Study Exclusion Criteria Research Articles

Implementation of an EMS protocol to improve prehospital sepsis recognition

PurposeOptimal sepsis outcomes are achieved when sepsis is recognized early. Recognizing sepsis in the prehospital, EMS setting can be challenging and unreliable. The purpose of this study is to evaluate whether implementation of an EMS sepsis screening and prehospital alert protocol called PRESS (PREhospital SepsiS) is associated with improved sepsis recognition by EMS providers. DesignWe conducted a 12-month, before-after implementation study of the PRESS protocol in a large, public EMS system. The study intervention was a PRESS training program delivered to EMS providers. EMS patient inclusion criteria included: age ≥ 18 years, EMS systolic blood pressure < 110 mmHg, EMS heart rate > 90 bpm, and EMS respiratory rate > 20 bpm. Study exclusion criteria included the presence of any of following EMS conditions: trauma, cardiac arrest, pregnancy, toxic ingestion, or psychiatric emergency. Retrospective chart review was performed on all eligible EMS encounters during the study period. The primary outcome variable was the proportion of patients with sepsis who were identified by EMS providers. ResultsApproximately 300 EMS providers were trained to use PRESS. A total of 498 patient encounters met criteria for study inclusion; 222 were excluded, primarily due to trauma. A total of 276 patient encounters were analyzed. Sepsis recognition by EMS providers increased from 12% pre-PRESS protocol to 59% post-PRESS protocol (p < 0.001). In a post-hoc analysis of the post-PRESS cohort, septic patients who were identified by EMS received antibiotics 24 min faster than septic patients who were not identified by EMS [28 min (IQR 18–48) vs 52 (IQR 27–98), respectively, p = 0.021]. ConclusionImplementation of an EMS sepsis screening and prehospital alert protocol was associated with an increase in sepsis recognition rates by EMS providers and a decrease in time to first antibiotic administration in the emergency department. Further studies are needed to evaluate the impact of this protocol in other populations.

Effectiveness of pedometer-based exercise program in phase 1 and phase 2 cardiac rehabilitation: A Systematic Review

Background: Physical Inactivity (PI) and sedentary behaviour are the most important and modifiable risk factors to prevent cardiovascular diseases (CVD). Cardiac rehabilitation (CR) is a multidisciplinary program for patients who have undergone cardiac surgeries. Through CR, monitoring physical activity (PA) is possible and may reduce the rate of rehospitalization. The pedometer is a device that is useful to track the step count of the person day to day. It helps in self-monitoring of PA. The purpose of this review was to summarise the evidence about the effect of pedometer-based exercise program in phase 1 and phase 2 CR. Methods: Databases such as MEDLINE, Cochrane, Scopus, Embase, and Web of Science were searched. This search is limited to randomized controlled trials (RCTs), human trials, a 10-year period, and English language journals. Based on inclusion criteria of pedometer-based exercise programs in phase 1 (inpatient phase) and phase 2 (outpatient phase) of CR and exclusion criteria of studies using pedometer in maintenance phase CR. The primary outcome of the study is step count, while secondary is PA (in terms of time), heart rate, sedentary behaviour, and quality of life. This study quality was assessed by the Downs and Black’s checklist. Results: The study includes 6 RCTs based on the inclusion and exclusion criteria. Most studies show a considerable increase in step count associated with increased patient PA. Few studies have explained a significant increase of PA in the study group and maintained for longer terms. More research is needed to determine the impact of cardiovascular risk factors.

Machine Learning OCT Predictors of Progression from Intermediate Age-Related Macular Degeneration to Geographic Atrophy and Vision Loss

PurposeTo describe spectral-domain OCT (SD-OCT) features, age, gender, and systemic variables that may be used in machine/deep learning studies to identify high-risk patient subpopulations with high risk of progression to geographic atrophy (GA) and visual acuity (VA) loss in the short term.DesignProspective, longitudinal study.ParticipantsWe analyzed imaging data from patients with intermediate age-related macular degeneration (iAMD) (N = 316) enrolled in the Age-Related Eye Disease Study 2 (AREDS2) Ancillary SD-OCT with adequate SD-OCT imaging for repeated measures.MethodsQualitative and quantitative multimodal variables from the database were derived at each yearly visit over 5 years. Based on statistical analyses developed in the field of cardiology, an algorithm was developed and used to select person-years without GA on color fundus photography or SD-OCT at baseline. The analysis used machine learning approaches to generate classification trees. Eyes were stratified as low, average, above average, and high risk in 1 or 2 years, based on OCT and demographic features by the risk of GA development or decreased VA by 5+ and 10+ letters.Main Outcome MeasuresNew onset of SD-OCT–determined GA and VA loss.ResultsWe identified multiple retinal and subretinal SD-OCT and demographic features from the baseline visit, each of which independently conveyed low to high risk of new-onset GA or VA loss on each of the follow-up visits at 1 or 2 years.ConclusionsWe propose a risk-stratified classification of iAMD based on the combination of OCT-derived retinal features, age, gender, and systemic variables for progression to OCT-determined GA or VA loss. After external validation, the composite early end points may be used as exclusion or inclusion criteria for future clinical studies of iAMD focused on prevention of GA progression or VA loss.

COVID-19 seroprevalence in Pakistan: a cross-sectional study

ObjectivesThis study adapted WHO’s ‘Unity Study’ protocol to estimate the population prevalence of antibodies to SARS CoV-2 and risk factors for developing SARS-CoV-2 infection.DesignThis population-based, age-stratified cross-sectional study was conducted...

Tolerability and Efficacy of Rivaroxaban Versus Warfarin for Non Vulvular Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is the most widespread chronic heart arrhythmia, affecting 1–2 % of the general population. Objectives: Patients with non-valvular atrioventricular fibrillation are the major focus of this research. Rivaroxaban is compared against warfarin in terms of tolerability and efficacy. Material and methods: This cross sectional comparative study was conducted in Pakistan Institute of Medical Sciences Islamabad during January 2020 till December 2020. A total of 120 OPD patients who satisfied the study's inclusion and exclusion criteria were included in the research after it was given the green light by the hospital's ethics committee. A complete medical history and physical examination were required to ensure that all participants met the criteria for inclusion. It was determined that obtaining express written consent was essential. Results: As indicated above, 15 individuals were removed from the study; six patients in the NOAC group refused to participate and departed the study; while four patients were lost to follow-up. In this study, rivaroxaban was administered to twenty-one participants, whereas warfarin was administered to the remaining twenty-four. Conclusion: Oral anticoagulants for stroke prevention in non-valvular AF have advanced in development, benefiting patients and clinicians alike with fewer medication and food interactions, no monitoring need, and a wider therapeutic index.

Metabolic Profile of Holstein Cows: Reference Values in Herds of Rio Grande do Sul - Brazil

Background: Assessing data from metabolic profile is a complex task depending on individual factors such as breed, age, sex and physiological status and environmental factors such as climate and management. Therefore, reference intervals produced in herds from different geographic regions are not always precise in the local reality. The aim of this study is to compile results of values of the most used parameters in the metabolic profile of healthy Holstein cows, grouped by lactation stage, obtained from studies in Rio Grande do Sul, Brazil, as an effort for the elaboration of regional reference intervals for dairy cattle in this geographic area.Materials, Methods &amp; Results: The research was defined through the PICO strategy, considering multiparous Holstein cows from scientific studies carried out in Rio Grande do Sul, during the period 1996-2021, in which the nitrogen, glycidic, lipidic, enzymatic or mineral metabolic profile was determined. Google Scholar, Scientific Electronic Library and PubMed were the electronic databases selected for the search, using the following descriptors: "profile" and "metabolic" and "metabolic profile" and "dairy" or "cattle" or "cow" and "Brazil" and "southern" or "Rio Grande do Sul". Studies in Portuguese, English and Spanish languages were considered. The references of the articles initially selected were also verified, through ResearchGate and Google Scholar, in addition to unpublished data, unfinished studies or data in the so called "gray literature". It was possible to identify a total of 34 publications, which were tabulated to assess the scientific quality and bias risk. Studies were evaluated by a pair of independent reviewers, in order to compare results. Eligibility confirmation was given after the complete reading of the articles, evaluating the presence of all the inclusion selection criteria, such as adequate population and the intervention made. Examples of exclusion criteria for studies were studies or data duplication and methodological flaws that could compromise reliability. Thus, of the 34 studies selected in the initial screening, 14 remained. Thereafter, observational studies were preferably sought for data extraction. In the case of clinical trials, only data from control groups were used, in order to avoid disturbances due to interventions or treatments that could be applied. The reference intervals or means of the evaluated metabolites extracted from these studies were grouped in tables, in order to facilitate the comparison with research results obtained in different regions or even for comparison with future studies in the region of interest.Discussion: This retrospective study obtained mean values and standard deviation of the most used parameters in the metabolic profile of Holstein cows, grouped by lactation stage, obtained from studies performed in the state of Rio Grande do Sul, Brazil. Divergences were observed in several evaluations, especially in values of albumin, beta-hydroxybutyrate, aspartate transaminase and calcium, in spite of all data represented healthy animals from research trials with adequate environment and diet. It is important to consider the risk of time bias in this study, as within this 25-year period there was a very large evolution in dairy farming and some values may not be fully representative of current management systems in Holstein herds. Nevertheless, the results reinforce the importance of using regional reference values for the proper interpretation of metabolic profile results in dairy cows. In addition, the proposing of database index for regional averages or reference intervals, is useful for comparing results of metabolic profiles carried out in different geographic regions, in future studies to be performed in this particular region, or even to be utilized by field practitioners of this particular region.Keywords: biochemical blood profile, regional reference, healthy cows.Título: Perfil metabólico de vacas da raça Holandesa:valores de referência em rebanhos do Rio Grande do Sul - BrasilDescritores: perfil bioquímico sanguíneo, referência regional, vacas sadias.

Overwhelming Support for Sexual Health Education in U.S. Schools: A Meta-Analysis of 23 Surveys Conducted Between 2000 and 2016

PurposeSurveys suggest that the general public (i.e., adults or parents) supports sexual health education in schools. However, the number of schools providing sex education continues to decline in the United States. The purpose of this study is to conduct a meta-analysis of U.S.-based representative surveys to provide a pooled estimate of public support for sexual health education delivered in schools. MethodsA systematic search of three databases (Medline, PsycInfo, and ERIC) was conducted to identify survey measuring adult and parent attitudes toward sexual health education in school between 2000 and 2016. Meta-analyses were conducted in OpenMetaAnalyst via the metaphor package in R using a DerSimonian-Laird random effect models to account for heterogeneity between surveys. ResultsA total of 23 citations met study inclusion and exclusion criteria, representing 15 unique probability surveys conducted with the public. Among the included surveys, 14 were nationwide and 11 included parents or an overrepresentation of parents. Across all survey findings, 88.7% (95% confidence interval = 86.2–91.2) of respondents supported sexual health education. Among surveys that only included parents or oversampled for parents, 90.0% (95% confidence interval = 86.5–93.4) supported sexual health education, and among nationally representative surveys, 87.7% (95% confidence interval = 85.1–90.6) of respondents supported sexual health education. ConclusionThese findings demonstrate overwhelming support for sexual health education delivered in schools. Additional research is needed to determine individual differences in support for specific sexual health education topics and skills delivered through classroom-based instruction.

Neurologic Prognostication After Cardiac Arrest Using Brain Biomarkers

Brain injury biomarkers released into circulation from the injured neurovascular unit are important prognostic tools in patients with cardiac arrest who develop hypoxic ischemic brain injury (HIBI) after return of spontaneous circulation (ROSC). To assess the neuroprognostic utility of bloodborne brain injury biomarkers in patients with cardiac arrest with HIBI. Studies in electronic databases from inception to September 15, 2021. These databases included MEDLINE, Embase, Evidence-Based Medicine Reviews, CINAHL, Cochrane Database of Systematic Reviews, and the World Health Organization Global Health Library. Articles included in this systmatic review and meta-analysis were independently assessed by 2 reviewers. We included studies that investigated neuron-specific enolase, S100 calcium-binding protein β, glial fibrillary acidic protein, neurofilament light, tau, or ubiquitin carboxyl hydrolase L1 in patients with cardiac arrest aged 18 years and older for neurologic prognostication. We excluded studies that did not (1) dichotomize neurologic outcome as favorable vs unfavorable, (2) specify the timing of blood sampling or outcome determination, or (3) report diagnostic test accuracy or biomarker concentration. Data on the study design, inclusion and exclusion criteria, brain biomarkers levels, diagnostic test accuracy, and neurologic outcome were recorded. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Summary receiver operating characteristic curve analysis was used to calculate the area under the curve, sensitivity, specificity, and optimal thresholds for each biomarker. Risk of bias and concerns of applicability were assessed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. We identified 2953 studies, of which 86 studies with 10 567 patients (7777 men [73.6] and 2790 women [26.4]; pooled mean [SD] age, 62.8 [10.2] years) were included. Biomarker analysis at 48 hours after ROSC demonstrated that neurofilament light had the highest predictive value for unfavorable neurologic outcome, with an area under the curve of 0.92 (95% CI, 0.84-0.97). Subgroup analyses of patients treated with targeted temperature management and those who specifically had an out-of-hospital cardiac arrest showed similar results (targeted temperature management, 0.92 [95% CI, 0.86-0.95] and out-of-hospital cardiac arrest, 0.93 [95% CI, 0.86-0.97]). Neurofilament light, which reflects white matter damage and axonal injury, yielded the highest accuracy in predicting neurologic outcome in patients with HIBI at 48 hours after ROSC. PROSPERO Identifier: CRD42020157366.

Absence of abdominal drainage after surgery for secondary lower gastrointestinal tract peritonitis is a valid strategy

Management of abdominal drainage after surgery for secondary lower gastrointestinal tract peritonitis (LGTP) is not a standardized procedure. A monocentric study was carried out in 2016 in our centre. (PI study) to evaluate the interest of drainage. Our objective was to revaluate, our actual use of abdominal drainage after peritonitis (PII study). We examined retrospectively patients who underwent surgery for secondary sub-mesocolic community-acquired peritonitis (January 2016-December 2019). Study exclusion criteria were primary peritonitis, peritoneal dialysis, nosocomial peritonitis, postoperative peritonitis, upper gastrointestinal tract peritonitis, peritonitis due to appendicitis, peritonitis requiring the implementation of Mikulicz's drain, and peritonitis in which the peritoneum was not described in the surgical report (i.e., the same criteria that the PI study which included 141 patients from January 2009 to January 2012). The primary endpoint was the rate of abdominal drainage. The secondary endpoints were the patient rate without a peritoneum description, major complications rate (Clavien ≥III), abscess rate, mortality rate and the length of stay in the non-drain group (D - ) and in the drain group (D + ) in PII study. Primary and secondary endpoints were also compared between PI and PII studies. Risk factors for post-operative abscess were also research. Of the 150 patients included 33% were drained vs 84% of the 141 patients included in PI study (p &lt; 0.001). In PII study peritoneum was described in 80.3% of patients vs 69% in PI study (NS, p = 0.06). Comparing the two groups D - and D + , no significant differences were found in major complications (respectively 45% vs 32%, p = 0.1), reoperation rate (respectively 25% vs 22%, p = 0.7), death rate (respectively 25% vs 14%; p = 0.1) and mean length of stay (respectively 12days vs 13days, p = 0.9). The abscess rate was significantly lower in the D - group (10% vs 30%, p = 0.002). Comparing PI and PII studies, there was no difference about major complications (35% vs 35%, p = 0.1), reoperation (16% vs 17.5%, p = 0.5), abscess rate (15% vs 8.5%, p = 0.1) and mortality (14.5% vs 17.5%, p = 0.7). The length of stay was longer in PI study than in P II (14days vs 9days, p = 0.03). Drainage (p = 0.005; OR = 4.357; CI [1.559-12.173]) and peritonitis type (p = 0.032; OR = 3.264; CI [1.106-9.630]) were abscess risk factors. This study therefore showed that drainage after surgery for LGTP may not be necessary and that, at least at the local level, surgeons seem to be inclined to discontinue it systematically. It may therefore be worthwhile to conduct a randomised control trial to establish recommendations on drainage after surgery for LGTP.

Dry Eye Disease Symptoms and Its Association with Daily Beverage Intake Among Adults in Saudi Arabia.

PurposeTo evaluate the association between dry eye disease (DED) symptoms and daily beverage intake among adults in Saudi Arabia.Patients and MethodsIn this cross-sectional, questionnaire-based study, we distributed an online questionnaire to men and women older than 18 years living in Saudi Arabia. The questionnaire consisted of items related to the sociodemographic characteristics of the participants and two validated indices: the Ocular Surface Disease Index (OSDI) and the brief 15-item Beverage Intake Questionnaire (BEVQ-15). Participants were excluded if they were aged less than 18 years; wore contact lenses; had existing eye disease (excluding refractive errors), history of eye surgery (including corrective eye surgeries), or autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s syndrome); or were currently taking specific medications including antidepressants, antihistamines, and diuretics.ResultsAfter applying the study exclusion criteria, a total of 615 participants were included in the statistical analysis. The majority of participants were 18–34 years old (450, 73.2%), and men (381, 62%) exceeded women (234, 38%) by approximately 1.5-fold. OSDI scores showed that 344 participants (55.9%) had DED symptoms, 145 (23.6%) had mild dry eyes; and 106 (17.2%) and 93 (15.1%) had moderate and severe dry eyes, respectively. There was a significant association between sex and DED symptoms (p = 0.012); the frequency of DED symptoms in women exceeded that in men. However, no significant differences were observed with other demographic data such as age and location of residence. Although beverage intake was moderately correlated to OSDI score (R = 0.27), we found no significant association between beverage intake and DED symptoms.ConclusionThis is the first study to highlight the association between DED symptoms and daily beverage intake. We found a significant association between DED symptoms and female sex. However, no significant association was found between DED symptoms and other demographic characteristics or beverage intake.

Maternity Violence Must Whither for Safe Mother and Safe Child

Introduction: It is essential that all pregnant women get quality and dignified care. But it does not seem to be happening. Although there is no consensus on what constitutes respectful or disrespectful care, emerging respectful maternity care (RMC) movement has mission of trying women centered, evidence based, and quality maternity care. Objectives: To collect information about burden of disrespectful care, interventions during pregnancy, birth, post birth which seem to violate woman’s rights, and are likely to affect woman’s life negatively, physically and mentally. Material and Methodology: Various studies related to maternity care were looked into by using search engines like Google scholar, NCBI, Pub med, upto, date etc. There were no inclusion or exclusion criteria for studies, reviews. Whatever was available was looked into. Local, national and international opinions were also searched and added. Self-experiences too were added. Results: Globally women’s health rights advocates have reported that disrespect and abuse during reproductive health care, especially to marginalized women who have limited resources, is widespread. What constitutes disrespectful and abusive care is really not clear but lack of privacy, non-consensual care, verbal, physical abuse, neglect or abandonment, detainment for non-payment of fees and so on seem to be part of every-day care. So how much is the burden is also lacking. So globally researchers are working on finding extent of disrespectful, abusive (D and A) maternity care. Conclusion: There is still no consensus on what constitutes, respectful or disrespectful, maternity care but whatever is believed to be disrespectful seems to be widespread global issue. It is essential that better designed studies are conducted. Studies need to incorporate cultural knowledge, responsiveness of health system, and health policies for delivery of quality maternal care with respect.

LONG-TERM RESULTS OF TREATING PATIENTS WITH OPEN FRACTURES OF LOW-LEG BONES.

The aim: To analyse long-term results of treating patients with open fractures of low-leg bones within a specific time period and to describe concomitant problems. Materials and methods: A retrospective study was carried out to evaluate the results of the final treatment of patients after one year and after five years. Patients were divided into two groups. Group I included 47 (61.84%) patients for whom the treatment method was changed from external fixation to internal fixation. Group II included 29 (38.16%) patients for whom the final treatment of an open fracture was performed with an external fixation device without changing the method. The study exclusion criteria were patients under 18 years old and patients with gunshot fractures of the lower leg bones. Results: Patient treatment included initial surgical debridement and fracture stabilization with external fixation devices. In all patients, wound healing occurred within 30 days (on average, 24 ± 4.5 days). When evaluating the treatment of patients in group I, 32 (68.09%) of them underwent a one-stage removal of an external fixation device and osteosynthesis of fragments during the first 7-10 days. In 3 (20.0%) patients, osteosynthesis was performed with an intramedullary locking nail, in 12 (80.0%) patients - with a plate. The decision to change the fixation method was made taking into account clinical and laboratory parameters. It is noted that the treatment of patients with type III open fractures of the lower leg bones according to the Gustilo-Andersen classification, provided that the method of external fixation is replaced with an internal one, gives better results compared to osteosynthesis with external fixation devices. Conclusions: Treatment of patients with high-energy injuries of the lower leg bones is a long-term process. It is possible to improve the therapy efficiency by changing the fixation method from external to internal one. In this regard, the main evaluative characteristics are such indicators as uncomplicated wound healing combined with the absence of laboratory and clinical signs of inflammation.

The contact lens dry eyes questionnaire (CLDEQ-8) validation and ocular surface dysfunction among soft contact lens wearers.

To translate and validate the Contact Lens Dry Eyes Questionnaire (CLDEQ-8) to Portuguese language and to describe the impact of soft contact lenses on the ocular surface. We conducted a descriptive transversal study with the aim to: (1) translate and validate the CLDEQ-8 questionnaire to Portuguese language and (2) apply the CLDEQ-8 to a group of contact lens wearers along with a broad evaluation of the impact of soft contact lens on the ocular surface. The evaluation of the impact of soft contact lens was performed for a study population of 81 subjects, categorized in two groups: Group A: 61 contact lens wearers and Group B (control): 20 noncontact lens wearers. The study exclusion criteria were rigid contact lens wear, systemic or ocular diseases, the use of medications predisposing to ocular surface damage, and previous ocular surgeries. For the CLDEQ-8 questionnaire translation and validation, Kappa agreement values were ³0.7 in all questions, implying a good agreement between the Portuguese and English language versions. Considering the ocular surface evaluation of the subjects, all parameters differed in Soft contact lens wearers when compared with the controls (p<0.05), except in those related to tear volume, such as the tear meniscus height and Schirmer test. This study provided a translated and validated Portuguese version of CLDEQ-8 questionnaire, which represents an important tool for the evolution of contact lens wearers. The broad evaluation of the ocular surface revealed an association between soft contact lens wearing and ocular surface disturbances.

From The Editors Desk…

Our editorial team has always endeavoured not just to improve the quality of the manuscripts but also to help the authors improve their writing skills. Depending upon the type of manuscript we recommend standard guidelines like the CONSORT, PRISMA, STROBE, CARE and STARD. We also recommend IMRaD format while writing the manuscript. The Introduction, which is around 3-4 paragraphs, should be structured from generalities to the specific elaborating what the shortcomings are in published literature and what void the current research would fill. The authors must understand that the “aim” is the broader intent, while the “objectives” are the more specific steps which one plans to achieve. The Material and Methods section needs to be detailed to such an extent that any researcher planning to replicate the study can do so with accuracy. In this section, the study design, the study setting, inclusion and exclusion criteria, sample size, interventions, outcome measures and statistics are elaborated. The results section provides outcome data about primary and secondary measures as well as the contrast between groups wherever applicable. Avoid presenting same result data in multiple formats as well as interpreting the results in this section. The discussion part compares the results with existing literature, analyses the strengths and limitations of the study and at the same time explain the practical implications as well as future research directions. Finally, at the end a summary of the concluding findings should be provided and whether they support your initial research hypothesis. Last but not the least, the author must remember the criticality of the abstract. Most reviewers and editors as well as readers base their initial judgement based on this short paragraph. Structured abstracts are preferred with relevant subsections. Authors must understand the significance of keywords, MeSH terms as well as how to do proper referencing. Writing medical literature is an art which needs to be groomed at an early stage. Competency develops as one writes more &amp; more. We hope this editorial will help authors understand how to ensure that their article is selected, printed, and finally appreciated by the readers. We end this editorial with a remembrance to a few of our dearest fellow Orthopaedicians whose demise shall leave a lasting void in Odisha Orthopaedics. Dr Prabhakar Mohanty, Dr Bijay Kumar Sadangi, Dr Binay Aggarwal and Dr Smarajit Pattnaik will always be in our cherished memories. Dr Satya Ranjan Patra Editor – In – Chief

From The Editors Desk…

Our editorial team has always endeavoured not just to improve the quality of the manuscripts but also to help the authors improve their writing skills. Depending upon the type of manuscript we recommend standard guidelines like the CONSORT, PRISMA, STROBE, CARE and STARD. We also recommend IMRaD format while writing the manuscript. The Introduction, which is around 3-4 paragraphs, should be structured from generalities to the specific elaborating what the shortcomings are in published literature and what void the current research would fill. The authors must understand that the “aim” is the broader intent, while the “objectives” are the more specific steps which one plans to achieve. The Material and Methods section needs to be detailed to such an extent that any researcher planning to replicate the study can do so with accuracy. In this section, the study design, the study setting, inclusion and exclusion criteria, sample size, interventions, outcome measures and statistics are elaborated. The results section provides outcome data about primary and secondary measures as well as the contrast between groups wherever applicable. Avoid presenting same result data in multiple formats as well as interpreting the results in this section. The discussion part compares the results with existing literature, analyses the strengths and limitations of the study and at the same time explain the practical implications as well as future research directions. Finally, at the end a summary of the concluding findings should be provided and whether they support your initial research hypothesis. Last but not the least, the author must remember the criticality of the abstract. Most reviewers and editors as well as readers base their initial judgement based on this short paragraph. Structured abstracts are preferred with relevant subsections. Authors must understand the significance of keywords, MeSH terms as well as how to do proper referencing. Writing medical literature is an art which needs to be groomed at an early stage. Competency develops as one writes more &amp; more. We hope this editorial will help authors understand how to ensure that their article is selected, printed, and finally appreciated by the readers. We end this editorial with a remembrance to a few of our dearest fellow Orthopaedicians whose demise shall leave a lasting void in Odisha Orthopaedics. Dr Prabhakar Mohanty, Dr Bijay Kumar Sadangi, Dr Binay Aggarwal and Dr Smarajit Pattnaik will always be in our cherished memories. Dr Satya Ranjan Patra Editor – In – Chief

Free Papers Compiled

BACKGROUND:Schizophrenia is a major mental disorder with a never-ending search for etiology. Ion channel dysfunction is one among the etiologies proposed and various studies have been done on the same (1)(2)(3). Patients with Schizophrenia have a high incidence of Sudden cardiac death, almost three times the risk of general population.Brugada syndrome(4) and QTc prolongation (5) are a few among the cardiac disorders characterized by ion channel dysfunction (6) and can also lead to Sudden cardiac death (7). Identifying these two abnormalities in ECG can help prevent Sudden cardiac deaths especially in schizophrenia patients. This study aims to identify the prevalence of these abnormalities in ECG of patients with Schizophrenia and the socio demographic, clinical profile and drug treatment were correlated with the prevalence of these abnormalities. The importance of routine ECG screening in patients with Schizophrenia should be understood as well.AIMS:To estimate the prevalence of Brugada pattern ECG and QTc prolongation in Patients with Schizophrenia and their correlation with demographic factors, clinical and co-morbid factors and use of antipsychotics.MATERIALS AND METHODS:Convenience sampling of 160 cases with Schizophrenia fulfilling the study inclusion and exclusion criteria were recruited after obtaining IRB approval and informed consent. The sociodemographic factors, clinical and comorbid profile, treatment profile were recorded and analysed. A 12 lead ECG recording was taken for these patients. Screening of ECG for Brugada pattern and QTc prolongation were done. Prevalence was calculated in percentage. Bivariate and multivariate analysis were done to assess the association between variables.

Effect of aluminum phosphate gel on prevention of early rebleeding after ligation of esophageal variceal hemorrhage.

BACKGROUNDLiver cirrhosis is the main cause of portal hypertension. The leading cause of death in patients with liver cirrhosis is its most common complication, esophageal variceal bleeding (EVB). Endoscopic variceal ligation (EVL) is recommended by many guidelines to treat EVB and prevent rebleeding; however, esophageal ulcers occur after treatment. Delayed healing of ulcers and unhealed ulcers lead to high rebleeding and mortality rates. Thus, the prevention of early postoperative rebleeding is of great significance in improving the quality of life and prognosis of patients.AIMTo evaluate the efficacy of aluminum phosphate gel (APG) plus a proton pump inhibitor (PPI) in the prevention of early rebleeding after EVL in patients with EVB.METHODSThe medical records of 792 patients who were diagnosed with EVB and in whom bleeding was successfully stopped by EVL at Shenzhen People’s Hospital, Guangdong Province, China from January 2015 to December 2020 were collected. According to the study inclusion and exclusion criteria, 401 cases were included in a PPI-monotherapy group (PPI group), and 377 cases were included in a PPI and APG combination therapy (PPI + APG) group. We compared the incidence rates of early rebleeding and other complications within 6 wk after treatment between the two groups. The two-sample t-test, Wilcoxon rank-sum test, and chi-squared test were adopted for statistical analyses.RESULTSNo significant differences in age, sex, model for end-stage liver disease score, coagulation function, serum albumin level, or hemoglobin level were found between the two groups. The incidence of early rebleeding in the PPI + APG group (9/337; 2.39%) was significantly lower than that in the PPI group (30/401; 7.48%) (P = 0.001). Causes of early rebleeding in the PPI group were esophageal ulcer (3.99%, 16/401) and esophageal varices (3.49%, 14/401), while those in the PPI + APG group were also esophageal ulcers (5/377; 1.33%) and esophageal varices (4/377; 1.06%); such causes were significantly less frequent in the PPI + APG group than in the PPI group (P = 0.022 and 0.024, respectively). The early mortality rate within 6 wk in both groups was 0%, which was correlated with the timely rehospitalization of all patients with rebleeding and the conduct of emergency endoscopic therapy. The incidence of adverse events other than early bleeding in the PPI + APG group (28/377; 7.43%) was significantly lower than that in the PPI group (63/401; 15.71%) (P < 0.001). The incidence of chest pain in the PPI + APG group (9/377; 2.39%) was significantly lower than that in the PPI group (56/401; 13.97%) (P < 0.001). The incidence of constipation in the PPI + APG group (16/377; 4.24%) was significantly higher than that in the PPI group (3/401; 0.75%) (P = 0.002) but constipation was relieved after patients drank more water or took lactulose. In the PPI and PPI + APG groups, the incidence rates of spontaneous peritonitis within 6 wk after discharge were 0.50% (2/401) and 0.53% (2/377), respectively, and those of hepatic encephalopathy were 0.50% (2/401) and 0.27% (1/377), respectively, presenting no significant difference (P > 0.999).CONCLUSIONPPI + APG combination therapy significantly reduces the incidence of early rebleeding and chest pain in patients with EVB after EVL.

Editors' Note: Automated Quantitative Pupillometry in the Critically Ill: A Systematic Review of the Literature

In “Automated Quantitative Pupillometry in the Critically Ill: A Systematic Review of the Literature,” Opic et al. summarized 58 articles (10 randomized trials) published from 1990 to 2019 on the use of automated pupillometry in adult critically ill patients. They reported that increased intracranial pressure (ICP), traumatic brain injury (TBI), ischemic brain damage, opioids and hypoxemia, and hypercarbia are potential confounders for pupillometry. Taccone et al. commented that increased ICP, TBI, and hypoxic ischemic brain injury (HIBI) should not be considered confounders of pupillometry (circumstances in which the test may be unreliable) but rather injuries that can cause pupillary abnormalities and that altered pupillary responses in these settings could be indicative of poor prognosis. In response, Opic et al. reinforced that medications can confound the pupillary assessment in certain circumstances but did not address the distinction between whether increased ICP, TBI, and HIBI typically confound or cause pupillary abnormalities. Larson commented that although opioids cause pupillary constriction, they do not affect the strength of the pupillary light reflex (PLR). They also pointed out that the systematic review did not include an article by Rollins et al., which described the persistence of a robust quantifiable PLR in the setting of opioid-induced hypoxia and hypercarbia. Opic et al. noted that they eliminated some articles based on the exclusion criteria of studies that used nonhandheld devices, but it is worth noting that Rollins et al. did, in fact, use a handheld device (the Neuroptics ForSite).[1][1],[2][2] Opic et al. acknowledged that although the PLR involves both static and dynamic parameters, most of the studies they reviewed regarding the impact of opioids on pupillometry discussed their confounding impact on static parameters. Opic et al. and Larson reinforced that pupillometry always requires interpretation by a clinician based on an individual patient's circumstances. In “Automated Quantitative Pupillometry in the Critically Ill: A Systematic Review of the Literature,” Opic et al. summarized 58 articles (10 randomized trials) published from 1990 to 2019 on the use of automated pupillometry in adult critically ill patients. They reported that increased intracranial pressure (ICP), traumatic brain injury (TBI), ischemic brain damage, opioids and hypoxemia, and hypercarbia are potential confounders for pupillometry. Taccone et al. commented that increased ICP, TBI, and hypoxic ischemic brain injury (HIBI) should not be considered confounders of pupillometry (circumstances in which the test may be unreliable) but rather injuries that can cause pupillary abnormalities and that altered pupillary responses in these settings could be indicative of poor prognosis. In response, Opic et al. reinforced that medications can confound the pupillary assessment in certain circumstances but did not address the distinction between whether increased ICP, TBI, and HIBI typically confound or cause pupillary abnormalities. Larson commented that although opioids cause pupillary constriction, they do not affect the strength of the pupillary light reflex (PLR). They also pointed out that the systematic review did not include an article by Rollins et al., which described the persistence of a robust quantifiable PLR in the setting of opioid-induced hypoxia and hypercarbia. Opic et al. noted that they eliminated some articles based on the exclusion criteria of studies that used nonhandheld devices, but it is worth noting that Rollins et al. did, in fact, use a handheld device (the Neuroptics ForSite).1,2 Opic et al. acknowledged that although the PLR involves both static and dynamic parameters, most of the studies they reviewed regarding the impact of opioids on pupillometry discussed their confounding impact on static parameters. Opic et al. and Larson reinforced that pupillometry always requires interpretation by a clinician based on an individual patient's circumstances. [1]: #ref-1 [2]: #ref-2

Process Evaluation in Health Communication Media Campaigns: A Systematic Review.

Objective. The objective is to examine the scope of health communication media campaign process evaluation methods, findings, and dissemination practices. Data Source. A systematic review of peer-reviewed literature was conducted using database searches. Study Inclusion and Exclusion Criteria. Published studies on process and implementation evaluation of health campaigns with a media component were included. Exclusion criteria included not health, non-empirical, no media campaign, or a focus on other evaluation types. Data Extraction. Articles were assessed for general campaign information, theory use, and details about process evaluation plan and procedures. Data Synthesis. A coding scheme based on 9 process evaluation best practice elements (e.g., fidelity and context) was applied. Process evaluation methods, measures, and reporting themes were synthesized. Results. Among 691 unique records, 46 articles were included. Process evaluation was the main focus for 71.7% of articles, yet only 39.1% reported how process evaluation informed campaign implementation strategy. Articles reported 4.39 elements on average (SD = 1.99; range 1-9), with reach (87.0%) and recruitment (73.9%) described most frequently, yet reporting was inconsistent. Further, the level of detail in reporting methods, theory, and analysis varied. Conclusions. Process evaluation provides insight about mechanisms and intervening variables that could meaningfully impact interpretations of outcome evaluations; however, process evaluations are less often included in literature. Recommendations for evidence-based process evaluation components to guide evaluation are discussed.

Effect of chiglitazar and sitagliptin on glucose variations, insulin resistance and inflammatory-related biomarkers in untreated patients with type 2 diabetes

AimsTo evaluate glycemic variations, changes in insulin resistance and oxidative stress after chiglitazar or sitagliptin treatment in untreated patients with type 2 diabetes mellitus (T2DM). MethodsBased on the study inclusion and exclusion criteria, 81 patients with T2DM were randomly divided to receive chiglitazar or sitagliptin treatment for 24 weeks. Continuous glucose monitoring (CGM) systems were conducted for 72 h in eligible patients. We analyzed the following glycemic variation parameters derived from the CGM data and measured the serum levels of hemoglobin A1c (HbA1c), fasting blood glucose (FBG), 2-h postprandial blood glucose (2-h PBG), fasting insulin (Fins) and inflammatory-related indicators at baseline and the end of the study. ResultsAfter treatment for 24 weeks, our data showed a similar reduction in HbA1c between chiglitazar and sitagliptin. The 24-h mean blood glucose (MBG), standard deviation (SD) and mean amplitude of glycemic excursion (MAGE) were significantly decreased, and the time in range (TIR) was increased after chiglitazar and sitagliptin therapy. Chiglitazar administration led to significant improvement in insulin resistance/insulin secretion (HOMA-IR, HOMA-IS), interleukin-6 (IL-6), prostaglandin F2α (PGF-2α), 17-hydroxyprogesterone (17-OHP) and adiponectin (ADP) score values compared with sitagliptin administration. ConclusionsChiglitazar therapy effectively reduced glucose variation and showed a larger improvement in insulin resistance and inflammatory parameters than sitagliptin.