bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and Predictors of Osteoporosis/BMD Below Expected Range for Age in Pheochromocytoma/Paraganglioma and BMD, TBS Change Post-Operatively: A Prospective Cohort Study
Authors: Khatiwada Saurav , Agarwal Shipra , Kandasamy Devasenathipathy , Kumar Rajeev , Jyotsna Viveka P , Tandon Nikhil 
Published: March 2023

Context:
Pheochromocytomas/paragangliomas (PPGLs) have recently been shown to be associated with lower bone mineral density (BMD) and trabecular bone score as compared to healthy controls suggesting low bone mineral concentration and disrupted bone microarchitecture. There is paucity of data on prevalence and clinical predictors of low BMD/osteoporosis in PPGL from India and the extent of change in BMD post-operatively.

Aims:
This study aimed to find prevalence of low BMD/osteoporosis and trabecular bone score (TBS)-adjusted FRAX score in subjects with PPGL and to see the post-operative change in BMD and TBS at follow-up.

Material and Methods:
32 consecutively diagnosed adult cases with PPGL were enrolled. Although the provisional diagnosis of PPGL was made based on imaging consistent with PPGL supported by biochemical evidence of catecholamine excess, its confirmation was made histopathologically before final analysis.

Results:
We found significantly low average BMD T-score/Z-score at spine, hip or wrist. Osteoporosis was evident in 87.5% of subjects (nine of 11 post-menopausal women or men >50 years of age) and BMD below the expected range for age in 42.9% of subjects (nine of 21 pre-menopausal women or men <50 years of age) by International Society for Clinical Densitometry criteria.

Conclusions:
87% of older subjects with PPGL had osteoporosis while 43% of younger subjects had BMD below expected range for age (Z-score ≤-2.0), more at lumbar spine than at hip. Decreased body weight was associated with osteoporosis in older or Z-score ≤-2.0 in younger subjects. There was no significant change in BMD and TBS scores at a median of four months post-operatively.
Study of Non-Thyroidal Illness Syndrome and Its Recovery in Critically Ill Patients at a Tertiary Care Centre in South India
Authors: Praveen N S , Modi K D , Sethi Bipin K. , Murthy JMK , Reddy Pawan K. , Kandula Srinivas 
Published: March 2023

Background and Objectives:
Transient thyroid hormone alterations are common during critical illness and are termed non-thyroidal illness syndrome (NTIS). We studied the prevalence of NTIS in the ICU setting and its impact on predicting mortality and other outcomes and compared it to the Acute Physiology and Chronic Health Evaluation II (APACHE II) score.

Materials and Methods:
The study included 119 consecutive patients admitted with a critical illness. APACHE II score was calculated. Total T3, total T4, TSH, free T3, and free T4 were measured at admission and after six weeks of discharge. NTIS and euthyroid groups were studied for ICU, hospital stays, mortality, readmission, and recovery. Predictors of mortality were compared between survivors and non-survivors.

Results:
The mean age was 60.15 ± 14.50 years with M:F = 84 (71%):35 (29%). NTIS was observed in 84 (71%), low T3 being the most common abnormality in 53 (63%). The occurrence of NTIS was significantly higher among non-survivors (28/30, 93%) versus survivors (56/89, 63%) (P = 0.002). Non-survivors showed significantly lower T3, TSH, and FT3/FT4 ratios and higher readmissions. NTIS group showed significantly greater ICU stay (P = 0.02) and had higher readmission rates (P = 0.032). Baseline T3 had the greatest power to predict mortality. APACHE II score also correlated significantly with mortality (19.60 ± 10.58 vs 11.99 ± 6.80, P < 0.001). The area under the curve (0.677) for the T3 level was lower than the APACHE II score (0.760). After six weeks, 61% had recovered from NTIS.

Conclusions:
NTIS was common amongst critically ill patients (71.5%), which reversed in 61% at six weeks. Low T3 was the most common abnormality and independently predicted mortality. Free T3/free T4 also significantly predicted mortality. The correlation between thyroid dysfunction and the severity of primary illness makes it an additional attractive low-cost marker of mortality.
Iodine Status, Thyroid Disorder and Feto-Maternal Outcome among the Tribal Pregnant Women of Eastern Himalayas
Authors: Sonowal Trisha , Sarmah Jatin , Sarma Paresh K. , Deka Manab 
Published: March 2023

Introduction:
Iodine deficiency and thyroid disorder during pregnancy have adverse effects on fetal and neonatal outcomes.

Objective:
To assess iodine status and thyroid functioning during pregnancy and to evaluate the feto-maternal outcome.

Methods:
Urinary iodine content (UIC) is determined by arsenic cerium catalytic spectrophotometry method and thyroid hormone analysis was carried out by chemiluminescence assay. Fetal and neonatal outcomes were obtained from hospital records.

Results:
Among the considered tribal pregnant women 56.75% had insufficient urinary iodine and 24.5% had a thyroid disorder. Thyroid disorder was more common in pregnant women with urinary iodine concentration (UIC) <99 μg/L than UIC >150 μg/L (56.75% vs 41.5%). Pregnant women with UIC<99 μg/L had a higher incidence of anemia (86.36%), gestational diabetes mellitus (GDM) (3.33%), and preeclampsia (5.71%) than UIC >150 μg/L. The fetal outcome with UIC <99 μg/L had a higher incidence of low birth weight (9.09%) and preterm births (1.9%). Stillbirths were distributed equally among different UIC groups. The neonatal outcomes with UIC <99 μg/L between 150-249 μg/L had a higher incidence of respiratory distress (5.23%). Hypothermia was equally distributed among different UIC groups. Subclinical hypothyroid had a high prevalence of anemia (62.96%), preeclampsia (3.7%), and GDM (6.17%) respectively than the euthyroid group. The fetal outcome with low birth weight (LBW) (9.87%), stillbirths (3.7%), and preterm birth (8.64%) was more common in the subclinical hypothyroid than in the euthyroid group. Among the neonatal outcomes respiratory distress (6.17%) and hypothermia (4.93%) were more common in subclinical hypothyroid than euthyroid pregnant women.

Conclusion:
Insufficient maternal iodine and thyroid disorders during pregnancy were associated with adverse pregnancy outcomes.
Thyroid Autoimmunity and Subclinical Hypothyroidism in Prolactinoma: A Case Control Study
Authors: Laway Bashir A. , Sahu Danendra , Bhat Moomin H. , Baba Mohammad S. , Viswanath S Arun , Misgar Raiz A. , Wani Arshad Iqbal , Bashir Mir Iftikhar , Shah Zaffar Amin , Mudassar Syed 
Published: March 2023

Background:
This study was aimed at determining the frequency of thyroid autoimmunity and subclinical hypothyroidism in patients with hyperprolactinemia due to prolactinoma compared to well-matched healthy controls.

Methods:
This was a cross-sectional study wherein 78 treatment naïve prolactinoma patients and ninety-two healthy control subjects were recruited. Serum prolactin (PRL), thyroid-stimulating hormone (TSH), total thyroxine (T4), circulating anti-thyroid peroxidase (anti-TPO), and anti-thyroglobulin (anti-Tg) antibody levels were measured in all study subjects. Progression of the antibody-positive population to subclinical hypothyroidism was determined.

Results:
The median PRL level among patients was 166 ng/ml (IQR 85-467) compared to 11.4 ng/ml (IQR 8.5-15.9) in controls (P < 0.001). There was no significant difference in levels of T4 (P = 0.83) and TSH (P = 0.82) between the cases and controls. Overall, 25% of patients had the presence of anti-thyroid antibodies as compared to 20% of controls (P = 0.56). SCH was more common in antibody-positive hyperprolactinemia subjects compared with antibody-positive controls.

Conclusion:
We did not find an increased prevalence of thyroid autoimmunity among untreated prolactinoma patients compared to healthy controls. At the same time, subclinical hypothyroidism was more common in thyroid antibody-positive patients with hyperprolactinemia than positive controls.
Clinicomicrobiological profile of mycotic keratitis patients presenting at a tertiary care hospital of rural North India
Authors: Sangwan Jyoti , Lohan Kirti , Kaur Manpreet , Kumar Yogesh , Saini Nishtha , Mane Pratibha , Singla Pooja , Khan Sameena 
Published: March 2023

Background:
Mycotic keratitis (MK) or keratomycosis is an infection of corneal stroma caused by a variety of fungal species. It is a condition resulting in blindness if untreated seen, especially in tropical and subtropical countries. The identification of causative fungus is key to starting appropriate treatment. This study aimed to describe clinicomicrobiological profile along with associated demographic factors of MK patients presenting at a tertiary care hospital situated in rural North West India.

Methodology:
A cross-sectional study was conducted for 3 years from June 2018 to June 2021 at a tertiary care hospital situated in rural North India after obtaining ethics committee approval. After obtaining informed consent, a detailed history was taken from suspected MK patients. Then, corneal scrapings were taken under the slit lamp and processed in the microbiology laboratory for isolation and identification of causative agents. The results obtained were analyzed.

Results:
A total of 114 nonrepetitive samples were collected from patients suspected of keratomycosis during the study period. Eighty-one (71.1%) samples were found to be positive for fungal growth. Males were affected more than females (1.53:1). Individuals belonging to the age group of 21–40 years were involved the most. Farmers (48.1%) were affected most of all. The predominant fungal species isolated was Candida followed by Aspergillus and Fusarium.

Conclusion:
The present study highlights the different etiology of MK across different geographical regions. Candida spp. was the most common etiological agent observed in the study followed by Aspergillus and Fusarium spp. Its prevalence, risk factors, and causative agents involved vary with geographic variation, occupation, and local prevailing practices. Timely diagnosis can get an individual the right treatment and can save the vision.
A study on the understanding of sterilisation in the central sterile services department by the healthcare personnel in a tertiary care hospital in Sikkim
Authors: Subba Sunu Hangma 
Published: March 2023

Background:
Globally, hundreds of millions of people are affected every year by avoidable infections in healthcare (healthcare-associated infections, [HAIs]). Through knowledge, best practices and infection prevention and control (IPC), we can prevent HAI to patients and health workers. Following recent threats caused by widespread epidemics and increasing awareness about the spread of antimicrobial resistance, several countries are paying more attention and investing resources to strengthening IPC infrastructures and improving practices.

Objective:
The objective was to assess the practices by the healthcare staff regarding the sterilisation process in the central sterilisation service department (CSSD) and to bring about improvements in the practices in the hospital.

Materials and Methods:
A cross-sectional study was conducted where the healthcare staff were given a set of questionnaires on sterilisation in the CSSD. The staff who participated in the study included doctors, intensive care unit nursing staff, infection control nurses, operation theatre nursing staff, CSSD staff and outpatient department nursing staff.

Results:
The questionnaire was administered to 120 health staff. All the staff agreed that instruments should be cleaned at the source. The majority of the participants (82%) believed that medical devices should be reprocessed centrally in CSSD; however, very few of them (18%) have felt otherwise. Almost 70% of staff did not know about the indicators used in CSSD and the zones in CSSD. The expiry date of the items once received from CSSD, 60% said it is not mentioned on the pack and 40% of participants agreed that it is mentioned on the pack.

Conclusion:
The processes of sterilisation and decontamination are complex, require specific infrastructure and equipment and involve several steps that need to be correct, from device collection, receipt by the unit, processing, storage and distribution them throughout the facility. Quality control measures to evaluate the proper functioning of the equipment are of the utmost importance.
Staphylococcal nasal colonisation amongst medical students
Authors: Gupta Munesh Kumar , Sinha Gargi , Singh Ashish Kumar , Prakash Pradyot 
Published: March 2023

Background:

Staphylococcus aureus is a common cause of hospital-acquired infections. Medical undergraduates are frequently exposed to hospital-adapted bacterial strains especially S. aureus and therefore are always at risk of colonisation.

Materials and Methods:
A prospective study was conducted on 150 undergraduate students, of different semesters, to detect S. aureus nasal colonisation. A detailed history regarding attending the hospital ward teaching, hospitalisation, frequency of nose touching and immunocompromised condition was unequivocally obtained from all the participants. Anterior nares were swabbed and inoculated on mannitol salt and blood agar plates. S. aureus isolates were subsequently verified by conventional microbiological techniques. The antibiotic susceptibility testing was done by the modified Kirby–Bauer disc diffusion method. In addition, PCR-based detection of mecA gene and pvl gene was performed.

Results:
Out of 150 students, we found 18 students (3 of 1st, 10 of 5th and 5 of 9th semester, respectively) to be colonised by S. aureus. Of these 18 isolates, 8 were found to be methicillin-resistant. We observed a significant association (P < 0.05) of hospital exposure, ward teaching/hospitalisation with S. aureus colonisation. These S. aureus isolates exhibited varying susceptibility towards different antibiotics with multiple antibiotic resistance indexes ranging from 0.08 to 0.58. Interestingly, all eight methicillin-resistant S. aureus isolates displayed mecA positivity while all were found to be pvl negative.

Conclusion:
The results indicate the importance of imparting knowledge about infection control practices during the initial years of undergraduate training in medical schools, which may increase awareness amongst students before getting outpatient or ward postings.
Sociodemographic profile, work practices, and disease awareness among stone mine workers having silicosis from Central Rajasthan
Authors: Dixit Ramakant , Kuldeep Rajveer , Goyal Mukesh , Agarwal Deepesh , Jalutharia Jitendra 
Published: March 2023

ABSTRACT

Background and Objectives:
Silicosis continues to pose an important health hazard among workers having occupational exposure to stone dust. Several studies have addressed clinical presentation, radiographic and pulmonary function abnormalities in workers with silicosis. This study was planned to analyze sociodemographic profile and awareness about several aspects of silicosis among the stone mine workers visiting our centre.

Methods:
A questionnaire was administered in a convenient sample of eligible subjects over six years period. The questionnaire was aimed to collect sociodemographic variables, like age, gender, educational status, residential background, smoking status etc., apart from information on work-related profile including protective measures taken. Also knowledge and attitude regarding silicosis was assessed. Silicosis awareness index was also calculated as per the response received.

Results:
Majority of the study subjects were male (96.6%) with rural background (98.5%). 54.1% subjects were in the age group of 30 to 50 years. 81.9% mine workers were illiterate. The common addictions observed among them included smoking (60%), tobacco chewing (34%), alcohol (20%) etc., Varying duration of work exposure was observed with more than 10 years in 63.4% and more than 20 years in 32.2% workers. The commonest work exposing them to stone dust was breaking stones by chisel and hammer (51%) followed by separation of stone slab (20%) and stone drilling (15%). 80.9% subjects were not aware of the term silicosis, more than 80% were not aware of the symptoms and causes of silicosis. Only one fifth subjects were having awareness of using protection against the disease. Overall awareness about silicosis was better among literate and youngers participants.

Conclusions:
Stone mining industry reflects male dominance, poor literacy, long working hours for many years, financial compulsion to start and continue the job and very poor awareness regarding the disease silicosis and importance of personal protection at workplace.
Large mediastinal/thoracic benign teratoma presenting with haemoptysis: Report of a case and review of the literature
Authors: Goyal Vikas Deep , Pahade Akhilesh , Misra Gaurav , Kaira Vaanika , Prajapati Neeraj 
Published: March 2023

ABSTRACT
The mediastinal teratomas can grow to a large size before becoming symptomatic. The symptoms are usually due to the compression of adjacent structures. A computed tomographic scan of the chest is the investigation of choice for making a provisional diagnosis and planning for further management. Removal of large mediastinal/thoracic teratoma can be associated with various intraoperative and postoperative complications, which can be life-threatening sometimes. We operated on a patient with a large mediastinal mass extending into the right thoracic cavity up to the costo-phrenic angle. The postoperative period was eventful and required judicious intensive care. The patient eventually recovered with conservative treatment. A literature search was done on PubMed using the keywords benign mediastinal teratoma. Case series/original articles published in the last two decades, that is, after the year 2000, were evaluated. As per the review of the literature, the prevalence of benign mediastinal teratoma may be higher in eastern countries. Thoracoscopic surgery is the preferred modality except for cases with adhesions or infiltration into surrounding structures.
Reinfection of COVID-19 among doctors at a tertiary care centre in Northern India: A report from a resource-limited setting
Authors: Reddy D. Himanshu , Kapoor Rohan , Rai Priyanka , Atam Virendra , Khan Farman , Pandey Saurabh , Malhotra Hardeep S. , Gautam Medhavi , Bharadwaj Nitin 
Published: March 2023

ABSTRACT

Background and Aims:
There is an increasing recognition of reinfection in coronavirus disease 2019 (COVID-19). We studied the reinfection of COVID-19 disease among doctors at a tertiary care centre in Northern India.

Methods:
All COVID-19 patients readmitted for COVID-19 disease after any duration with at least a positive Real time- polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 were included. Their clinical profile, vaccination status, outcome and Centre for disease control (CDC), Atlanta, USA reinfection criteria screening were recorded.

Results:
A total of 57 (0.53%) doctors were identified and 56 of them satisfied the CDC criteria. It included 13 (20.3%) females and 89.3% of cases were from clinical specialities; 98.2% of individuals had the first infection in 2020 and mean duration between 2 infections was 156.29 ± 76.02 (35–298) days. Duration between two episodes of the disease with more than 90 days apart was in 80.3% cases. One (1.8%) patient developed severe disease and two (3.6%) cases were of moderate severity. Symptoms were similar in both infections except significantly higher number of extra-respiratory complaints (2.2% vs. 9.1%). There were 37.5% cases who had received first dose of vaccination of any duration at the time of second infection. Nine (16.1%) and four (7.1%) patients with more than 4 weeks after the first and second dose of vaccination developed the second infection, respectively.

Conclusion:
Majority of reinfection were symptomatic and developed after 90 days and so majority followed CDC criteria. Breakthrough infections among vaccinated healthcare worker are real, and with sustained exposure to the virus, they should continue to use precaution including hand hygiene and mask in order to prevent reinfection.
The impact of lockdown on symptoms and health status of patients with chronic airway diseases: An appraisal of patient perceived impressions
Authors: Bhattacharyya Parthasarathi , Mukherjee Sikta , Chatterjee Moumita , Saha Dipanjan , Sengupta Sayoni , Dey Debkanya 
Published: March 2023

ABSTRACT

Background:
The pandemic-specific lockdown may influence the health status of patients with chronic airflow obstruction (CAO) as COPD, COPD-PH, and chronic asthma.

Objectives:
To find the impact of the lockdown on symptoms, and the degree of perceived change in physical activity and emotional health with possible reasons including the indicators of ambient air pollution.

Methods:
A cohort of CAO patients was telephonically enquired regarding their perceived well-being in symptom status, physical activity, and emotional health with the perceived contribution from plausible reasons (regular medication, simple food, no pollution, and family attention) for the change; all being expressed in percentages. The change in symptom scores as 0-39, 40-79, and 80-100 were regarded as ‘low’, ‘medium’, and ‘high’ respectively. The impact of the individual contributing factor was calculated statistically. The assessment of the CAT (COPD assessment test) score and the ambient air pollution (PM2.5 and PM10) was also done for their association with well-being.

Results:
There was a universal improvement (p < 0.5) in COPD (n = 113), COPD-PH, (n = 40), and chronic asthma, (n = 19) as regards symptoms, physical activity, and emotional health that tallies to overall and individual change in CAT score. There were concomitant reductions in PM10 and PM2.5 levels during the lockdown compared to the same period of the previous year. All the four listed factors contributed with the ‘no/low pollution’ and ‘simple food being the most important; on acting together, they reduced the moderate and severe symptoms impressively.

Conclusion:
Reduced air pollution and simple food appear most important for the improvement of CAO patients during the lockdown period.
Combining four screening tools for cost effective screening of OSA in train drivers: A UK experience
Authors: Ogunyemi Lanre , Nafisa Syeda , Stacey Tanya , Sovani Milind 
Published: March 2023

ABSTRACT

Background:
Obstructive sleep apnoea (OSA) in drivers/workers has been implicated in railway and road traffic safety incidents; however, there are insufficient data on its prevalence and cost-effective screening methods.

Aim:
This pragmatic study examines four OSA screening tools: the Epworth sleepiness scale (ESS), the STOP-Bang (SB), the adjusted neck circumference (ANC) and the body mass index (BMI), exploring their suitability and effectiveness separately and in combination.

Method:
Using all four tools, 292 train drivers were opportunistically screened between 2016 and 2017. A polygraph (PG) test was carried out when OSA was suspected. Patients with an apnoea–hypopnea index (AHI) ≥5 were referred to a clinical specialist and reviewed annually. Those who had continuous positive airway pressure (CPAP) treatment were evaluated for compliance and control.

Results:
Of the 40 patients who had PG testing, 3 and 23 participants met the ESS >10 and SB >4, criteria, respectively, whereas 25 participants each had an ANC >48 and a BMI >35 with a risk factor or ≥40 with none. OSA was detected in 3, 18 and 16 of them who met the ESS, SB and ANC criteria, respectively, and was positive for OSA in addition to 16 others who met the BMI criteria. A total of 28 (72%) were diagnosed with OSA.

Conclusion:
Although when used individually, these screening methods are less effective/inadequate, combining them is easy, feasible and offers the maximum chance of OSA detection in train drivers.