Higher Number Of Subjects Research Articles

Correlations between clinical parameters and PSQ in children with suspected OSA

The aim of this study was to measure tonsils and adenoid vegetations, investigate the modified Mallampati score, determine BMI according to body mass and corresponding percentile, and compare these data with the results of the Pediatric Sleep Questionnaire (PSQ). The subjects were children aged 2 to 18 who were indicated for adenotonsillectomy at the Clinic for Otorhinolaryngology and Head and Neck Surgery. A doctor specialist conducted the clinical examinations. According to the PSQ, 75 subjects were divided into two groups: those at high risk and those at low risk for developing obstructive sleep apnea (OSA). The PSQ results showed that 45 subjects (60 %) were at high risk for OSA, and these subjects had significantly lower weight and BMI. Although a higher number of subjects had grade 4 tonsils and grade 3 and 4 adenoids, this distribution was not statistically significant. There was no statistically significant difference in the distribution of the modified Mallampati score when compared with the PSQ results. Lower body mass and BMI were statistically significant risk factors for OSA, while the size of the tonsils and adenoids, as well as the modified Mallampati score, did not show any statistically significant difference in comparison with the PSQ results.

Phenotype and Clinicoradiological Differences in Multifocal and Focal Bronchiectasis.

Introduction: Bronchiectasis is a chronic progressive respiratory disease characterized by permanent dilatation of the bronchi. It is a complex condition with numerous different etiologies, co-morbidities, and a heterogeneous presentation. As we know, there is a lack of studies that describe the differences and compare the characteristics between focal and multifocal bronchiectasis. The aim of this study is to identify differences in clinical characteristics presentation, severity or distribution in focal and multifocal bronchiectasis, and prognostic implications. Methods: 126 patients with computed tomography (CT)-verified bronchiectasis were enrolled. Baseline characteristics that included age, sex, smoking history, and respiratory symptoms were recorded, with special attention paid to hemoptysis appearance, body mass index, and comorbidities. The type of bronchiectasis determined by CT scan and the modified Reiff scores indicating radiological severity were recorded. Patients were divided in two groups (I is focal and II is multifocal). Results: There were no statistically significant differences in age, smoking status, comorbidity, and BMI between the two groups. Multifocality was associated with a significantly higher proportion of females (p = 0.014), the rate of hemoptysis (p = 0.023), and the number of hospitalizations, but not of exacerbations and prevalence of immunodeficiency (p = 0.049). Significantly, a high number of subjects with multifocality had bronchiectasis of moderate severity, and post-infective and asthma-associated phenotypes were the dominant in this group. Unexpectedly, the cystic and varicose radiological phenotype (which need more time to develop) were more dominant in the focal group. The cylindrical phenotype was equally observed in the multifocal and focal groups. Conclusions: Our study suggests that multifocality is not related to age, number of exacerbations, or radiological phenotype, but it seems to be associated with the clinical post-infective phenotype, immunodeficiency, frequent hospitalizations, and severity. Thus, the presence of multifocal bronchiectasis may act as a biomarker of severity and poor outcomes in these patients.

Nebulized dexmedetomidine prior to flexible bronchoscopy in reducing procedural cough episodes a randomized double blind clinical trial. (NCT: CTRI/2022/07/044389, NICOBAR group of investigators)

BackgroundFlexible bronchoscopy (FOB) or video bronchoscopy is a day-care procedure indicated in the diagnosis of various pulmonary disorders. FOB is done under conscious sedation with the use of local lignocaine to reduce cough episodes. Nebulized dexmedetomidine has been shown to have local anaesthetic as well as systemic action. This study investigated the role of Nebulized dexmedetomidine delivered prior to FOB to reduce cough episodes. MethodsIt was a double blind, randomized controlled trial conduced on subject undergoing diagnostic FOB. Subjects with recent history of myocardial infarction or cerebrovascular accidents were excluded. Subjects undergoing therapeutic bronchoscopy or endobronchial ultrasound were also excluded. Subjects in intervention arm received Nebulized dexmedetomidine at a dose of 2 μg/kg whereas control arm subjects were nebulized with normal saline. Primary outcome of the study was to compare the proportion of subjects with moderate-to-severe cough among the two groups. ResultsOver a period of 6 months, 128 cases were screened and 100 were randomized in a ratio of 1:1. Mean age of study population was 49.5 ± 15.6 years with majority being males (64%). Baseline characteristics were similar in the two groups. A higher number of cases in Nebulized dexmedetomidine arm underwent bronchoalveolar lavage (50% versus 24%) whereas a higher number of subjects in control groups underwent “bronchoscopy for airway inspection” (42% versus 20%). The difference in the proportion of subjects with moderate to severe cough in the two groups was not statistically significant (22% versus 18% in Nebulized dexmedetomidine group and control group, respectively, p > 0.05). Doses of anaesthetic drugs (fentanyl, midazolam, locally instilled lignocaine) were also similar in the two groups. However, the discomfort level experienced by the patient as well as ease of doing procedure for the operator, as measure by VAS score, were significantly lower in the intervention arm as compared to the control arm (51 ± 20.6 versus 72.2 ± 13.1, for patient reported discomfort and 12.5 ± 9.8 versus 36.6 ± 27.2, for operator ease of doing procedure). Mean Richmond Agitation Sedation Scale score was significantly lower in the Nebulized dexmedetomidine arm (−0.22 ± 0.1 versus 0.12 ± 0.1). Dexmedetomidine as well as normal saline were equally well tolerated in nebulized form. None of the study subjects reported any intervention related adverse events. ConclusionThis study demonstrated that Nebulized dexmedetomidine has insignificant topical action to reduce cough episodes as compared to normal saline in diagnostic FOB, but systemic effects remain to be investigated.

A Co-Simulation Model Integrating a Musculoskeletal Human Model with Exoskeleton and Power Tool Model

Working at and above head height with a power tool represents a common activity in craft and assembly applications. To assist and protect the user from overload and injuries in these situations, the development and use of application-specific support systems, such as exoskeletons and power tools, have greatly increased in recent years. Thus, the integration of aspects of the user-centered product development of support systems in the early phases of product development process has high potentials. A common approach to integrate the user early in the product development process is the use of musculoskeletal human models, which allow the evaluation of effects on the human body. This could also be applicable in the mentioned use case to enable the evaluation of the interactions for the user. Therefore, a co-simulation model for virtual modelling and simulating human–machine interactions is presented. The co-simulation model is made up of a musculoskeletal human model and the models of the technical systems (exoskeleton and power tool). By applying the co-simulation model, the impact of technical systems on the human body can be taken into account to derive design alternatives for the technical system due to the requirements of the user. The paper describes the design of the co-simulation model and particularly, the interaction of the submodels. The evaluation of the co-simulation model is carried out with the help of a subject study for the selected use case working at and above head height. The results show plausible results for the muscle loads considering the support by an exoskeleton. Furthermore, the comparison of simulated results to measured muscle activations via surface electromyography shows a good agreement. Thus, the co-simulation model passes the test for functionality and seems to be applicable for the derivation of design alternatives of technical systems regarding the user needs. In future, the co-simulation model will be further validated with a higher number of subjects and to implement design alterations in the technical systems.

Efficacy of Cognitive Behaviour Therapy in Major Depressive Disorders: An Original Research.

The present study assessed the benefits of cognitive behavioral treatment in patients suffering from major depressive disorders. Hundred patients were included in the present study. The cases were assigned alternatively to the experimental group, who received cognitive behavior therapy in addition to the antidepressant medications, whereas in the control group, patients were managed using medications. Four outcome measures were used, viz., Beck Depression Inventory, Hamilton Depression Rating Scale, Beck Anxiety Inventory, and Visual Analog Scale. Chi-square test was used to analyze the data using SPSS. The highest number of subjects (55%) were found in the age group of 15-25 years. The mean Beck Depression Inventory score in the experimental group was 35.60 (standard deviation 9.52) and in the control group, it was 26.40 (standard deviation 8.26) giving a mean difference of 9.20 which is statistically significant. It was found that the patients who received cognitive behavior therapy reported greater improvement in their symptomatology than the patients who were receiving medications only.

Study of Genetic Drifts in Some Fat Mass and Obesity Associated Gene Variatiants in Type 2 Diabetics in Some Ethinic Groups Residing in Delta State, Nigeria

Aim: Detailing and distribution of some predominant FTO genes among subjects with diabetes mellitus selected from Igbo, Ika, Ijaw and Isoko tribes of Delta state, Nigeria.
 Study Design: Case-control, observational study.
 Place and Duration of Study: Federal Medical Center, Asaba, Delta State and Safety Molecular Pathology Laboratory Enugu, Nigeria, between March 2020 and Febuary 2022.
 Methodology:100 subjects (20 diabetic and 5 non diabetic from each of the four tribes; age range; 28-74 years) Venous blood was collected for the assay of FBS, Hb1ac and molecular assay of four variants of FTO (Fat Mass and Obesity Associated) gene. Results obtained were statistically analysed.
 Result: The genotypes identified in the subjects were AA, GA, GG, AC, CC, TT, and AT. AA (Ijaw 17, Urhobo 18, Ika 18, Igbo 19) and GG (Ijaw 17, Urhobo 18, Ika 19, Igbo 18) had highest level of occurrence in all tribes. Recombinant genotype and recessive allele had higher number of subjects as compared to the originating genotypes. Hardy- Weinberg statistics demonstrated significant genetic deviations in rs2388405(AA -0.12 x2 =0.0002, GA 0.12 x2=0.002) rs201041270(GG-0.12 x2 =0.0002, GA 2.12 x2=0.002), and rs8050136 (CC -0.34 x2 =0.001, AC 2.32, x2=0.05) proving a chance of finding new SNP in the studied population with a probability of 2.25 as seen in the odd ratio of T allele in Igbo tribe.
 Conclusion: Statistically significant genetic drifts exist in the studied population.

Constrained Independent Vector Analysis with Reference for Multi-Subject fMRI Analysis.

Independent component analysis (ICA) is now a widely used solution for the analysis of multi-subject functional magnetic resonance imaging (fMRI) data. Independent vector analysis (IVA) generalizes ICA to multiple datasets (multi-subject data). Along with higher-order statistical information in ICA, it leverages the statistical dependence across the datasets as an additional type of statistical diversity. As such, IVA preserves variability in the estimation of single-subject maps but its performance might suffer when the number of datasets increases. Constrained IVA is an effective way to bypass computational issues and improve the quality of separation by incorporating available prior information. Existing constrained IVA approaches often rely on user-defined threshold values to define the constraints. However, an improperly selected threshold can have a negative impact on the final results. This paper proposes two novel methods for constrained IVA: one using an adaptive-reverse scheme to select variable thresholds for the constraints and a second one based on a threshold-free formulation by leveraging the unique structure of IVA. Notably, the proposed algorithms do not require all components to be constrained, utilizing free components to model interferences and components that might not be in the reference set. We demonstrate that our solutions provide an attractive solution to multi-subject fMRI analysis both by simulations and through analysis of resting state fMRI data collected from 98 subjects - the highest number of subjects ever used by IVA algorithms. Our results show that both proposed approaches obtain significantly better separation quality and model match while providing computationally efficient and highly reproducible solutions.

Analysis of dose distribution reproducibility based on a fluence map of in vivo transit dose using an electronic portal imaging device

Morphological changes can affect distribution of dose in patients. Determination of the dose distribution changes for each fraction radiotherapy can be done by relative in vivo dosimetry (IVD). This study analysed the distribution of doses per fraction based on the fluence map recorded by the electronic portal imaging device (EPID) of the patient’s transit dose. This research examined cases involving the cervix, breast, and nasopharynx. Transit dose analysis was performed by calculating the gamma index (GI) with composite and field-by-field methods. The gamma passing rate (GPR) value was assessed for its correlation with the subject’s body weight. In the case of the nasopharynx, breast, and cervix, the GPR value decreased as the fraction increased. In the case of the nasopharynx, the correlation between the GPR and fraction radiotherapy showed no difference when using either composite or field-by-field methods. However, in cases involving the cervix and breast, there was a difference in the correlation values between the composite and field-by-field methods, where the subject had a significant correlation (p < 0.05) when it was done using a field-by-field method. In addition, the nasopharynx had the highest number of subjects with significant correlation (p < 0.05) between GPR and body weight, followed by the cervix and breast. In the nasopharynx, breast, and cervix, the reproducibility of the dose distribution decreased. This decreased reproducibility was associated with changes in body weight.

Evaluation of Cardiovascular Risk in Patients with Type 1 Diabetes: How Ankle Brachial Index Can Be Usefull?

Background: Patients with type 1 diabetes (T1D) face a significantly higher mortality risk compared to the general population, primarily due to elevated rates of cardiovascular disease (CVD). Detecting cardiovascular disease at its preclinical stage is essential for effective primary prevention in this relatively young population. This study aims to assess the link between steno-risk and subclinical atherosclerotic disease, as detected by the Ankle-Brachial Index (ABI), in T1D patients and determine the prevalence of these abnormalities among them. Methods: A cohort of 312 adults with T1D (151 males and 161 females, mean age 31 ± 12 years) was examined. Patients were categorized based on their ABI values (ABI &lt; 0.9 indicating peripheral arterial disease (PAD), ABI ≥ 1.3 indicating arterial calcification (AC), and ABI between 0.9 and 1.3 indicating normal ABI). The study analyzed the relationship between ABI anomalies and cardiovascular risk factors and their association with the steno-risk category. Results: Among the patients, 138 (44.2%) had a normal ABI, 112 (35.9%) had PAD, and 62 (19.9%) had AC. AC was more prevalent in men than in women (p = 0.006). A family history of stroke was common in both the PAD and AC groups (p = 0.042 and p = 0.046, respectively). Patients with AC were often older (36 ± 13 vs. 30 ± 12; P = .012), had a longer duration of diabetes (20 ± 11 vs. 14 ± 9; P &lt; 0.001), a higher prevalence of hypertension (25.8% vs. 14.5%, P = 0.05), and a higher prevalence of smoking (19.3% vs. 9.4%, P = 0.046). A higher number of subjects with AC were found in the Steno-Risk 10–20% and Steno-Risk ≥20% categories compared to the Steno-Risk &lt; 10% (37.5 vs. 15.5; 29 vs. 15.5, p = 0.0106, respectively). Conclusion: This study demonstrates that an ABI &gt; 1.30 is more common in older patients with type 1 diabetes and is associated with a longer duration of diabetes, male gender, smoking, hypertension, and a family history of stroke. Furthermore, an ABI &gt; 1.30, indicating arterial calcification, is significantly linked to moderate and high cardiovascular risk assessed by steno-risk in patients with type 1 diabetes. The ABI may serve as a straightforward tool for screening atherosclerosis in T1D.

Cross Sectional Study on Prevalence of Falsely Low HbA1c in Diabetic Patients on Dapsone Therapy

Background : Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels.[1] Objective: The aim of our study was to establish the prevalence of falsely low HbA1c in diabetes patient on dapsone therapy and the possible mechanism behind it. Study design: we conducted a retrospective Cross-sectional study on 30 subjects more than or equal to 18yrs attending the Endocrinology and Dermatology outpatient department (OPD ) ,patients with diabetes mellitus on oral anti diabetic drugs and or insulin therapy on dapsone therapy and patients on documented dapsone therapy for Hansen’s disease or any other skin condition were eligible for enrolment. HbA1c measured by HPLC(high performance liquid chromatography) was compared with expected A1c value suggested by other parameters like fructosamine assay and mean blood glucose. Also other parameters of haemolysis was measured to establish the possible mechanism behind the falsely low A1c. Results: Out of 30 subjects 25 patients were found to have low HbA1c value compared to their fructosamine assay and expected HbA1c. Prevalence of inappropriately low A1c was 25(83.45%) ,16 of them in diabetic group (53.3%) and 9 in non-diabetic group (30.0%).. There were higher number of subjects in discordance group with &gt;2% methaemoglobin with marginally positive correlation .Factors of haemolysis too was higher in more number of subjects [reticulocyte count (18.2%) mcv(90.9)LDH(86.6%)] in discordance Hba1c group compared to cordance HbA1c group but was not statically significant owning to small sample size. Conclusion :The prevalence of falsely low A1c in patient on dapsone therapy was as high as 83.5% and possible reason for this being hemolysis suggesting there are a number of drugs, some of them quite commonly used, which can cause inappropriately high or low HbA1c levels for the degree of glycemia

A cross-sectional study on assessment of birth control methods in family planning facilities among pregnant mothers in parts of Hong, Adamawa State, Nigeria

The study assessed the knowledge, accessibility and utilized birth control methods among pregnant mothers. Surveys and choice-type questionnaires were the study methodology used. A total of 222 pregnant women were drawn at random from three different health facilities in Hong. Frequency and percentage were used in the data presentation. Age group 36–50 (47.1%) years, NCE/Diploma (38.1%), civil servant (25.1%), pregnant women with parity of 3 and 4 children (24.8%) and child spacing of ≥ 2 years (53.4%) had the highest number of subjects, according to the sociodemographic characteristics of those who participated. Participant's knowledge of and access to birth control methods revealed those who were already sensitized (83.3%), knowledge source of birth control method was hospital (46.3%), who knew the precise time of ovulation (65.2%), who had access to birth control through Primary Health Care centers and acknowledge the importance of birth control techniques (80.5%) recorded high numbers of participants. According to the utilization of birth control techniques, the highest rates were seen in both participants who frequently breastfed and utilized a calendar or rhythm with equal score (40.5%) as a natural method of birth control, those who employ coitus interruptus (54.3%), menstruated while breastfeeding (56.6%), and who frequently used condoms, pills etc. (37.4%). Additionally, 57.4% cited cost serve as a barrier for condom utilization, while 58.2% cited their culture and religious beliefs have not prevented them from utilizing birth control. Therefore, Birth control technique sensitization at home and health care center, level of education alongside availability and access point to modern contraceptive at health care influence utilization of both natural and modern methods of birth control.

The Efficacy of Intradermal Injection of Botulinum Toxin Type-A on Painful Diabetic Neuropathy: A Systematic Review.

Diabetes is one of the most common causes of neuropathy. Morbidity and mortality increase in patients suffering from diabetic polyneuropathy and are experienced by approximately 10 to 54% of diabetic patients. Severe pain, loss of sensation, increased risk of ulceration, and even amputation are the complications of diabetic neuropathy. Intradermal injection of botulinum toxin type-A (BTX-A) is a relatively novel method for the treatment of painful diabetic neuropathy. This method is becoming popular considering its acceptable and long-lasting pain control and minimal systemic side effects. This narrative systematic review aimed to evaluate the effectiveness of intradermal BTX-A injection on painful diabetic neuropathy. The queried databases included PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, Web of Science, Scopus, and Google Scholar. The final search was performed in February 2022, and no time limits were set for the search. All the relevant clinical trials were included. The inclusion criteria and search strategy were set as follows: Type of study: Randomized clinical trial (RCT) or other types of interventional studies; publication date: All published studies until February 22, 2022; sample size: No restrictions; outcomes: Effect on diabetic neuropathy pain; quality: Earning a minimum acceptable score based on critical appraisal; and language: English. The searches and article screening were performed by two independent reviewers to minimize the possibility of bias. In case of disagreement about a study, the comments of an expert (as a third person) were used to resolve the ambiguity. In a review of 4 RCTs and 1 case-control study on the effectiveness of BTX-A in reducing the pain of diabetic neuropathy, 273 patients were evaluated in total. The lowest and highest number of subjects was 18 and 141. The sex distribution included 43.22% men and 56.77% women, all of whom were 47.8 to 74.8 years old. Three studies were conducted in Iran, Taiwan, and Egypt. The results of this review showed significant improvement in pain reduction, e.g., based on the Visual Analog Scale (VAS) and Neuropathic Pain Scale (NPS). A few studies evaluated sleep and psychosocial complications, and their results indicated a statistically significant improvement in the Pittsburgh sleep quality index (PSQI) and the physical subscale of the 36-Item Short Form Survey (SF-36). The results of this systematic review demonstrated that intradermal injection of BTX-A causes significant and long-term (up to 12 weeks) improvement in diabetic neuropathy pain. The improvement in sleep and mental or physical functions was not consistent, and no conclusive result could be reached.

Distribution of Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) Immunoglobulins G and M among Frontline Health Workers in Eleme Local Government of Rivers State, Nigeria

Background: The fight against Corona Virus Disease (COVID-19) globally among front line health workers has been a challenging task, it encompasses working lengthy hours at the isolation Centre’s, intensive care units, emergency departments and molecular laboratories, and also been exposed to pathogens, fatigue, and psychological distress. This has led to high morbidity and mortality rate among front line health workers all over the globe.&#x0D; Aim: This study aimed at determining the distribution of SARS CoV -2 IgG and IgM among frontline health workers in Eleme Local Government of Rivers State, Nigeria.&#x0D; Materials and Methods: A total of 100 frontline Covid-19 health workers were recruited for this study comprising 48 males and 52 females with ages between 23 and 49 years and included janitors, hygienist, nurses, data Officers, logistics and ambulance drivers, physicians, and medical laboratory scientists, working at the molecular laboratories, sample collection booths and isolation center. The bio-data of the subjects were obtained using a well-structured questionnaire. Only subjects who gave informed consent were recruited for this study. 60ul of capillary blood was collected from each participant using an aseptic technique and immediately followed by the analysis of SAR-CoV-2 IgM and IgG using a lateral flow immunochromatographic assay technique.&#x0D; Results: Results from this study showed a total of forty-two (42) 42% subjects were reactive to IgG antibodies while fifty-eight (58) 58% subjects were non-reactive to IgG antibodies also a total of Twenty-One (21) 21% subject were reactive to IgM antibodies while a total of seventy-nine (79) 79% subjects were none reactive to IgM antibodies. A total of nine (9) subjects who were exposed to SAR-CoV-2 for more than one year were reactive to SAR-Cov-2 IgM and IgG antibodies, while a total of two (2) subjects who were exposed to SAR-CoV-2 for less than one year were reactive to SAR-Cov-2 IgM and IgG antibodies and the difference (p ₌ 0.013) was statistically significant. Also, a higher number of subjects within the 20-29 age bracket were reactive to SAR-CoV-2 IgM antibodies while subjects with in the age bracket of 30-39 were more reactive to IgG antibodies.&#x0D; Conclusion: This study reveals that serological testing is an ideal approach in assessing the proportion of frontline health workers who might have been exposed to SARS-CoV-2 as part of effort in combating COVID-19 disease globally.

Automated Vibration and Acoustic Crepitus Sensing in Humans

Abstract Crepitus vibrational and acoustic signal analysis of the human facet joints of the lumbar spine has historically been a difficult problem due to the inhomogeneous and varied signal characteristics. Although previous studies have examined tribological characteristics of facet joints, we have found vibrational and acoustic signals to be a satisfactory analog to facet joint tribology and function. Here, we improve upon our previous automated computational method, now enhancing it for the analysis of human crepitus. Compared with this group’s previous studies using a mechanical model, human crepitus is extremely complex. Therefore, we proposed an automated method (AM) of analysis that used a test set (n = 16) and an experimental set of data (n = 48). We had a fair level of interrater agreement (Kw = 0.367, standard error (SE) = 0.054, 95% confidence interval (CI) = 0.260–0.474) between the AM and human observers before adjustments were made in the AM. Following adjustments to the AM, interrater agreement improved to a substantial level (Kw = 0.788, SE = 0.056, 95% CI = 0.0.682–0.895). In the future, we recommend a machine learning study with a larger number of subjects who can better capture the nuances of varying types of human crepitus.

CLINICAL FEATURES AND OUTCOMES OF PATIENTS WITH METASTATIC BREAST CANCER

The retrospective study was conducted in the Department of Oncology, Hameed Latif Hospital, JPMC &amp; GINUM, from January 2020 to January 2023 to assess the shift in the prognosis of MBC over time in the real-life clinical setting. Patients were divided into groups based on disease diagnosis (Group I: January 2020-January 2021 and Group II: January 2022-January 2023) and disease presentation (de novo vs. recurrent), and the correlation between prognostic factors and survival was assessed. A total of 781 patients were included in the study, 240 in Group I and 541 in Group II. There were 484 (61.9%) HR+, 210 (26.8%) HER2+, and 86 (11.01%) TN cases. 412 (53%) had recurrent disease, with a gradual increase in frequency (P &lt;0.001). Incidence of HR+ disease (56%) was significantly higher than HER2+(20%) and TN subtypes (12%)(P&lt;0.001). 375 (48%) had dnMBC, consisting of 52% with HR+ disease, 29% withHER2+ and 5.8% having TNMBC. Despite a gradual decrease in frequency, de novo disease was most common in the HER2+ subtype (62% in Group I vs. 49% in Group II, P = 0.007). A higher number of subjects with HR+ disease had chemotherapy in Group I compared to Group II (P=0.01), while endocrine therapy (ET) was more common in Group II (n = 238, 44%) compared to Group I (n = 118; 38.4%) (P=0.14). There were significant variations among pathological subtypes; HR+ was 18.0 months, HER2+ was 17.0 months, and TNBC was 10 months ( P&lt; 0.001). The median OS among all patients after a follow-up of 36 months was 50.0 (47.0-54.0) months. TN group had the worst OS of 27 months (P&lt;0.001). The impact of modern treatment approaches in Group I vs. Group II (52 vs. 52 months) was insignificant. Advancement in the treatment is associated with improved prognosis of MBC, particularly for luminal B-HER2+. TNBC has the worst prognosis and is the most challenging to treat. The findings of this study will provide insight into disease patterns and survival, which can be valuable for improving outcomes through the use of novel treatment.

Kejadian anemia, pola menstrual bleeding dan status nutrisi pada siswi di SMAN 3 Salahutu, Maluku Tengah

Background: Anemia is a nutritional problem with a high incidence. Anemia is characterized by decreased hemoglobin (Hb) levels below normal. Adolescents are one of the groups at high risk of anemia because they experience menstrual cycles every month. Irregular menstrual bleeding patterns and nutrition can also be risk factors for anemia. Prevention of anemia is necessary to reduce the risk of anemia.Objectives: To determine the incidence of anemia, menstrual bleeding patterns, and nutritional status in female students at Salahutu Senior High School, Central Maluku.Methods: The study was descriptive and observational with a cross-sectional design. The study was conducted in October-December 2022 at Senior High School 3 Salahutu, Central Maluku. The number of subjects was 142, who met the inclusion criteria with an age range from 14 to 19 years. The research variables consisted of checking Hb levels using digital hb, and anthropometric measurements, namely BMI, and filling out questionnaires. Data analysis in this study used the Chi-square test at the 95% significance level.Results: The results showed that the number of age categories 16 years with the highest number of subjects, 35,9%, and underweight IMT category as much as 59,2%. The results of the anemia hemoglobin examination were 7,7%. The age of menarche is mainly at the age of 13 years 34,5%, and based on the length of menstruation, 3-5 days as much as 66,9% and 5-7 days as much as 29,6% with a menstrual cycle of 21-28 days as much as 59,9%. There was no relationship between nutritional status and duration of menstruation (p = 0,648) and Hb levels (p = 0,552). There is a relationship between nutritional status and menstrual cycle (p = 0,020).Conclusion: There is no relationship between nutritional status and duration of menstruation and Hb levels, but there is a relationship between nutritional status and menstrual cycle.

Evaluation of major depressive disorder using 7 Tesla phase sensitive neuroimaging before and after mindfulness-based cognitive therapy

ObjectiveWe applied 7 Tesla phase sensitive imaging to evaluate the impact of brain iron levels on depression severity and cognitive function in individuals with major depressive disorder (MDD) treated with mindfulness-based cognitive therapy (MBCT). MethodsSeventeen unmedicated MDD participants underwent MRI, evaluation of depression severity, and cognitive testing before and after receiving MBCT, compared to fourteen healthy controls (HC). Local field shift (LFS) values, measures of brain iron levels, were derived from phase images in the putamen, caudate, globus pallidus (GP), anterior cingulate cortex (ACC) and thalamus. ResultsCompared to the HC group, the MDD group had significantly lower baseline LFS (indicative of higher iron) in the left GP and left putamen and had a higher number of subjects with impairment in a test of information processing speed. In the MDD group, lower LFS values in the left and right ACC, right putamen, right GP, and right thalamus were significantly associated with depression severity; and lower LFS in the right GP was correlated with worse performance on measures of attention. All MBCT participants experienced depression relief. MBCT treatment also significantly improved executive function and attention. MBCT participants with lower baseline LFS values in the right caudate experienced significantly greater improvement in depression severity with treatment; and those with lower LFS values in the right ACC, right caudate, and right GB at baseline performed better on measures of verbal learning and memory after MBCT. ConclusionsOur study highlights the potential contribution of subtle differences in brain iron to MDD symptoms and their successful treatment.

Issues related to pregnancy, pregnancy prevention and abortion in the context of the COVID-19 pandemic: a WHO qualitative study protocol

IntroductionWHO has generated standardised clinical and epidemiological research protocols to address key public health questions for SARS-CoV-2 (COVID-19) pandemic. We present a standardised protocol with the aim to fill a...

High Prevalence of Anemia in Children in Dharavi Locality of Mumbai: Possible Role of Homeopathy

Background: Prevalence of Anemia is reported to be as high as about 90% in some segments of the population in India. Dharavi is arguably the largest slum in Asia. Due to its socioeconomic status, there is a possibility of malnutrition in this area. We have surveyed the area for the prevalence of anemia in Dharavi. &#x0D; Methods: The status was assessed with the help of Local Laboratories at Dharavi. Children from 5 to 15 years of age were surveyed from 7 different areas of Dharavi. Their name, age, gender, contact number and the hemoglobin level were collected in the survey and analysed based on WHO criteria of mild (11 – 11.4 g/ dL), moderate (8.1 – 10.9 g/dL) and severe anemia (&lt;8g/dL) in primary school-age children (5-11 years), middle-school-age childhood (12-14 years) and secondary school-age childhood (15 years). &#x0D; Results &amp; Discussion: There were 673 children surveyed. Kumbharwada had the highest number of subjects with 172 children. There were 380 male and 293 females. 324 children were from the primary school-age group, 255 from the middle-school-age group (12-14 years) and 94 from secondary school age childhood (15 years). Of the total 673 children, 363 children were non-anemic, and 310 children were anemic. There were 44, 91, and 41 children who were of mild anemic from the primary school-age group respectively, 77, 23and 16 children were moderate anemic from the middle-school-age group respectively, and 8, 6 and 4 children were severely anemic from the secondary school-age group respectively. &#x0D; Conclusion: Dharavi, one of the most populated localities in the world, has a significant number of children with anemia. Homoeopathic can be a possible solution for the same in addition to the appropriate supplement.

Tofacitinib Associated with Reduced Intubation Rates in the Management of Severe COVID-19 Pneumonia: A Preliminary Experience.

BackgroundThe second wave of COVID-19 pandemic was not only associated with a rapid and severe surge in the number of cases but also limited availability of recommended medicines. Baricitinib has been known to reduce recovery time in COVID-19 pneumonia in association with remdesivir. Tofacitinib, with limited evidence, was used in severe COVID-19 pneumonia based on its similarity of action with baricitinib.MethodsData of all patients admitted to the COVID-19 intensive care unit in the month of April were accessed and analyzed. Data of patients who were on other immunomodulators, invasive ventilation, or suffering from end-stage organ diseases were excluded from the analysis.ResultsOut of 73 patients, data of 50 were analyzed. Twenty-five received tofacitinib and the other 25 were managed with standard of care. Age, comorbidities, and gender distribution between the two groups were similar. On day 7 of admission, the change in SpO2/FiO2 ratio was 1.26 ± 1 and 0.72 ± 1 in the tofacitinib group and control group, respectively. Similarly, a higher number of subjects in the control group showed worsening in the World Health Organization (WHO) ordinal scale (36 vs 12%, p = 0.01). The clinical objective improvement was similar in the two groups. The intubation rates in the tofacitinib group were significantly lower than that in the control group (32% vs 8%, p = 0.034).ConclusionTofacitinib, in this retrospective single-center experience, was found to be associated with reduced intubation rates and reduced worsening in the WHO ordinal scale. There was no difference in mortality in the two groups.How to cite this articleSingh PK, Lalwani LK, Govindagoudar MB, Aggarwal R, Chaudhry D, Kumar P, et al. Tofacitinib Associated with Reduced Intubation Rates in the Management of Severe COVID-19 Pneumonia: A Preliminary Experience. Indian J Crit Care Med 2021;25(10):1108–1112.