bluuebunny/crossref_metadata_2025_split huggingface dataset:
Step-in step-down approach in the management of bronchial asthma in adolescents and adults
Authors: Gupta Prahalad Rai , Sarnaik Ravindra , Gupta Neeraj 
Published: August 2022

Introduction:
Despite the step-up step-down approach of asthma management suggested by the Global Initiative for Asthma (GINA), control of asthma continues to be poor. It was hypothesized that a new “Step-in Step-down approach” could prove to be a better alternative. The present study was carried out with the objective to assess the efficacy and adverse effects of this new approach in the control of asthma.

Materials and Methods:
All treatment-naïve asthma patients were randomly allocated to either Group I (patients received budesonide 400 mg + formoterol 6 mg twice daily via dry powder inhalation device along with as-needed salbutamol) or Group II (patients received stepwise treatment as per GINA guidelines, 2017). Patients were monitored on a fortnightly basis for control of symptoms, spirometry, and complications if any. Asthma Control Questionnaire (ACQ-7) was used to assess control of asthma. Adverse effects, if any, were recorded and managed appropriately. Step-down was attempted on achieving sustained control of asthma, i.e., ACQ score of <0.75 on two consecutive fortnight assessments in both the groups. In Group I patients, long-acting b2-agonist was withdrawn first. Subsequently, a dose of budesonide was also reduced. In Group II patients, the treatment was decreased to the next lower step medicines as per the GINA guidelines.

Results:
After exclusions, a total of 787 patients were randomized to either Group I or II. The demographic profile of patients in the two groups was similar. Patients on “step-in step-down” approach had a statistically significant advantage over those on conventional step-up step-down approach in terms of (a) time to the first control (271 vs. 98 within first 4 weeks), (b) need for rescue steroids (two patients in Group 1 vs. 40 in Group 2), (c) number of exacerbations (30 vs. 232), and (d) use of rescue SABA (Only 30 patients in group I required > 5 inhalations per week as compared to all in group II). Adverse reactions were not observed in any of the patients in either group.

Conclusion:
We conclude that step-in step-down approach is a more robust and safer approach for control of asthma.
Pleural fluid lysozyme as a diagnostic biomarker of pleural tuberculosis
Authors: Aggarwal Ashutosh Nath , Agarwal Ritesh , Dhooria Sahajal , Prasad Kuruswamy Thurai , Sehgal Inderpaul Singh , Muthu Valliappan 
Published: August 2022

Objective:
Pleural fluid lysozyme (LP) and its ratio to serum lysozyme (LP/LS) have been proposed as potential biomarkers for diagnosing tuberculous pleural effusion (TPE). We assessed the diagnostic accuracy of LP and LP/LS for TPE and evaluated their ability to differentiate TPE from other effusions.

Methods:
We queried the PubMed and Embase databases for studies indexed until October 2021. We included studies that (a) provided information regarding the sensitivity and specificity of LP or LP/LS for the diagnosis of TPE, or (b) compared LP or LP/LS between TPE and malignant or parapneumonic effusions. We used hierarchical summary receiver operating characteristic plots to model summary sensitivity and specificity. Random effects modeling was employed to pool standardized mean differences (SMD) across descriptive studies comparing TPE and other effusions.

Results:
We included 11 publications in our review, most of which were small and of poor quality. The summary estimates for sensitivity, specificity, and diagnostic odds ratio (DOR) were 0.94 (95% confidence interval [CI] 0.53–1.00), 0.89 (95% CI 0.63–0.97), and 129.88 (95% CI 6.26–2695), and 0.98 (95% CI 0.58–1.00), 0.91 (95% CI 0.84–0.96), and 708.47 (95% CI 11.42–43946), respectively, for LP and LP/LS. Mean LP and LP/LS in TPE were significantly higher than in malignant effusions (summary SMD 1.51 [95% CI 1.04–1.98] and 1.77 [95% CI 1.31–2.22], respectively), and parapneumonic effusions (summary SMD 0.86 [95% CI 0.51–1.22] and 1.15 [95% CI 0.64–1.66], respectively).

Conclusion:
There is low-quality evidence of good diagnostic accuracy for both LP and LP/LS in identifying TPE, the latter being marginally superior.
Knowledge, attitude and practices towards seasonal influenza vaccination among healthcare workers
Authors: Padmanabhan Arjun , Abraham Sujith Varghese , Koul Parvaiz A. 
Published: August 2022

Background:
Vaccination as a primary prevention strategy is a well-established public health policy for preventing influenza. Despite strong recommendation, vaccination coverage among health workers is still not satisfying. The intention of the current study is to evaluate the knowledge, attitudes and practices towards influenza vaccination among healthcare workers.

Materials and Methods:
In this cross-sectional, single-centre study, 789 healthcare workers (out of total 1380) participated. Institutional ethical committee clearance was obtained before the study. It was conducted in October 2021. A structured questionnaire in the form of Google sheet was sent to all healthcare professionals (HCPs) affiliated with the institution. Data collected was tabulated using MS Excel and analysed using appropriate statistical tools.

Results:
Of the 1380 approached, a total of 789 (57.17%) HCPs responded to the questionnaire. The overall vaccination coverage in the study population was 71.6%. The overall vaccination acceptance rate drops to 36.78% when those taken vaccine as a recommended pre-employment requisite and got never vaccinated again were excluded. Also, 88.21% of the respondents believed that influenza is a potentially dangerous disease and 93.16% believed that flu vaccination is effective against preventing influenza. Although 736 participants (93.28%) were aware that seasonal influenza vaccine is recommended for healthcare workers, irrespective of age and comorbidities, only 411 (52.1%) intended to take vaccine in the coming year. Also, 97.34% of the participants considered vaccine as safe.

Conclusion:
Influenza vaccination coverage among healthcare workers is still at an unsatisfactory level. This is despite majority of the HCPs accepting that the vaccine is safe and preventive against influenza. Efforts are still needed to improve the coverage.
Efficacy and safety of glycopyrronium/formoterol delivered via a dry powder inhaler in patients with moderate to severe chronic obstructive pulmonary disease
Authors: Salvi Sundeep , Kumar Anand , Agrawal Sumit , Leuva Amritlal , Shukla Vineet Kumar , Deshpande Shrikant Vishnu , Balamurugan Santhalingam , Singh Ajit , Tikkiwal Sharad , Gupta Sandeep K. , Singh Bhanu Pratap , Lopez Meena , Sawant Sandesh , Vaidya Abhijit , Gogtay Jaideep 
Published: August 2022

Background:
We designed this randomised, open-label, parallel group, multi-centre study to investigate the efficacy and safety of glycopyrronium/formoterol, a long-acting muscarinic antagonist/long-acting b2-agonist fixed dose combination, delivered through a dry powder inhaler (DPI) in patients with chronic obstructive pulmonary disease (COPD).

Material and Methods:
We randomised (1:1) patients with moderate to severe COPD (N = 356) to receive glycopyrronium 25 mg/formoterol 12 mg via DPI twice daily (GF-DPI) or glycopyrronium 50 mg monotherapy via DPI once daily (G-DPI). The primary study endpoint was the mean change from the baseline in pre-dose trough-forced expiratory volume in one second (FEV1) at 12 weeks.

Results:
At week 12, the mean increase from the baseline in pre-dose trough FEV1 was higher in the GF-DPI group (120 ml) than in the G-DPI (60 ml) group. The mean difference (MD) between treatment groups was 0.06 L (95% CI: 0.00–0.12 L, P < 0.0001 for non-inferiority). At week 12, the mean pre-dose forced vital capacity (FVC), 1 hour post-dose FEV1, and post-dose FVC increased significantly from the baseline only in the GF-DPI group (p < 0.0001). The reduction in the COPD assessment test score was greater in the GF-DPI group (p = 0.0379). The average daily number of puffs of rescue medication and the reduction in mean modified Medical Research Council scale, COPD, and Asthma Sleep Impact Scale score at week 12 were similar between groups (p > 0.05). Overall, 35 adverse events and two serious adverse events unrelated to study drugs were reported. Both groups had similar results for overall drug safety.

Conclusion:
The results demonstrate efficacy and safety of GF-DPI in Indian patients with moderate to severe COPD. Treatment with GF-DPI significantly improved the lung function and quality of life and was well tolerated.
To Assess the Perception, Attitude, and Practice Related to Mucormycosis during COVID-19 Era
Authors: Gurjar Yamini J. , Kansagara Trusha , Chauhan Meet , Savani Nikita Maheshbhai 
Published: August 2022

Background:
Recently, mucormycosis cases were increasingly reported in people with coronavirus disease-2019 (COVID-19), particularly from India. With the subsequent waves of COVID 19 in India, mucormycosis cases may rise again. Besides, people's perception, attitude, and practice toward mucormycosis can be explored with the web-based survey so its outcome can be used in spreading awareness among the general population.

Aim and Objectives:
The study's aim and objective were to assess the perception, attitude, and practice related to mucormycosis in the COVID-19 era and the associated sociodemographic factors among the general population of Gujarat.

Materials and Methods:
A cross-sectional community-based study was carried out for 2 months (June 21–July 21) using semistructured questionnaire in the local language. The form was circulated through WhatsApp application. The principle of the snowball technique was used for data collection. Information related to sociodemographic profile, followed by questions on perception, attitude, and practice related to mucormycosis was collected and analyzed.

Results:
A total of 998 responses for sociodemographic variables were obtained for the study. Seven hundred and eighty-six participants were part of the study for the assessment of perception, attitude, and practice of mucormycosis. A total of 61.45%, 61.83%, and 63.99% of participants had good perception, attitude, and practice, respectively. Binary logistic regression revealed that education and relation with health-care workers for perception, sex, and place of residence for attitude and occupation for practice were independent determinants.

Conclusion:
Good perception, attitude, and practice toward mucormycosis among respondents show that good efforts have been done toward Information, Education, and Communication by health authorities and mass media. Still, there is a need for more collaborative actions in spreading awareness toward the remaining population.
Treatment of Late-Onset Blount's Disease using Linear Rail System and Double Corrective Osteotomies at the Intra-Articular and Metaphyseal Regions
Authors: Enemudo Roy Efetoboh , Lasebikan Omolade Ayoola , Obumse A. T. , Uyilawa Okhuaihesuyi 
Published: August 2022

Background:
Blount's disease is a developmental anomaly that affects the posteromedial aspect of the proximal tibia physis with changes seen in the epiphysis, metaphysis, and sometimes, in severe cases, the distal femur as well. It results in a posteromedial deformity, internal tibial torsion, and shortening of the affected leg.

Aim:
The purpose of this study is to document the results of the treatment of the late form of this deformity using intra-articular and metaphyseal osteotomies of the proximal tibia and a linear rail system (LRS) device.

Patients and Methods:
Six patients were treated for late-onset unilateral Blount's disease. The procedure consisted of intra-articular osteotomy below the physis to elevate the depressed medial tibia plateau and a metaphyseal osteotomy below the tibia tubercle to address any residual varus deformity, tibial torsion, and leg shortening using a LRS device.

Results:
The mechanical axis deviation was corrected from a mean of 6.0 cm (range of 3.1–9.6 cm) to 1.4 cm (0–2.9 cm). The tibiofemoral angle was corrected from a mean of 23.2° varus (range of 16°–30°) to a mean of 1.8° varus (range of 5° valgus–7° varus). The limb length discrepancy was corrected. Operation time was 90 min on average. The device use time was three months on average. Schoenecker outcome criteria were good for all the patients.

Conclusion:
The use of double corrective osteotomies at the proximal tibia and the LRS device were found to be cheap, easy to use, and very effective in the treatment of Blount's disease deformity.
Impact of Basic Life Support Training on the Knowledge of Cardiopulmonary Resuscitation among Final-Year Medical Students
Authors: Dalhat Salahu , Mujahid Hassan , Saheed Adesope , Miko Abdullahi Mustapha , Mohammad Abdullahi Maryam , Sani Adamu , Shuaibu Ibrahim 
Published: August 2022

Background:
Effective and prompt intervention following an episode of cardiac arrest increases survival probability. This underscores the need for basic life support (BLS) training among first-line health-care workers. This study assesses the impact of BLS training among final-year medical students in a Nigerian institution.

Materials and Methods:
Pre- and Post-BLS training questionnaires aimed at assessing knowledge of cardiopulmonary resuscitation (CPR) were administered to 72 final-year medical students. Response to 20 questions were scored (total score 20), collated, and analyzed. Knowledge was graded as good if total score was 15 and above and poor if total score was <15.

Results:
The lowest score pre-BLS training was 6 and the highest score was 16, with a mean of 10.68 ± 2.24. The lowest score post-BLS training was 13 and the highest score was 19, with a mean of 16.8 ± 1.52. Good knowledge of BLS was demonstrated in 8.3% and 88.9% of students pre- and post-BLS training, respectively.

Conclusion:
The knowledge base about CPR of final-year medical students in Nigeria is low but was remarkably improved with a focused BLS training.
The Use of Art-Based Interventions in the Care of Patients in Health-Care Institutions in Nigeria
Authors: Oladeji Emmanuel Olusola , Ezeme Constantine , Bamigbola Albert Seun 
Published: August 2022

Background:
Arts-based Interventions involve the use of aesthetic engagements, sensory activation, evocation of emotion and cognitive stimulation and involvement of the imagination, to promote wellbeing. This include a wide range of practices, from prehistoric traditions to the modern day evidence based usage of different forms of arts for therapeutic purposes. Despite the early recognition and proven efficacy of art-based interventions, an organized structure for integration of art into healthcare is lacking in Nigeria.

Aim:
This review aims to explore and describe the existing literature on the use of various art forms in the care of patients in health care institutions in Nigeria.

Materials and Methods:
A scoping review was done. MEDLINE, Embase, African Index Medicus and PsycINFO were searched using the following key words; art in medicine in Nigeria, art therapy in Nigeria and art in health in Nigeria. The search results were screened for articles using predefined criteria. A hand search for articles and communication with Arts in Medicine Project Nigeria were also done. The articles included in the review were read and summarized using a proforma.

Result:
Overall there is a sparseness of academic articles on the use and effectiveness of arts-based interventions in the management of patients in health care institutions in Nigeria. The most commonly applied art forms are music and visual arts.
Reduced Admissions in the Children's Emergency Room During Coronavirus-19 Pandemic in the University of Port Harcourt Teaching Hospital, Nigeria
Authors: Yarhere Iroro E. , Oragui Onyinye 
Published: August 2022

Background:
Coronavirus Disease (COVID-19), the novel global pandemic that was first reported in Wuhan, China, in 2019, and subsequently in Nigeria in 2020, and its negative impact on child health has been receiving attention in the past years. One such impact was the reduction in hospital admissions during lockdown.

Aim:
This study set out to evaluate the effect of the COVID-19 pandemic on the children's emergency ward attendance from January to July 2020 and that of the preceding year.

Materials and Methods:
Hospital records of admissions from January to July 2019–2020 were extracted and exported into IBM SSPS 24 for Mac. The diagnosis was coded using the international classification of diseases. The complex diagnoses were recoded based on the severity or chronologically important ones.

Results:
There was 6.6% fewer admissions in 2020 compared to 2019 (P = 0.009). The duration of illness prior to presentation, cases of acute respiratory infection, severe malnutrition, and gastroenteritis was higher in 2020.

Conclusion:
This study showed the impact of COVID-19 on child health vis-à-vis delay in hospital presentation, reduced hospital admissions, increase in various illnesses when compared to the preceding year as a result of increase in the risk factors that would ordinarily have been mitigated pre-COVID-19.
Career Choices and Determining Factors among Final Year Medical Students in Lagos Nigeria
Authors: Falase Bode , Olufemi Setemi , Adeleye Ayowade Funmilayo , Amogbonjaye Adeola O. , Sunmola Samiat , Olaiya Ayomide , Folaranmi Omowumi 
Published: August 2022

Background:
Identifying the factors that influence the choices medical students make regarding their careers can prove invaluable in the management of healthcare manpower.

Aim:
The aim of this study was to determine the career choices and the determining factors for these choices among final year medical students at the Lagos State University College of Medicine, Nigeria.

Materials and Methods:
This study is a cross-sectional survey of two consecutive final year classes with a total of 141 students surveyed in February 2014 and February 2015.

Results:
A total of 141 students were surveyed. 75.2% intended to specialise, the most common specialties being: Surgery (29.2%), Paediatrics (14.2%), Obstetrics and Gynaecology (13.2%) and Internal medicine (13.2%). More men preferred surgery (43.5% vs 18.3%; p = 0.005) and more women paediatrics (20% vs 6.5%; p = 0.011). 24.8% did not want to specialise. The reasons included: rigours of residency (48.6%), unacceptable hours of practice (34.3%), difficulty getting placements (28.6%) and family requirements (22.9%). 48.1% of the respondents chose to do their residency abroad, 27.4% chose to stay at home and 24.5% were undecided. The main factors influencing choice of residency abroad were better exposure (88.2%), improved standards of living (82.4%), avoiding incessant strike actions (80.4%) and better financial rewards (72.5%).

Conclusion:
Most students showed a preference for the core clinical specialties with significant gender disparity in specialty preference. The potential for continuous 'brain drain' is also identified. Appropriate steps should be taken to mitigate the factors identified that influenced these choices, to protect the future medical workforce.
Risk Perception on Breast Cancer and Acceptance of Screening with Mammogram by Female Nurses in Tertiary Health Facilities in Jos, Plateau State, Nigeria
Authors: Mandong Barnabas Mafala , Mandong Jagshak Barnabas , Emmanuel Innocent , Zoakah Ayuba Ibrahim , Akpa Philip Ojile 
Published: August 2022

Background:
Breast cancer remains the major cause of cancer morbidity and mortality among women globally. The risk of breast cancer increases with advancing age. Screening programs have been demonstrated to significantly reduce breast cancer mortality.

Aim:
The main objective was to assess risk perception and acceptance of mammogram as a screening tool for the early detection of breast cancer among female nurses working in three tertiary health facilities in the city of Jos. The study also determined the factors that impede the acceptance of mammogram.

Materials and Methods:
Self-administered semi-structured questionnaires were administered at random to 450 female nurses across the three tertiary health facilities in the city of Jos. The questionnaires were structured into six sections, namely sociodemographic, knowledge of the risk of breast cancer, mammogram use and acceptance barriers to the use of mammogram, and possible obstacles to the utilization of mammogram. The resources were scored and graded accordingly.

Results:
A total of 450 nurses participated with the median age of the participants as 28 years (23–39), 66.7% were younger than 35 years of age, and 54.4% were single. The educational background showed that 53.6% had bachelor's degrees and the remaining had diplomas (46.4%). On risk perception, only 40.7% of the respondents had a good perception of risk factors for breast cancer, while 59.3% had a poor perception. Only 52 (11.6%) of the 450 participants have ever had a form of the mammogram.

Conclusion:
The study showed that less than half of the respondents had a good perception on the risk of breast cancer and also the rate mammogram acceptance was very low.
Knowledge and Associated Factors for the Uptake of Hepatitis B Vaccine among Nonmedical Undergraduate Students in a Private University in Ekiti State, Nigeria
Authors: Elegbede Olusegun Elijah , Alabi Ayodele Kamal , Alao Taiye Adeyanju , Sanni Taofeek Adedayo 
Published: August 2022

Background:
Hepatitis B is a life-threatening viral infection that causes acute and chronic diseases of the liver. Hepatitis B infection is endemic in Nigeria with a national pooled prevalence rate of 9.5%. However, a safe and effective vaccine that offers the protection against hepatitis B virus (HBV) is available.

Aim:
This study assessed the knowledge of hepatitis B vaccine and the associated factors for the uptake of the vaccine among non medical undergraduate in a Private University in Ekiti State.

Materials and Methods:
This survey is a cross-sectional study involving 420 nonmedical undergraduate students of a private university in Ekiti State, Nigeria, using a multistage sampling technique. Data were collected using a structured pretested self-administered questionnaire between March and May 2019. Analysis was done using SPSS version 23, and the level of significance was taken as P < 0.05.

Results:
The mean age of respondents was 20.3 ± 2.7 years. Almost half of the students (47.4%) were within the age range of 15–19 years. Females constitute 51.4% of the respondents and mostly practiced Christianity (77.4%). The majority of respondents had good knowledge of HBV vaccine (77.6%). Just a little over a quarter (26. 9%) of the respondents have taken one or more doses of hepatitis B vaccine. There was a statistically significant association between respondents' age (P = 0.032), the college of study (P = 0.006), and good knowledge of HBV vaccine (P < 0.001) and uptake of hepatitis B vaccine. The factors associated with uptake of hepatitis B vaccine include older age group (25–29 years), studentship in the college of science, and good knowledge of hepatitis B vaccine.

Conclusion:
The majority of respondents had good knowledge of hepatitis B vaccine. Associated factors identified for uptake of hepatitis B vaccine include age (25–29) years, studentship in faculty of science, and good knowledge of hepatitis B vaccine. It is recommended that health education about hepatitis B and its vaccine should be offered to undergraduates to increase the uptake of hepatitis B vaccine.