Study Subjects Research Articles

Articles Published in Korean Journal of Family Medicine: Impact of COVID-19 on Study Trends.

The Korean Journal of Family Medicine (KJFM), which is an official journal of the Korean Academy of Family Medicine, is an English-text medical journal published since 2009. Although nearly 15 years have passed since the journal was launched, to the best of our knowledge, no study has reviewed articles published in the KJFM. Accordingly, we analyzed articles published in the KJFM for the first time. Articles published in the KJFM between January 2018 and November 2023 were categorized according to article type. Information about author affiliations, study subjects, research methods, and modes of data collection was then scrutinized. Moreover, we compared the frequencies of subjects, research methods and modes of data collection before, during, and after the coronavirus disease 2019 pandemic. Original article was the most common article type. Approximately 52% of the articles were published by authors affiliated with departments other than family medicine, and 40% were published by family medicine. Approximately 60% and 38% of the articles were published by Korean authors and authors of international affiliations, respectively. Throughout the pandemic periods, research subjects focusing on "diseases & symptoms" have diminished, while "principles of family medicine" have progressively increased. Additionally, the use of cross-sectional study methods has declined. In terms of data collection, the use of "big data," "medical records," and "questionnaires" has decreased, whereas the use of "study results" has increased. KJFM is journal with wide and international participation covering various research subjects and study methods. We believe that our study provides valuable data for the future direction and development of the KJFM.

Do Personality Traits Predict Mental Well-being in the Context of Erroneous Subjective Estimation of Smartphone Screen Time?: Findings from a Cross-sectional Observational Study Among College Students

Background: The current article reports on the findings from a cross-sectional survey conducted among college students on a subjectively reported and objectively measured smartphone screen time (ST) and its relation to mental well-being. Methods: We explored the magnitude of discrepancy between subjectively reported and objectively measured smartphone ST. Moreover, we assessed the interaction of mental well-being with personality traits among subjects with a discrepancy between the subjectively reported and objectively measured smartphone ST. The mental health of study participants was assessed using the WHO well-being index. Personality was assessed using the Big Five Inventory (BFI)- 10. A total of 202 students shared screenshots of the phone ST function and were included in the analysis. Results: A total of 145 (71.8%) participants underestimated their daily smartphone ST, whereas 56 (27.7%) of them overestimated ST. In the regression analysis, the predicted odds of poor mental well-being were 1.43 times greater for subjects with higher neuroticism scores in the overall sample. Moreover, the predicted odds of poor mental well-being were 1.593 times greater for subjects with higher neuroticism scores among the study subjects who underestimated their ST. Conclusions: The findings of the current study suggested that the magnitude of discrepancy between the subjectively estimated and objectively estimated ST varies across college students, with the discrepancy being significantly higher among those who overestimated their ST. The predicted odds of poor mental well-being were about one and a half times greater for subjects with higher neuroticism scores among college students who underestimated their ST.

Survival Impact of Postoperative Whole-brain Radiotherapy and Systemic Chemotherapy After Surgical Resection of Brain Metastases.

Resection of brain metastases is a well-established treatment modality that can prolong the survival of patients for whom surgery is indicated. Whole-brain radiotherapy (WBRT) has been the standard postoperative therapy. In recent years, however, clinicians have increasingly avoided WBRT due to its associated adverse events. This study investigated the impact of postoperative WBRT and systemic chemotherapy as prognostic factors on the survival of patients who had undergone resection of brain metastases. The study subjects were 172 patients who underwent surgical resection for brain metastases. Comparative analyses of survival after WBRT and systemic chemotherapy were performed. Postoperative WBRT had no survival-prolonging effect, whereas postoperative systemic chemotherapy prolonged survival. A comparison based on the number of systemic chemotherapy regimens administered prior to surgery showed that fewer regimens correlated with a better prognosis. The addition of WBRT after surgical resection of brain metastases is no longer a standard treatment strategy and systemic chemotherapy after surgery is a positive prognostic factor.

Correlation study: Bone density and circulating inflammatory markers in postmenopausal patients.

This study aims to investigate the correlation between changes in bone mineral density (BMD) in postmenopausal women and circulating inflammatory markers. This retrospective study focused on postmenopausal women admitted to the orthopedic department of Suzhou Benq Medical Center from June 2022 to December 2023, following predetermined inclusion and exclusion criteria. We retrospectively collected data on initial blood routine test results and bone density measurements for all study subjects upon admission, including parameters such as white blood cell count (WBC), C-reactive protein, interleukin-6 (IL-6), and procalcitonin (PCT). Additionally, the systemic immune-inflammation index (SII) was calculated using neutrophil count, lymphocyte count, and platelet count. Statistical analyses using SPSS and GraphPad software were performed to assess the correlation between bone density and inflammatory markers. Patients were classified into three groups based on BMD results, including 60 individuals in the osteoporosis (OP) group, 127 individuals in the osteopenia group, and 37 individuals in the Normalgroup, respectively. Principal component analysis analysis suggested that WBC, SII, and postmenopausal OP(PMOP) held significant feature values. Correlation analysis indicated a correlation between WBC (p = 0.021), IL-6 (p = 0.044), SII (p = 0.034), and PMOP. One-way ANOVA analysis revealed significant differences in IL-6 (p = 0.0179), SII (p = 0.0210), and PCT (p = 0.0200) among the three groups. Finally, ROC curve analysis demonstrated that SII (area under the curve = 0.716) has predictive value for PMOP. This study identified a certain predictive value for PMOP through the assessment of inflammatory markers in peripheral blood using routine blood tests.

Evaluation of Latrogenic Genitourinary Fistula after Major Gynaecological Operation in Patient Group Admitted in BSMMU

Introduction: Close proximity of urinary tract and genital systems in females poses potential risk of fistulas formation during surgical interventions. Gynaecological malignancy, bleeding, prolonged surgery, the presence of active infection during operation, endometriosis, large uterus, previous pelvic operation, pelvic adhesions and myoma uteri are major predisposing factors that may increase the risk of urological injuries & genitourinary fistulas. Genitourinary fistulas result in continuous or intermittent urinary incontinence and a significant public health issue with negative physical, emotional and social impacts on individuals. Materials and Methods: This cross sectional observational study was conducted in Department of Obstetrics &Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from 27th March 2017 to 26th September 2017. The sample was collected by purposive sampling technique. The study subjects were women with iatrogenic fistula (diagnosed after a clinical examination and investigations) attended in out-patients or in-patients department. Result: Mean age of patients was 32.5 ± 9.54 years. Vesicovaginal fistula was commonest cause for iatrogenic genitourinary fistula, present in 34 patients. Ureterovaginal fistula was 10 patients and 6 patients detected urethrovaginal. Aetiological factors revealed that, 46.0% occurred during vaginal hysterectomy, 18.0% due to abdominal hysterectomy, 20.0% due to laparotomy with salphingoophorectmy and 16.0% during laparotomy with cystectomy. Conclusion: The commonest urogenital fistula is the vesicovaginal fistula. Urinary leakage following gynaecological surgery is a dreaded complication due to the formation of urogenital fistula. Thorough evaluation, using all diagnostic tools for complete diagnosis, understanding the pathophysiology and choosing the best surgical procedure are mandatory to obtain good outcomes after the surgical procedures. Medicine Today 2024, Vol.36 (2): 110-113

Pattern of health awareness by a health care provider in Maldives: A descriptive study

Abstract: Health awareness is considered to be one of the most essential ingredients of life. In Maldives, Mass media has been utilized to create health awareness among the people. Formally in Maldives, radio represents a popular form of communication and was the most extensively utilized form of mass media used to create health awareness among public. However, with advancement in technologies other forms of media social media platforms have been started using to create health awareness in the recent few years. The main objective of the study was to identify the pattern of health awareness created by selected health care provider (HCP), a single medical doctor who has been creating health awareness during the past 14 years period starting from 2010 till end of 2023.A retrospective descriptive cross-sectional study conducted using pre-collected data, by preparing a check list through note sheets of selected health care provider (HCP). The population for the current study is tasks or events performed by selected HCP with intention to create health awareness. Henceforth, total 359 events or tasks were included in this study as study subjects which were performed by the selected HCP in the past 14 years period starting from 2010 till end of 2023, which is also considered as sample size of the study. Majority of the awareness activity occurred in the year 2020, while majority occur specifically in the month of March. Radio was major source of awareness created, Voice Of Maldives (VOM) was main station where most of the awareness events took place and radio discussion was main method of awareness used by the selected HCP. Major topics covered in health awareness include tobacco, non-communicable disease, communicable disease, nutrition, Ramadan and health. Radio was major source of health awareness created by selected health care provider.

Validity of Serum Ammonia Level for Diagnosis of Severity of Hepatic Encephalopathy in Children

Hepatic encephalopathy is a broad spectrum neuropsychiatric abnormalities of liver dysfunction. Ammonia level may correlate with the severity of liver failure. The brain is very sensitive to the toxic effects of ammonia. As a result patient may manifests with irritability, slurring of speech, reversal of sleep-awake cycle, flapping tremor, confusion, stupor or even deep coma. This study was aimed to validate the ammonia level in children with liver failure for the assessment of its severity considering hepatic encephalopathy. This cross-sectional comparative study was conducted among 64 children aged 1-15 years of both sexes (study subjects) diagnosed as acute or acute on chronic liver failure in the Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period of November 2017 to September 2019. The subject were divided into two groups for the comparison of ammonia level to assess the severity in contrast to hepatic encephalopathy. In the first group 32 were liver failure with encephalopathy and in the second group 32 were liver failure without encephalopathy. Hepatic encephalopathy was diagnosed on the basis of West Haven Criteria. The analysis was done by the Receiver Operating Characteristic Curve with SPSS-20. Among the 64 patients female were 45% whereas male patients were 55%, male female ratio was 1.2: 1. Regarding etiology, Wilson disease was the most common cause and it was nearly two-third (65.6%) of children, cryptogenic cirrhosis was 10%, Hepatitis A was 9.4%, Autoimmune Hepatitis (AIH) was 3.10%, Hepatitis E, Hepatitis B, Hepatitis C, biliary atresia and lipid storage were 1.60% respectively. This study showed that, ammonia of ≥71 µmol/L is an indicator for presence of hepatic encephalopathy in children. The analysis by the Receiver Operating Characteristic Curve showed area under the curve (AUC) is 0.86 with upper bound 0.96 and lower bound is 0.77. It was observed that about half (48.4%) of the children had positive blood ammonia level (≥71.0 umol/L) and among the children of positive blood ammonia level most of them (80.65%) had hepatic encephalopathy and 19.35% had no encephalopathy. More than half (51.6%) children had negative (<71.0 umol/L) blood ammonia level, among them 21.21% children had encephalopathy and 78.79% patients had no encephalopathy. Sensitivity of blood ammonia was found 78.1%, specificity 81.2%, positive predictive value 80.6%, negative predictive value 78.8% and accuracy 79.7%. In conclusion, high level of ammonia is found with higher grade of encephalopathy and hyperammonia is also found in liver failure without encephalopathy. Bangladesh Med J. 2023 May; 52(2): 1-5

Anti-CCP Antibodies in Unaffected First-Degree Relatives of Rheumatoid Arthritis Patient

Introduction: Rheumatoid arthritis (RA) is perhaps the most common inflammatory arthritis, affecting 0.5% to 1% of the general population worldwide. Environmental and genetic influences are important risk factors for pathogenesis of RA. First-degree relatives (FDRs) of RA patients sharing genetic and environmental risk factors for RA may represent as pre-RA state. Since anti-CCP antibody appears years before the onset of RA, it can be used to estimate risk-potential for future development of RA in unaffected FDRs of RA patient. Objective: To see the serum anti-CCP antibody in unaffected FDRs of RA patients. Materials and Methods: This cross-sectional study was conducted from July 2019 to June 2020 in Department of Biochemistry, Dhaka Medical College, Dhaka. A total number of 50 subjects were selected among which 25 were unaffected FDRs of RA patients and the other 25 were age & gender matched healthy subjects. The related RA patients were selected from Rheumatology outdoor, Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and the healthy subjects were taken from the attendants came to the same institute who did not have RA patient in their family. The key variables (age and gender) were recorded and outcome variable (anti-CCP antibody in study subjects) was estimated. Statistical analysis was done by SPSS 26.0 and the significance was defined as p < 0.05. Results: Mean age of the FDRs of RA patient was 31.36 ± 10.51 years and that of healthy subjects was 31.56 ± 8.89 years. Most of the participants were in age group 20-29 years followed by 30-39 years. 4% of FDRs of RA patient were anti-CCP antibody positive and no positive case was recorded in healthy subjects. The median level of anti-CCP antibody in FDRs of RA patient was 0.50 U/mL and that in healthy subjects was 0.09 U/mL. The level of significance (p = 0.002) showed that serum anti-CCP antibody level was significantly higher (within normal range) in FDRs of RA patient than in healthy subjects, which was even more significant in FDRs of seropositive RA patients. Conclusion: This study revealed that serum anti-CCP antibody level was significantly higher (within normal range) in FDRs of RA patient than in healthy subjects and the proportion of positive anti-CCP antibody was more in FDRs of RA patient than in healthy subjects. Medicine Today 2024, Vol.36 (2): 76-81

Indocyanine green fluorescence imaging as a predictor of long-term testicular atrophy in testicular torsion: a pilot study.

This pilot study evaluated indocyanine green-guided near-infrared fluorescence (ICG-NIRF) imaging of testicular blood flow to predict long-term testicular atrophy after testicular torsion (TT) surgery. The subjects of this retrospective study were patients who underwent surgery for TT at our hospital between December, 2020 and July, 2022. After detorsion, testicular blood flow was evaluated by ICG-NIRF imaging and classified into three categories: fluorescence detected, no fluorescence detected, and fluorescence detected only in the tunica albuginea vessels. Testicular volume was measured by ultrasonography up to 12months after surgery to evaluate long-term outcomes. Twelve patients were included in this analysis. We found a 100% correlation between the absence of ICG-NIRF signals and subsequent testicular atrophy. In three patients without an ICG-NIRF signal, the median testis size 12months postoperatively was significantly smaller (16.5% of the contralateral testis; range 13-20%) than that in six patients with an ICG-NIRF signal (96%; 89-115%) (p = 0.013). Mild atrophy (74.5%; 73-76%) was also observed in the three patients for whom an ICG-NIRF signal was detected only in the tunica albuginea vessels. Our pilot study highlights the potential of ICG-NIRF imaging as a prognostic tool for guiding surgical decision-making for patients with TT, by predicting postoperative testicular atrophy.

Screening of Intensive Care Unit Patients for the Presence of Carbapenem-resistant Enterobacterales (CRE) on Admission as a Measure of Infection Control

The global spread of carbapenem-resistant Enterobacteriaceae (CRE) has been fostered by the lack of preemptive screening of patients in healthcare facilities that could prevent patient-to-patient transmission. To screen patients admitted to Medical Intensive Care Unit (MICU) for CRE carriage to take appropriate infection control measures. This prospective surveillance study was conducted in the MICU of a tertiary healthcare hospital between September to December 2022. Patients more than 18 years of age admitted to the MICU were included in the study. Patients transferred from different units within the hospital to MICU were excluded. Immediately after admission, two rectal swabs were collected after obtaining consent from the patients. These patients were selected based on the questionnaire framed from the Centers for Disease Control and Prevention (CDC) CRE tool kit. The samples were further analyzed and the antimicrobial susceptibility test was performed. The present study included 91 study subjects of which 53% were males. Of selected participants, 63.7% did not have any specified medical intervention or device placed and 78% had not used antibiotics previously. Of the tested isolates, Of the tested isolates, 12 (13.2%) were observed to be CRE colonized. These isolates were found to be resistant to both imipenem and meropenem. An association was reported between CRE and device placement (p = 0.000) as well as between CRE and previous use of antibiotics (p = 0.000). Current use of antibiotics (p = 0.6381) and gender (p = 0.6066) did not show any association with CRE colonisation. The study concludes that the presence of CRE is an existing danger for patients in ICUs and that there is a possible association between CRE and device placement as well as previous use of antibiotics which can be further studied.

Drug utilization evaluation of ceftazidime-avibactam in a tertiary care hospital

Background: The World Health Organization considers antimicrobial resistance a major global threat, and ceftazidime-avibactam (CAZ-AVI) is a treatment for multidrug-resistant Gram-negative infections. The FDA approved its use in 2015 for infections with limited treatment options. Methods: A retrospective study was conducted in a hospital in India to analyse the use of CAZ-AVI formulation in patients. Data was collected from electronic records and included information on patient demographics, clinical and microbiological profiles, antibiotic treatment, and patient outcomes for those in the ICU. Results: A total of 110 patients were included in the study. On assessing the results of this study, it was found that, the median age of population who received CAZ-AVI was 63 years and hypertension, diabetes mellitus were the common comorbidities present in the patients. Out of 110 subjects, 66 (60%) patients were started with a high-end antibiotic as an empirical therapy. While analysing the resistance pattern, it was found that 22 (20%) were resistant and 84 (76%) of the study subjects were sensitive to ceftazidime-avibactam. There was higher clinical success for BSI, CUTI, VAP amongst the indications of CAZ-AVI and combination of CAZ-AVI with aztreonam has given the most successful treatment outcome. The combination of CAZ-AVI with one or two high end antibiotics was observed as a common clinical practice. Conclusions: The analysis of results showed encouraging clinical cure rates. Our study results suggest that ceftazidime-avibactam could be an effective standard therapy for managing MDR Gram -negative organisms.

Uses of antiseizure medication among pregnant women with epilepsy and risk of adverse obstetric outcomes: A group-based trajectory analysis.

This study was undertaken to examine the association between different patterns of antiseizure medication (ASM) use during pregnancy and adverse obstetric outcomes (preterm birth, low birth weight [LBW], and small for gestational age [SGA]). This retrospective cohort study used the Birth Certificate Application and National Health Insurance data in Taiwan (January 1, 2004 through December 31, 2018). We retrieved weekly ASM among pregnant women with epilepsy who were prepregnancy chronic users and used group-based trajectory modeling to identify distinct patterns of use. Logistic regressions were adopted to examine the association between patterns of ASM use and risk of preterm birth, LBW, and SGA. In addition, we revealed postnatal ASM utilization pattern among these prepregnancy chronic users as an exploratory study. Of 2175 pregnant women with epilepsy, we identified four patterns of ASM use during pregnancy: frequent and continuous (64.87%), frequent but discontinuous (7.08%), intermittent (19.72%), and intermittent and discontinuous users (8.32%). Compared to frequent and continuous users, the adjusted odds ratios for preterm birth in frequent but discontinuous, intermittent, and intermittent and discontinuous users were .83 (95% confidence interval [CI] = .47-1.48), .71 (95% CI = .47-1.05), and .88 (95% CI = .52-1.49), respectively. Similar results were observed for LBW and SGA. In the exploratory study, we found that most of our study subjects maintained the same patterns before and after delivery. After considering duration and timing of exposure, our study did not find an association between four distinct patterns of ASM use and adverse obstetric outcomes among women with epilepsy. The findings suggested that optimal seizure control could be received for pregnant women with epilepsy after evaluating the risks and benefits.

Factors Influencing Turnaround Success in Financially Distressed Tourism, Hotel, and Restaurant Companies Listed on IDX (2020-2023)

The Covid-19 pandemic has significantly impacted business activities across various industries, leading many companies to face financial distress. Companies opting to continue their business operations may undergo corporate restructuring to sustain and reverse their performance (turnaround). This study aims to analyze the influence of management actions based on restructuring and economic conditions, including expense retrenchment, asset retrenchment, DER ratio, CEO turnover, and GDP, on the success of turnaround in companies experiencing financial distress, with free assets and firm size set as control variables. The Altman Z-Score model will be employed as a measurement of financial distress. This study's subjects are all 37 tourism, hotel, and restaurant companies consistently listed on the Indonesia Stock Exchange from 2020 to 2023. Sample selection utilized purposive sampling techniques, resulting in a sample size of 12 companies observed over three years. Logistic regression analysis will be used to test hypotheses. The research findings indicate that all independent variables positively influence turnaround success, but only expense retrenchment significantly impacts it.

Outcomes and complications of open mesh inguinal hernia repair in a district-level hospital in Bangladesh

Background: An inguinal hernia occurs when tissue protrudes through a weak spot in the abdominal muscles near the groin. Open mesh inguinal hernia repair aims to reinforce the abdominal wall with a mesh implant, reducing the risk of recurrence. This study aimed to assess the outcomes and complications of open mesh inguinal hernia repair. Methods: This cross-sectional study was conducted at the Department of Surgery, Moulvibazar 250 bed District Sadar Hospital from January, 2022 to July, 2023. As the study subjects, a total of 83 cases who had mesh repair for inguinal hernia were enrolled by using a purposive sampling technique. Data were analyzed using MS Office tools. Results: In this study, inguinal hernia recurrence was observed in 3 cases (3.6%), with 2 cases (2.4%) requiring reoperation. Intraoperatively, 96.4% (n=80) experienced no complications, while 1.2% (n=1) each suffered from injury to the spermatic cord and neurovascular structures. Postoperatively, over 10% of participants reported complications, including numbness (18.1%), hematoma (16.9%), scrotal swelling (15.7%), and seroma (13.3%). Conclusions: Recurrence and reoperation rates in open mesh inguinal hernia repair are relatively low. However, physicians should remain vigilant regarding potential postoperative complications such as numbness, hematoma, scrotal swelling, and seroma in patients undergoing this procedure.

Effects of Bifidobacterium bifidum tetragonum tablets and Jin Gui Ren Qi Pill on intestinal flora and metabolism in patients with diabetic kidney disease

ObjectiveTo investigate the effects of Bifidobacterium bifidum tetragonum tablets and Jin Gui Ren Qi Pill on intestinal flora and metabolism in patients with diabetic kidney disease.MethodsIn the study conducted at Heping Hospital of Changzhi Medical College from March 2021 to December 2022, 30 cases of patients diagnosed with diabetic nephropathy were meticulously selected as study subjects. Employing a double-blind randomized table method, these patients were randomly allocated into three groups: the control group (n = 10), the Bifidobacterium bifidum tetragonum tablets group (n = 10), and the Jin Gui Ren Qi Pill group (n = 10). The control group received standard western medical treatments for diabetic nephropathy, including serum glucose, blood lipids, blood pressure management, and other conventional therapies. In addition to the standard treatments, the Bifidobacterium bifidum tetragonum tablets group received Bifidobacterium bifidum tetragonum tablets, while the Jin Gui Ren Qi Pill group received Jin Gui Ren Qi Pill. Before and after a 4-week treatment period, various baseline parameters were assessed, including fasting blood glucose, 2-h postprandial blood glucose, triglycerides, serum total cholesterol, serum low-density lipoprotein cholesterol, serum high-density lipoprotein cholesterol, random urine microalbumin/creatinine ratio (ACR), blood creatinine (SCr), and traditional Chinese medicine evidence scores. Stool specimens were collected from all three groups before and after treatment for 16S rDNA high-throughput sequencing, followed by comprehensive analyses including OUT clustering, Alpha diversity, Beta diversity, species composition analysis, LEfSe analysis, and KEGG function prediction. Spearman correlation analysis was employed to explore the relationship between intestinal flora and clinical indicators. Furthermore, fasting peripheral venous blood was collected from patients in the Bifidobacterium tetrapunctate tablets group and the control group before and after intervention to measure the optical density values of tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2), and interleukin-6 (IL-6) using the Beijing Biolite ELISA kit. This study was conducted with the approval of the Ethics Committee of Changzhi Medical College.Results1. The 2hPBG, total cholesterol and LDL levels were observed among patients with diabetic kidney disease (DKD) across all groups: the Jin Gui Ren Qi Pill group, the Bifidobacterium bifidum tetragonum tablets group, and the control group (p < 0.05). 2. The Jin Gui Ren Qi Pill demonstrated superior efficacy in alleviating TCM symptoms and reducing the ACR compared to both the Bifidobacterium bifidum tetragonum tablets group and the control group. Conversely, Bifidobacterium bifidum tetragonum tablets exhibited a more pronounced reduction in TC levels compared to both the Jin Gui Ren Qi Pill and control groups. Notably, Bifidobacterium bifidum tetragonum tablets effectively decreased (IL-2) levels in patients with DKD. 3. Bifidobacterium bifidum tetragonum tablets also demonstrated efficacy in reducing IL-2 levels in DKD patients. 4. Analysis of intestinal microorganism abundance and diversity before and after the intervention, as well as among the three groups, revealed no significant alterations. Similarly, comparisons of ACE, Chao, Simpson, and Shannon indices showed no statistically significant differences (p > 0.05). 5. Qualitative analysis of intestinal microorganisms before and after intervention, as well as among the three groups, indicated no significant differences. Anosim test results also did not reveal qualitative distinctions (Anosim test R = 0.021, p = 0.215). 6. LEfSe analysis unveiled a noteworthy increase in Prevotella_7 abundance within the Jin Gui Ren Qi Pill group post-intervention (p < 0.05). 7. Furthermore, Chinese medicine evidence scores, body mass index, TC, and LDL levels correlated positively with the relative abundance of Tyzzerella_3 bacterial flora. Conversely, age, disease duration, and 2hPBG correlated positively with the relative abundance of Christensenellaceae_R_7 flora, while TC and LDL levels displayed a negative correlation with the relative abundance of Christensenellaceae_R_7 flora.ConclusionThe combination of Jin Gui Ren Qi Pill with western medical treatment exhibited superior efficacy in ameliorating clinical symptoms and reducing the ACR in patients with DKD compared to western medical treatment alone. Furthermore, this combination therapy led to an increase in the abundance of Prevotella_7 within the intestinal flora of patients, suggesting a potential enhancement in carbohydrate metabolism by the intestinal microbiota. On the other hand, Bifidobacterium bifidum tetragonum tablets bacterial tablets combined with western medical treatment demonstrated enhanced efficacy in reducing TC levels in DKD patients compared to western medical treatment alone. Additionally, this combination therapy effectively reduced the levels of IL-2 in DKD patients, thus mitigating inflammation in these individuals.

MANAGERIAL ENTRENCHMENT: SCALE VALIDATION

Objective: This work focused on the influence of managerial entrenchment on investment decisions. The objective was to understand the main characteristics of this variable in order to develop an instrument that could measure it.. Theoretical Framework: The decision-making process in finance is influenced by several factors related to the decision maker, such as their psychological and cognitive biases, their risk tolerance, and even their intentions to entrench themselves in the management of a company. Behavioral finance began to address the complexity of the decision-making process, starting from the complexity of the individual themself, displacing the idea of the pragmatic decision of Homo economicus that traditional theory represented Method: A questionnaire was developed and applied to a sample of 154 managers. Then, the instrument was subjected to an exploratory factor analysis and a reliability test. Results and Discussion: The findings of this research pointed to three components for measuring managerial entrenchment. These components were called “Managers’ Decision Autonomy”, “Power Hierarchies” and “Freedom of action” in the use of the organization’s financial resources. As a result, the instrument was validated, which was found to be capable of measuring entrenchment with consistent reliability. Research Implications: The practical and theoretical implications of this research are discussed, providing insights into how the results can be applied or measured management entrenchment practices in investment decision-making. Originality/Value: Thus, this qualitative study contributes both to the finance literature by summarizing the main characteristics of managerial entrenchment and to behavioral finance studies by providing a validation instrument for one of its main subjects of study.

Increasing Pitch Count is Associated with Increasing Elbow Flexion Angle at Ball Release in Youth Baseball Pitchers

Baseball is one of the most popular sports among youth athletes in the United States, and among these players, pitchers are at a particularly high risk of sustaining an injury. Overuse of the arm from repetitive pitching is a common mechanism for injury. Despite the attention that overuse injury has received, little is known regarding the mechanism that leads to elbow injury. This study aims to determine the effect of increasing pitch count on elbow flexion at ball release in a youth pitching cohort. The authors hypothesize that elbow flexion will increase as pitch count increases. Study subjects included volunteers from youth baseball players from local teams and public advertisements. Retro-reflective markers attached to bony landmarks were placed on the players according to ISG recommendations. Pitchers threw an indoor simulated game. Three-dimensional marker trajectories were collected using a 12-camera optical motion capture system, and ball velocity was captured using a radar gun. Voluntary maximal isometric strength of the internal and external rotators was evaluated before and after pitching. Paired two-tailed t-tests were performed to determine if a significant change occurred between the fresh and fatigued sets. Twelve adolescent male pitchers were recruited. Eleven of 12 pitchers completed the prescribed 6 sets of 15 pitches, culminating in a 90-pitch simulated game. The ball speed in the second set was found to be the highest in all pitchers and was considered the "peak set" (p = .021) while ball speed was the slowest in the sixth set of pitches and was therefore considered the "fatigue set" (p = .001). There was a moderate but statistically significant inverse correlation between elbow flexion at ball release and maximum internal rotation velocity (p = .005). Elbow flexion at ball release was also significantly positively correlated with shoulder abduction at ball release (p = 0.004). Elbow flexion at ball release was not significantly correlated with ball velocity (p=.108). In a simulated game laboratory setting, increasing pitch count was associated with increasing elbow flexion angle at ball release in youth baseball pitchers. These findings demonstrate that pitching with fatigue may cause biomechanical changes that have been associated with increased rates of elbow injury in the adult throwing population. Further investigation on the association between elbow flexion angle and elbow injury in the youth baseball population is needed.

Evaluation of antidiabetic potential of Co3O4 and TiO2 nanoparticles on alloxan-induced diabetic mice

The worldwide well-being distress recognized as diabetes mellitus is categorized by the unregulated breakdown of glucose and its linked effects. In this work, the possibility of cobalt oxide (Co3O4) and titanium dioxide (TiO2) nanoparticles (NPs) created by hydrothermal methods for the prevention of diabetes in mice using alloxan injections is examined. The NPs were characterized via XRD, SEM, EDX, and UV-vis spectrophotometry. For assessing the effect of treatment genes of the liver such as Glucokinase (GK), Protein kinase B (AKT), and immune-response (IR) were expressed via quantitative real-time PCR (qRT-PCR). In addition, histological inspection was carried out for the liver and spleen. Next, the anti-diabetic effect of the as-synthesized nanoparticles was examined. The trial, which assessed TiO2 and Co3O4 NPs' potential to prevent diabetes in mice given alloxan, was skillfully carried out. Together with Glucophage, TiO2 and Co3O4 NPs were shown to have higher levels of IR, GK, and AKT mRNA expression. As a consequence, the cells absorb glucose more readily. Since TiO2 and Co3O4 nanoparticles may have hypoglycemic effects, further study is necessary to fully appreciate their potential as a practical and affordable diabetic therapy option. Toxicology, biologic compatibility, and the dependability of artificial nano-formulations are examples of possible study subjects.

Correlation in retinal thickness and macular retina plus choroidal microcirculation in pediatric myopia.

To analyze the relationship in retinal thickness, macula retina and choroidal microcirculation in pediatric patients with myopia. Pediatric patients with high myopia (high myopia group, n = 30, 60 eyes) and pediatric patients with low to moderate myopia (low myopia group, n = 30, 60 eyes) admitted to our hospital from January 2021 to January 2022 were randomly selected as the study subjects. Retinal thickness, the blood density of retina, and the blood density of the choroid were collected in each area of the macula by taking optical coherence tomography (OCT) and OCT angiography (OCTA). Pearson correlation analysis was conducted to compare the results from the 2 groups. Outer retinal thickness showed a weak positive correlation with Superficial vascular complex flow density (SVD) and deep vascular complex flow density (DVD) (P < .05), but no significant correlation with choroidal capillary density (P > .05); inner retinal thickness showed a weak positive correlation with SVD and DVD (P < .05), but no significant correlation with choroidal capillary density (P > .05). In pediatric patients with myopia, there is a positive correlation between the blood flow density of macular retina and retinal thickness, and the retinal thickness will become thinner with increasing myopia.

Pattern of occupational lung disease among industrial workers attending a medical college of Eastern India

ABSTRACT Background: Occupational lung diseases (OLDs) contribute a significant proportion to the global burden of pulmonary morbidities but are grossly misdiagnosed due to the relative lack of attribution given to occupational exposures. Obstructive lung diseases are known to be associated with long-lasting disability and loss of earning capacity (LOEC) among workers in industrial setups, thus reducing nationwide productivity. Objective: In this context, the study aimed to find out the pattern of OLD and factors associated with the severity of it among patients in a tertiary care hospital. Materials and Methods: The study was a record-based secondary data analysis conducted in the Medical Records Department of a Medical College in Kolkata. A computerized database of patients attending Special Medical Board (SMB) examinations from the Department of Medical Records was utilized for data collection. A data abstraction format was constructed to collect information on pulmonary morbidity, occupational exposure, and sociodemographic and behavioral variables. Extracted data were analyzed in Microsoft Excel and Statistical Package for Social Sciences (SPSS) software Results: After a review of records, it was shown that 62.3% (66 out of 106 people) of the study subjects had an obstructive type of OLD, the most common being Jute Byssinosis. A negative correlation (Spearman’s ρ = -0.136) was found between pulmonary function (FEV1/FVC) and LOEC (%) in the study subjects. In the multivariable logistic regression, exposure to organic dust was found to be significantly associated with worsened lung function {adjusted-Odd’s Ratio (95% Confidence Interval) =3.11 (1.1–8.8), P value = 0.03}. Conclusion: OLD is an understated health issue, especially in an industrial diaspora of developing countries, like India. Healthcare facilities should utilize their resources properly for the advancement of medical surveillance in industries where organic dust is produced. Health education of the stakeholders regarding the consequences of OLDs and the benefits of preventive primary approaches will go a long way in alleviating the burden of disease.