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Objective: We sought to evaluate the myocardial strain by four-dimensional speckle-tracking echocardiography (4D-STE) in patients with stable angina pectoris (SAP) to determine the severity of coronary artery disease (CAD) based on the Gensini score. Methods: The present study comprised of 150 patients with SAP. Patients with history of SAP, normal left ventricular ejection fraction, and without regional wall motion abnormalities (RWMA) were scheduled for elective coronary angiography. Based on Gensini score, there were two groups: non-critical stenosis group [Gensini score (0e19), n ¼ 117] and critical stenosis group [Gensini score 20, n ¼ 33]. Correlation between Gensini score and 4D-STE strain parameters were investigated. Results: Out of 150 patients, critical stenosis group had significantly depressed values of all 4D-STE strain parameters than non-critical stenosis group (p < 0.001), except global radial strain (GRS) parameter. Significant positive correlation was found between Gensini score and 4D global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) with Spearman's correlation coefficient (r) as 0.626, 0.548, and 0.631, respectively (p < 0.001), whereas significant negative correlation was found between Gensini score and GRS (r ¼ 0.433, p < 0.001). A 4D GLS value of 17 had 84.9% sensitivity and 97.4% specificity, GAS 31 (90.9% sensitivity, 78.6% specificity), GCS 17 (69.7% sensitivity, 92.3% specificity), and GRS <47 (sensitivity 72.7%, specificity 76.1%) to detect critical CAD described by Gensini score 20. Conclusion: The 4D-STE can aid in the assessment of severe CAD stenosis with good sensitivity and specificity in the patients with SAP without RWMA on traditional echocardiography.
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Purpose: Extraction of tear protein from Schirmer’s strip is a prerequisite for the proper identification and screening of biomarkers in dry eye disease. The study compares different methods of extraction of tear proteins from the Schirmer’s strip. Methods: Reflex tear was collected from healthy controls (HC; n = 12), Stevens–Johnson syndrome (SJS; n = 3) and dry eye disease (DED; n = 3) patients using capillary tube. This tear was used to measure the volume absorbed by Schirmer’s strip per microliter. Different buffers (6) were used to compare the protein yield from the Schirmer’s strip in four different conditions. The tear proteins extracted using the highest protein yield buffer were analyzed by mass spectrometry. Results: A linear relationship between the tear volume and wetting length was observed (r = 0.0.997, n = 6). The highest yield was observed after incubation of the Schirmer’s strip in 100 mM ammonium bicarbonate (ABC) with 0.25% Nonidet P?40(NP?40) at 4°C for an hour (P < 0.00005). The in?solution digestion of tear eluted in the above condition 100 Mm ABC + 0.25% NP?40 with one?hour incubation yielded a total of 2119 proteins in HC, SJS, and DED. The unique protein observed in SJS and DED was 0.6% and 17.9%, respectively. The significantly expressed proteins are associated with innate immune response, proteolysis, wound healing, and defense response. Conclusion: A method for extraction of protein from Schirmer’s strip was optimized for increase in protein yield from the tear sample. SJS and DED tear samples have unique protein signature. The study will aid in better design of tear protein?based experimental study.
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Background & objectives: Activation of renin-angiotensin system and tubulointerstitial damage might be seen in pre-albuminuria stage of diabetic nephropathy (DN). Here, diagnostic utility of four urinary biomarkers [Angiotensinogen (Angio), Interleukin (IL)-18, Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Cystatin] during pre-albuminuria stages of non-hypertensive type 2 diabetes patients was studied. Methods: A total of 952 type 2 diabetes mellitus (T2DM) patients were screened for nephropathy [estimated glomerular filtration rate (eGFR) ?120 ml/min and albumin–creatinine ratio (ACR) ?30], and 120 patients were followed up for one year. At one year, they were classified into hyperfiltration (43), normoalbuminuria (29) and microalbuminuria (48) groups. Another 63 T2DM patients without nephropathy were included as controls. Hypertension, patients on angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, eGFR <60 ml/min/1.73 m2 and all proteinuric conditions were excluded. All were subjected to testing for urine protein, ACR, HbA1C, eGFR, along with urinary biomarkers (IL-18, cystatin-C, NGAL and AGT). Comparative analysis of all the diagnostic tests among different subgroups, correlation and logistic regression was done. Results: Urinary IL-18/Cr, cystatin/creatinine (Cr) and AGT/Cr levels were higher in groups of hyperfiltration (13.47, 12.11 and 8.43 mg/g), normoalbuminuria (9.24, 11.74 and 9.15 mg/g) and microalbuminuria (11.59, 14.48 and 10.24 mg/g) than controls (7.38, 8.39 and 1.26 mg/g), but NGAL/Cr was comparable. The area under receiver operating characteristic curve (AUC) and sensitivity of AGT to detect early CKD were higher than ACR and eGFR (0.91 and 90.4%, 0.6 and 40% and 0.6 and 37%, respectively). AUC values of other biomarkers, namely IL-18/Cr, cystatin/Cr and NGAL/Cr, were 0.65, 0.64 and 0.51, respectively. Angio/Cr and IL-18/ Cr showed correlation with log albuminuria (r=0.3, P=0.00, and r=0.28, P=0.00, respectively). NGAL showed correlation with log eGFR (r=0.28 P=0.00). Multivariate logistic analysis showed that odds ratio of developing nephropathy was 7.5 times with higher values of log Angio/Cr. Interpretation & conclusions: Urinary AGT showed a higher diagnostic value than ACR and eGFR followed by IL-18 and cystatin to diagnose DN during pre-albuminuric stages.
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Background & objectives: The pandemic caused by the SARS-CoV-2 has been a threat to humankind due to the rapid spread of infection and appearance of multiple new variants. In the present study, we report the dynamics and persistence of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in asymptomatic and symptomatic COVID-19 patients by chemiluminescent assay. Methods: A total of 463 serum samples from 218 SARS-CoV-2 PCR-positive patients were collected over a period of 124 days post-onset of disease (POD). Antibody levels were measured by chemiluminescence bioanalyzer. Neutralizing antibody titres were assessed by plaque reduction neutralization test (PRNT) for SARS-CoV-2. Results: Both IgM and IgG started appearing from day five post-infection in symptomatic and asymptomatic patients. IgM antibody response peaked around day 35 POD and rapidly diminished thereafter, with the last IgM-positive sample observed at 90 days POD. IgG antibody response peaked around 45 days POD and persisted till 124 days. The chemiluminescence immunoassay (CLIA) results showed a moderate correlation (R=0.5846, P<0.001) compared with PRNT. Additional analysis indicated a neutralizing titre of 250 corresponded to 12.948 AU/ml of YHLO iFlash SARS-CoV-2 IgG units. Interpretation & conclusions: Both symptomatic and asymptomatic COVID-19 patients seem to initiate production of antibody responses from day five of onset of disease. Although the CLIA gives high sensitivity and specificity and also its binding IgG antibody titres may correlate moderately with protective immunity, our results indicate that the values of binding antibody alone may not be a perfect guide to represent virus neutralization titre during donor selection for plasma therapy. However, IgM and IgG antibody detection may help in monitoring the status of disease progression and burden in the community.
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Tissue-resident stem cells are surrounded by a microenvironment known as ‘stem cell niche’ which is specific for each stem cell type. This niche comprises of cell-intrinsic and -extrinsic factors like biochemical and biophysical signals, which regulate stem cell characteristics and differentiation. Biochemical signals have been thoroughly studied however, the effect of biophysical signals on stem cell regulation is yet to be completely understood. Biomaterials have aided in addressing this issue since they can provide a defined and tuneable microenvironment resembling in vivo conditions. We review various biomaterials used in many studies which have shown a connection between biomaterialgenerated mechanical signals and alteration in stem cell behaviour. Researchers probed to understand the mechanism of mechanotransduction and reported that the signals from the extracellular matrix regulate a transcription factor yesassociated protein (YAP)/transcriptional coactivator with PDZ-binding motif (TAZ), which is a downstream-regulator of the Hippo pathway and it transduces the mechanical signals inside the nucleus. We highlight the role of the YAP/TAZ as mechanotransducers in stem cell self-renewal and differentiation in response to substrate stiffness, also the possibility of mechanobiology as the emerging field of regenerative medicines and three-dimensional tissue printing.
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Tissue-resident stem cells are surrounded by a microenvironment known as ‘stem cell niche’ which is specific for each stem cell type. This niche comprises of cell-intrinsic and -extrinsic factors like biochemical and biophysical signals, which regulate stem cell characteristics and differentiation. Biochemical signals have been thoroughly studied however, the effect of biophysical signals on stem cell regulation is yet to be completely understood. Biomaterials have aided in addressing this issue since they can provide a defined and tuneable microenvironment resembling in vivo conditions. We review various biomaterials used in many studies which have shown a connection between biomaterialgenerated mechanical signals and alteration in stem cell behaviour. Researchers probed to understand the mechanism of mechanotransduction and reported that the signals from the extracellular matrix regulate a transcription factor yesassociated protein (YAP)/transcriptional coactivator with PDZ-binding motif (TAZ), which is a downstream-regulator of the Hippo pathway and it transduces the mechanical signals inside the nucleus. We highlight the role of the YAP/TAZ as mechanotransducers in stem cell self-renewal and differentiation in response to substrate stiffness, also the possibility of mechanobiology as the emerging field of regenerative medicines and three-dimensional tissue printing.
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PURPOSE@#The human-wildlife conflicts (HWCs) causing nuisances and injuries are becoming a growing public health concern over recent years worldwide. We aimed to study the demographic profile, mode of injury, pattern of injury, and outcome of wild animal attack victims presented to the emergency department.@*METHODS@#This retrospective cross-sectional study was conducted in the emergency department of a tertiary-care hospital in Eastern India. Data were retrieved from the medical records from May 2017 to May 2021. Patients of all ages and genders attacked by wild animals and secondary injuries were included in this study. Patients with incomplete data, injuries due to the attack of stray and domestic animals and trauma due to other causes were excluded. Demographic profile, mode of injury, the pattern of injury, injury severity score (ISS), radiological pattern, and outcome were recorded. Statistical analysis with R (version 3.6.1.) was conducted.@*RESULTS@#A total of 411 wild animal attack victims were studied, of which 374 (90.9%) were snakebite injuries and 37 (9.1%) were wild mammalian (WM) attack injuries. The mean age of WM attack victims was 46 years, and the male-to-female ratio was 4:1. Elephant attack injury (40.5%) was the most common WM attack injury reported. Most WM attacks (43.2%) occurred between 4:00 a.m. to 8:00 a.m. The median ISS was 18.5 (13-28), where 54.2% of patients had polytrauma (ISS>15). Elephant attack was associated with a higher ISS, but the difference was not significant compared to other animal types (p = 0.2). Blunt trauma was common pattern of injury in the elephant attack injury cases. Lacerations and soft tissue injuries were common patterns in other animal attacks. Among snakebites, neurotoxic was the most common type (55.4%), and lower extremity was the most common site involved.@*CONCLUSION@#The young male population is the major victim of HWCs; and elephant is the most common animal involved. There is a need to design scientifically sound preventive strategies for HWCs and to strengthen the preparedness in health establishments to manage victims effectively.
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Animals , Female , Humans , Male , Middle Aged , Animals, Wild , Cross-Sectional Studies , Emergency Service, Hospital , Injury Severity Score , Retrospective StudiesABSTRACT
Aims and Objectives: The aims of the study were to find out the correlation between coronary angiographic findings and hemodynamic parameters derived from impedance cardiography (ICG) and echo-Doppler study. Patients, Materials and Methods: A total of 200 patients of acute myocardial infarction having chest pain, ST elevation in two or more contiguous leads of electrocardiogram (ECG), biomarker positivity, echocardiographic evidence of regional wall motion abnormality (RWMA), and coronary angiographic evidence of coronary lesions were recruited. Subjects unwilling to participate, moribund, critically ill subjects, and patients with concomitant heart failure, arrhythmia, and valvular lesions were excluded from the study. GE™ Vivid 7 Dimension machine was used for ECG-gated echo-Doppler studies. The left ventricular ejection fraction (LVEF), stroke volume (SV), RWMA, diastolic function, etc., were observed. ICG measured LVEDV, LVESV, LVEF, and other parameters particularly amplitudes of the different waves. Coronary angiography (CAG) was done in the Cath Lab having “Siemens™ Axiom Artis Zee (floor)” equipment. Results and Analysis: Results-analysis revealed there is negative correlation (Pearson’s correlation coefficient, r = −0.8) between augmentation pressure and coronary angiographic stenosis percentage and P value is also significant (P = 0.034). Pulse pressure (PP) also is positively correlated (r = −0.78) with coronary angiographic stenosis percentage and P value is also significant (P = 0.027). There is a negative correlation (r = −0.259) between augmentation index (AIx) and coronary angiographic lesions and that is statistically significant (P = 0.03). Conclusion: There is a positive correlation between ICG -derived hemodynamic parameters and the percentage stenosis of coronary arteries. Rise of augmentation pressure and PP in the ICG waveform is associated with coronary artery disease severity. AIx is negatively correlated with severity of coronary arterial stenosis
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Background@#One of the rare complications of primary total knee arthroplasty is intra-operative fracture. Intraoperative fracture during revision knee arthroplasty has been well-documented but there is limited literature on fractures occurring during primary knee arthroplasty. We conducted a systematic review of the literature to compare and contrast the various studies to clearly define the predisposing factors, incidence, and characteristics of the fracture itself and to arrive at a consensus on the management and prevention of intra-operative fractures during primary knee arthroplasty. @*Methods@#The PubMed/Medline, Cochrane, Scopus and Embase databases were searched using keywords “intraoperative fracture”, “distal femoral fracture”, “tibial fracture”, “patella fracture” and “primary total knee arthroplasty”. A total of 158 articles were retrieved and after further filtration and exclusion processing, 10 articles that evaluated intra-operative fractures in primary total knee arthroplasty were included for the review. @*Results@#The reported incidence of intra-operative fractures varied from 0.2% to 4.4%. A higher incidence in female patients with a male to female ratio of 0.4 was reported. Posterior stabilized (PS) total knee arthroplasty was associated with higher risk of intra-operative femoral fractures by many authors in this review. Timing of occurrence and location of the intra-operative fractures can vary widely, with femoral fractures occurring more commonly during bone preparation, trialing and impaction of the final implant and tibial fractures occurring during preparation for the tibial keel and impaction of the tibial component. @*Conclusions@#Intra-operative fractures during primary total knee arthroplasty are rare with higher risk associated with osteoporosis, rheumatoid arthritis, advanced age, female gender, chronic steroid use, metabolic bone disorders, PS type of femoral implant and difficult surgical exposure of the knee joint due to severe deformities. A plethora of management options have been utilized according to surgeon preference. Standard principles of fracture fixation and arthroplasty principles should be followed to achieve stable internal fixation and any unstable fracture site should be bypassed with the utilization of stemmed components. Satisfactory radiographic and functional outcome can be expected with appropriate treatment.
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Background: The morbidity rates for Whipple’s procedure has remained high even as mortality rates were coming down. This study was intended to assess postoperative morbidity rates in a tertiary care centre and to compare it with other centres.Methods: Data was collected from various registers and medical records for this retrospective cohort study. All Whipple’s procedures for 5 years were included in the study. Statistical analysis was done using R statistical software and the results were tabulated.Results: There were 48 patients and half of them developed morbidity. Surgical site infection was the most common complication (18.8%) followed by pulmonary complications (12.5%) and bile leak (6.25%). Half of the patients having pulmonary complications died while nobody with surgical site infection or bile leak died.Conclusions: In this study the morbidity rates were comparable to other centres. Hypoalbuminemia is a significant predictor of morbidity. Surgical site infection was the most common morbidity. Pulmonary complications were the most common cause for death. Morbidity rate is comparable to other centres and Whipple’s procedure is a safe surgery in the tertiary centre where the study was conducted.
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Background: Dengue is one of the most serious and fast emerging tropical diseases. Its incidence of is influenced by many meteorological factors such as rain fall in mm, temperature, humidity etc. Information about these factors can be used to forecast the incidence of dengue fever cases in the next coming months.Methods: The current study was an analytical study using retrospective secondary data from Kerala state. The annual integrated disease surveillance reports of dengue fever cases. Rain fall data and mean monthly temperatures for a period of twelve years from 2006 to 2017 were used. Best fitted model was developed and accuracy of the prediction was tested. All analyses were performed in R software using the mgcv package and nlme package.Results: A total of 144 months study period from January 2006 to December 2017 was used for analysis. Five different models developed for prediction of dengue cases among them, best fitted model including optimal combination of meteorological variables and recent and long term transition of dengue was selected. Out of 84 months predictions in the training period, 68 months prediction was correctly negative, 5 months prediction was correctly positive, 2 months prediction was incorrectly negative and 9 months prediction was incorrectly positive.Conclusions: A better predictive generalized additive model can be developed using the optimal combination of meteorological predictors and dengue fever counts. It will enable the health care administrators to forecast future out breaks and to take better precautionary measures.
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The mortality rates for Whipple’s procedure has come down during the last few years. This study was intended to assess perioperative mortality rates in a tertiary care centre and to compare it with other centres. Methods: Data was collected from various registers and medical records for this retrospective cohort study. All Whipple’s procedures for 5 years were included in the study. Statistical analysis was done using R statistical software and the results were tabulated. Results: There were 48 patients and 8 of them died. A median serum bilirubin level of 16.9 mg% was found statistically significant with respect to mortality. Similarly placed was median serum albumin levels of 2.71 gm% and poor differentiation of tumour. Conclusion: In this study the mortality rates were comparable to other centres. Hypoalbuminaemia is a significant predictor of mortality. Tumour size of more than 3 cm is associated with high mortality. High serum bilirubin levels is an independent predictor of mortality. Several studies also show similar predictors of death in Whipple’s procedure. Pulmonary complications were the most common cause for death. Mortality rate is comparable to other centres and Whipple’s procedure is a safe surgery in the tertiary centre where it was studied.
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Background: This study aimed to assess the prevalence of prediabetes using glycated hemoglobin (HbA1c) in above 40 years age group health care professional in Patna.Methods: This was a cross sectional study carried out amongst 315 employees of the Independent Public Central Hospital in Patna. The selection of healthcare professionals for the study was random. The largest study subgroup (63.4%) were nurses, followed by word attender (13.5%), other administrative employee (10.3%), and orderlies (6.6%). All subjects underwent glycated hemoglobin level measurement at hospital laboratory. Data were analysed using descriptive statistics, chi-square and binary logistic regression tests at value of p <0.05.Results: The study group was evaluated for prediabetes (expressed in the form of HbA1c levels) with an American Diabetes Association-approved classification. The results indicated that a vast majority of the evaluated healthcare personnel (383 people; 82.4%) had normal glycated hemoglobin levels. The remainder of the study group showed carbohydrate metabolism disturbances. The range of glycated hemoglobin levels (5.7-6.4%) found in 73 people (15.7%) suggested an increased risk for diabetes. As a result of the study, as few, or as many, as 9 people (1.9%) were diagnosed with diabetes (initial diagnosis).Conclusions: These results emphasize the need to develop an urgent public program to improve the detection, prevention, and treatment of diabetes. Most of the evaluated healthcare professionals (79.36%) showed no evidence of being at risk for type 2 diabetes mellitus. Only 17.6% of respondents were unaware of their metabolic disturbances. The study demonstrated a positive correlation between body mass index values and glycated hemoglobin levels in the evaluated group of healthcare professionals (R=0.3), which was similar to that found in the general population.
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Globally, the epidemic of obesity in children and young adults is on a constant rise over the past decade. Obesity makes individual highly susceptible to a variety of chronic diseases and their complications. An altered autonomic response in the form of enhanced baseline sympathetic activity, feeble response to sympathetic stimuli and compromised parasympathetic activity is observed in obesity. We have assessed potentially perturbed autonomic responses in young overweight/obese first year medical students. Methods: This cross sectional analytical study was undertaken in the research lab of the Department of Physiology, M.K.C.G. Medical College over a period of 12 months on 300 students (both males and females) to determine sympathetic and parasympathetic responses to stress using hand-grip dynamometer and sinus arrhythmia test respectively. Independent ‘t’ test, Pearson’s correlation coefficient and multiple linear regression analysis in SPSS 20.0 was used to statistically ascertain the differences for the aforementioned parameters between obese and non-obese adults. Results: Weight, Body mass index (BMI), waist hip ratio (WHR), Pulse rate (PR), baseline systolic blood pressure (BSBP) & baseline diastolic blood pressure (BDBP) is significantly greater in obese than in non-obese. BMI shows positive correlation with BSBP & BDBP (r=0.660**; p<0.001 & 640**; p<0.001) and negative correlation with ΔDBP, and E/I Ratio. A negative correlation is appreciated amongst ΔDBP and BMI (R2 = 39.6). A similar negative correlation is again seen between E/I ratio and BMI (R2 = 37.2). Conclusion: Obesity potentially alters autonomic balance with increased sympathetic and reduced parasympathetic tone posing elevated risk of cardiovascular and cerebrovascular accidents.
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Background and Objectives: Stature estimation has a valuable importance for the anatomist, anthropologist and the forensic experts. Long bones are usually used for the estimation of individual height for the said purpose since 1952. The purpose of this study is to formulate a linear regression equation for the estimation of the stature of living female adult population from the length of ulna. Materials and Methods: This research was conducted at M.B. Kedia Dental College Birgunj on 150 subjects who were chosen from among the patients and their attendants in the OPD. The height was measured from the crown to the heel and the length of the ulna was measured from the tip of the olecranon process to the tip of the styloid process. The recorded data was calculated by the standard statistical software. Results: The correlation coefficient (r) was found to be 0.55(p<0.001) for the left ulna with stature and it was 0.463 (p<0.001) for the right ulna with stature after analyzing the data. Supportive regression equations and scatter-plot diagrams could successfully interpret the height from the ulnar length of the population. Conclusion: The ulna length can be used for estimating the height of an individual. The regression equation which were proposed in this study will be useful for forensic esperts, clinicians, anatomists, archeologists, and anthropologists . Such evidence provides the investigator to gauge that aspect of an individual’s physical description.
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Background: The Umbilical cord is the fetal lifeline and it is a structure that connects the foetus to the placenta.Placenta and umbilical cord acts as a mirror which reflects intrauterine status of foetus. The length of theumbilical cord varies from achordia to 300 cm. This study aims to identify the relationship between the umbilicalcord length and birth weight and other parameter such as maternal age, gestational age and gender. More recentresearch suggests that the length of the cord at birth is influenced by intrauterine fetal activity & thereforecorrelate with fetal well being.Materials and Methods: This cross sectional study was conducted in Anatomy department in collaboration withgynecology department of our hospital on 100 freshly delivered samples of placenta with cord which are obtainedfrom labour room of our Government Hospital.Conclusion: The range of cord length was 28- 106 cm .However maximum were between 40cm to 60 cm in length.The mean length was 53.18 cm. Cord length varies with birth weight and conclude that as cord length showspositive correlation with birth weight (r=0.40).
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Background: Acute aneurysmal subarachnoid hemorrhage (aSAH) is a potentially devastating event often presenting with a plethora of hemodynamic fluctuations requiring meticulous fluid management. The aim of this study was to assess the utility of newer dynamic predictors of fluid responsiveness such as Delta down (DD), superior vena cava collapsibility index (SVCCI), and aortic velocity time integral variability (VTIAoV) in patients with SAH undergoing neurosurgery. Materials and Methods: Fifteen individuals with SAH undergoing surgery for intracranial aneurysmal clipping were enrolled in this prospective study. Postinduction, vitals, anesthetic parameters, and the study variables were recorded as the baseline. Following this, patients received a fluid bolus of 10 ml/kg of colloid over 20 min, and measurements were repeated postfluid loading. Continuous variables were expressed as mean ± standard deviation and compared using Student's t-test, with a P < 0.05 considered statistically significant. The predictive ability of variables for fluid responsiveness was determined using Pearson's coefficient analysis (r). Results: There were 12 volume responders and 3 nonresponders (NR). DD >5 mm Hg was efficient in differentiating the responders from NR (P < 0.05) with a sensitivity and specificity of 90% and 85%, respectively, with a good predictive ability to identify fluid responders and NR; r = 0.716. SVCCI of >38% was 100% sensitive and 95% specific in detecting the volume status and in differentiating the responders from NR (P < 0.05) and is an excellent predictor of fluid responsive status; r = 0.906. VTIAoV >20% too proved to be a good predictor of fluid responsiveness, with a sensitivity and specificity of 100% and 90%, respectively, with a predictive power; r = 0.732. Conclusion: Our study showed that 80% of patients presenting with aSAH for intracranial aneurysm clipping were fluid responders with normal hemodynamic parameters such as heart rate and blood pressure. Among the variables, SVCCI >38% appears to be an excellent predictor followed by VTIAoV >20% and DD >5 mmHg in assessing the fluid status in this population.
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PURPOSE: Different students may adopt different learning approaches: namely, deep and surface. This study aimed to characterize the learning strategies of medical students at Trinity School of Medicine and to explore potential correlations between deep learning approach and the students' academic scores. METHODS: The study was a questionnaire-based, cross-sectional, observational study. A total of 169 medical students in the basic science years of training were included in the study after giving informed consent. The Biggs's Revised Two-Factor Study Process Questionnaire in paper form was distributed to subjects from January to November 2017. For statistical analyses, the Student t-test, 1-way analysis of variance followed by the post-hoc t-test, and the Pearson correlation test were used. The Cronbach alpha was used to test the internal consistency of the questionnaire. RESULTS: Of the 169 subjects, 132 (response rate, 78.1%) completely filled out the questionnaires. The Cronbach alpha value for the items on the questionnaire was 0.8. The score for the deep learning approach was 29.4±4.6, whereas the score for the surface approach was 24.3±4.2, which was a significant difference (P<0.05). A positive correlation was found between the deep learning approach and students' academic performance (r= 0.197, P<0.05, df= 130). CONCLUSION: Medical students in the basic science years at Trinity School of Medicine adopted the deep learning approach more than the surface approach. Likewise, students who were more inclined towards the deep learning approach scored significantly higher on academic tests.
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Humans , Informed Consent , Learning , Observational Study , Saint Vincent and the Grenadines , Students, MedicalABSTRACT
PURPOSE@#Different students may adopt different learning approaches: namely, deep and surface. This study aimed to characterize the learning strategies of medical students at Trinity School of Medicine and to explore potential correlations between deep learning approach and the students' academic scores.@*METHODS@#The study was a questionnaire-based, cross-sectional, observational study. A total of 169 medical students in the basic science years of training were included in the study after giving informed consent. The Biggs's Revised Two-Factor Study Process Questionnaire in paper form was distributed to subjects from January to November 2017. For statistical analyses, the Student t-test, 1-way analysis of variance followed by the post-hoc t-test, and the Pearson correlation test were used. The Cronbach alpha was used to test the internal consistency of the questionnaire.@*RESULTS@#Of the 169 subjects, 132 (response rate, 78.1%) completely filled out the questionnaires. The Cronbach alpha value for the items on the questionnaire was 0.8. The score for the deep learning approach was 29.4±4.6, whereas the score for the surface approach was 24.3±4.2, which was a significant difference (P<0.05). A positive correlation was found between the deep learning approach and students' academic performance (r= 0.197, P<0.05, df= 130).@*CONCLUSION@#Medical students in the basic science years at Trinity School of Medicine adopted the deep learning approach more than the surface approach. Likewise, students who were more inclined towards the deep learning approach scored significantly higher on academic tests.
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BACKGROUND: Immune thrombocytopenia (ITP) is an immune-mediated disease caused by autoantibodies against platelets membrane glycoproteins GPIIb/IIIa and GPIb/IX. The etiology of ITP remains unclear. This study evaluated the association of polymorphisms in interleukin (IL)-1B-31, IL-1B-511, and IL-1Ra with ITP. METHODS: Genotyping of IL-1B-31, IL-1B-511, and IL-1Ra was performed in 118 ITP patients and 100 controls by polymerase chain reaction restriction fragment length polymorphism and detection of variable number tandem repeats. RESULTS: Genotype differences in IL-1B-31 and IL-1Ra were significantly associated with ITP. Patients showed a higher frequency of the IL-1B-31 variant allele (T) and a 1.52-fold greater risk of susceptibility to ITP (odds ratio [OR]=1.52, 95% confidence interval [CI]=1.04–2.22, P=0.034). The frequencies of both homozygous and heterozygous variant genotypes of IL-1B-31 were higher (OR=2.33, 95% CI=1.069–5.09, P=0.033 and OR=2.044, 95% CI=1.068–39, P=0.034) among patients and were significantly associated with ITP susceptibility. Both homozygous and heterozygous variant genotypes of IL-1Ra were also more frequent (OR=4.48, 95% CI=1.17–17.05, P=0.0230 and OR=1.80, 95% CI=1.03–3.14, P=0.0494) among patients and were associated with ITP risk. IL-1B-31 and IL-1Ra also showed significant association with severe ITP. However, IL-1B-511 was not associated with ITP. CONCLUSION: IL-1B-31 and IL-1Ra polymorphisms may significantly impact ITP risk, and they could be associated with disease severity, which may contribute to the pathogenesis of ITP.