months in non-intensive care unit (ICU) patients when compared to ICU patients (p = 0.007). The mean EQ-VAS score significantly improved at 3 months when compared to 1 month (80.34 ± 12.77 vs. 91.69 ± 12.34; P < 0.001). The severity of illness was correlated with QOL (p < 0.007).

Conclusion:
The study results demonstrate ongoing improvement in the QOL and persistent symptoms, while a minority still were symptomatic after 3 months post-COVID-19 illness.
Navigating patient journey in early diagnosis of lung cancer in India
Authors: Biswas Bivas , Talwar Deepak , Meshram Priti , Julka Pramod K. , Mehta Anurag , Somashekhar SP , Chilukuri Srinivas , Bansal Abhishek 
Published: December 2022

ABSTRACT
Lung cancer (LC) is one of the leading causes of cancer deaths worldwide. In India, the incidence of LC is increasing rapidly, and a majority of the patients are diagnosed at advanced stages of the disease when treatment is less likely to be effective. Recent therapeutic developments have significantly improved survival outcomes in patients with LC. Prompt specialist referral remains critical for early diagnosis for improved patient survival. In the Indian scenario, distinguishing LC from benign and endemic medical conditions such as tuberculosis can pose a challenge. Hence, awareness regarding the red flags—signs and symptoms that warrant further investigations and referral—is vital. This review is an effort toward encouraging general physicians to maintain a high index of clinical suspicion for those at risk of developing LC and assisting them in refering patients with concerning symptoms to specialists or multidisciplinary teams as early as possible.
Prevalence of pre-extensively drug-resistant tuberculosis (Pre XDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) among extra pulmonary (EP) multidrug resistant tuberculosis (MDR-TB) at a tertiary care center in Mumbai in pre Bedaquiline (BDQ) era
Authors: Utpat Ketaki V. , Rajpurohit Rakesh , Desai Unnati 
Published: December 2022

ABSTRACT

Background:
Drug-resistant tuberculosis (DR-TB) is the most exigent and calamitous challenge encountered in treatment of TB. Extra pulmonary (EP) DR-TB poses a complex diagnostic and therapeutic challenge owing to myriad of presentations and paucibacillary nature. Data available on this subset is limited. We studied the prevalence of EPDR-TB cases among the total DR-TB cases visiting our Programmatic management of Drug-Resistant TB (PMDT) site. We also studied the demographic and microbiological profile of these cases and analyzed the prevalence of pre-extensively drug-resistant TB (pre XDR-TB) and extensively drug-resistant TB (XDR-TB) among patients of EPDR-TB in pre Bdq era.

Results:
Of the 1086 DR-TB patients, 64 (5.89%) were cases of EPDR-TB. Seven out of 64 (10.93%) were primary EPDR-TB. The site wise distribution of cases was 34 (53.125%) lymph node DR-TB, 18 (28.125%) pleural DR-TB, 9 (14.0625%) spinal DR-TB/paraspinal abscess/psoas abscess, 1 case (1.5625%) each of abdominal DR-TB, sternal and gluteal abscess. On the basis of the second-line drug susceptibility testing (DST), patients were grouped into: (1) multidrug-resistant TB (MDR-TB), (2) MDR-TB with fluoroquinolone (FQ) resistance {pre XDR XDR-TB (FQ)}, (3) MDR-TB with second-line injectable (SLI) resistance {pre XDR XDR-TB (SLI)}, (4) XDR-TB. Of the 64 patients, 43 (67.185%) had MDR-TB, 19 (29.687%) had preXDR-TB (FQ), none had preXDR-TB (SLI) and 2 (3.125%) had XDR-TB. Gastro esophageal reflux disease (GERD) was the most common comorbidity seen in 26 (40.6%) patients, followed by anemia in 5 (7.8%), psychiatry problems 5 (7.8%), hypertension in 3 (4.6%), renal disorders in 2 (3.1%) while thyroid disorder, HIV and thalassemia in 1 each (1.5%).

Conclusion:
EPDR-TB forms a small but significant proportion of total DR-TB. Lymph node DR-TB is its most common subclass. Our study emphasises the momentousness and essentiality of baseline DST to FQ and SLI in patients of DR-TB. This enables an appropriate modification of therapy at baseline itself to better the treatment outcomes.
We observed a strikingly high proportion of preXDR-TB (FQ) in our study group.
Biomarkers in severe asthma
Authors: Gvalani Aanchal , Athavale Amita , Gupta Disha 
Published: December 2022

ABSTRACT
Asthma is a chronic condition of bronchial hyper-reactivity associated with inflammation ranges from mild to severe form. It affects 1 – 18% of the population globally and it is estimated that > 300million people in the world have asthma. Of this 5 – 10% have severe asthma. while the proportion of patients suffering from severe are smaller, the morbidity and mortality are higher in this group. With the advances in our understanding of the pathophysiology of asthma there is a need to understand the role of various biomarkers. We live in an era of precision medicine and today there is a clear unmet need to understand targeted therapies. This review aims to raise awareness to the available biomarkers used in clinical practice in India and their role in predicting response to targeted therapies.
Evaluation of humoral immune deficiency in Indian patients with bilateral bronchiectasis with no apparent aetiology
Authors: Rohit K.O. , Thangakunam Balamugesh , Mehta Vinay , Christopher Devasahayam J. , James Prince 
Published: December 2022

ABSTRACT

Background:
Infections continue to be the leading aetiology of bronchiectasis in developing countries like India. Among non-infectious cases, the majority will have no identifiable cause despite extensive evaluation. Recently, immunodeficiency has been recognized as an important aetiology, but data on its prevalence remain rather sparse.

Objectives:
The objective of this study is to evaluate the prevalence of humoral immunodeficiency in a cohort of adults with bilateral bronchiectasis with no apparent aetiology.

Methods:
This is the single-site study from Christian Medical College (Vellore, India) of adults with HRCT-proven non-infectious bronchiectasis. Humoral immunity was assessed through quantitative analysis of immunoglobulins and IgG subclass levels.

Results:
Among 158 cases, immunoglobulin deficiency was found in 15%. Low IgM was the most predominate finding (7%), followed by common variable immunodeficiency (3%) and low IgA (2.5%). In addition, IgG subclass deficiency was found in 5%. In 53% of cases, no specific aetiology could be identified.

Conclusion:
Humoral immune deficiency is present in a significant proportion of patients with non-infectious bronchiectasis. Routine measurement of serum immunoglobulins should therefore be considered as part of the evaluation.
Clinical characteristics of pulmonary hypertension patients who underwent right heart catheterization in Thailand
Authors: Chiansirikraivuti Nichanun , Sapankaew Tunlanut , Pirompanich Pattarin 
Published: December 2022

ABSTRACT

Aim:
Pulmonary arterial hypertension (PAH) is an uncommon and difficult-to-recognize condition. There is still limited evidence on Asian populations. This study aimed to clarify the clinical characteristics of pulmonary hypertension (PH) patients who underwent right heart catheterization (RHC).

Setting and Design:
A single-centre retrospective observational analysis.

Methods and Material:
An observational analysis of adult patients diagnosed with PH by RHC from 2015 to 2019; clinical characteristics and investigations were recorded and compared between PAH and non-PAH. The correlations between maximal tricuspid regurgitation velocity (TRVmax) and mean pulmonary arterial pressure (mPAP) were also estimated.

Results:
From a total of 243 RHC patients, 79 PH patients were enrolled. The mean (SD) age was 56 (19) years. Dyspnea on exertion (DOE) was the most common clinical manifestation; 70 (89%). Most of them were in functional class II; 58 (73%). PAH was the most prevalent PH group; 46 (58%), followed by PH due to left heart disease; 26 (33%). In the PAH group, congenital heart disease-associated PAH was the most common aetiology; 25 (54%). Compared with the non-PAH group, PAH patients were younger and had fewer comorbidities, particularly atrial fibrillation. There were strong correlations between TRVmax and mPAP (r = 0.62, P < 0.01).

Conclusion:
PAH was the most prevalent among PH who underwent RHC. The most common presentation of PH patients was DOE. There were strong correlations between parameters from echocardiography and RHC (TRVmax and mPAP).
Coronavirus disease-19 triggered systemic lupus erythematous
Authors: Garg Yadvir , Kakria Neha , Singh Sarvinder , Jindal Ashok Kumar 
Published: December 2022

ABSTRACT
Coronavirus disease 19 (COVID-19) has been associated with varied immunological diseases due to dysregulated immune responses. We hereby report a rare case of COVID-19 triggered Systemic lupus erythematous arising in a young healthy male, necessitating the use of immunomodulatory drugs for the remission of the disease process.
Prescription Patterns and Antibiotic Resistance Rates of Respiratory Tract Infections in a Saudi Tertiary Medical Centre
Authors: Al Munjem Manea Fares , Thabit Abrar K. , Rasool Sahibzada Tasleem , Emeka Promise Madu , Al Munajjim Fahad Fares , Al Habeeb Mohd 
Published: December 2022

Objectives:
Respiratory tract infections (RTIs) are a significant cause of hospitalization due to morbidity and mortality. The unwise use of antimicrobial agents in RTI management may contribute to the emergence of bacterial resistance. Therefore, we aimed to assess prescription patterns and antibiotic resistance among hospitalized patients with RTIs.

Materials and Methods:
This retrospective study included patients with any RTI who were hospitalized between 2016 and 2017. Antibiotics prescribed and changes in antibiotic resistance over time were evaluated.

Results:
The 405 included patients ranged in age from a few months old to over 65 years old. The most common clinical manifestations were fever (98% of patients) and sore throat (57.5%), followed by cough (46.7%) and dyspnea (27.2%). C-reactive protein was elevated in 43%. The most common diagnoses among all the patients were tonsillitis (43.2%), pharyngitis (36%), and pneumonia (23%). The most commonly isolated organisms were Haemophilus influenza (93.2%), Streptococcus pneumoniae (90.9%), Pseudomonas aeruginosa (84.1%), and Klebsiella pneumoniae (84.1%). Amoxicillin/clavulanate was mostly prescribed for upper RTIs, whereas levofloxacin was mostly prescribed for lower RTIs. Amoxicillin/clavulanate was the major antibiotic prescribed for pediatric patients, whereas geriatric patients (≥65 years) were mostly prescribed levofloxacin. No major changes in resistance rates were observed for amoxicillin/clavulanate, levofloxacin, or ciprofloxacin before (in 2015), during the study period (2016–2017), and after the study (2018).

Conclusion:
Amoxicillin/clavulanate and levofloxacin were the most commonly prescribed antibiotics, but resistance to these antibiotics did not increase over time. However, clinicians should make every attempt to collect cultures from patients with severe RTIs to rule out bacterial involvement.