Antibiotic prescription patterns among pediatric patients with pneumonia in primary care – A retrospective cohort study

Background and Objectives@#The etiology of pneumonia in the pediatric population varies by age group. Among patients one month to 59 months old, viral pathogens are the most common cause of lower respiratory infections. The study aims to determine the frequency distribution of antibiotic prescription among patients one month to 59 months old and to determine the adherence of primary care facilities to local guidelines with recommended antibiotics. @*Methods@#A descriptive retrospective study using electronic medical records was conducted at two primary care sites. Patients aged 1 month to 59 months old seeking consult via telemedicine or face-to-face diagnosed with community acquired pneumonia from April 2019-March 2020 in the rural facility and May 2019-April 2020 in the remote facility were included in the study. The primary outcome was to determine the patterns of antibiotic use in pneumonia in remote and rural areas and adherence to the recommended antibiotics by the 2016 Philippine Academy of Pediatric Pulmonologists pediatric community-acquired pneumonia clinical practice guidelines (CPG). @*Results@#There were 30 pediatric patients diagnosed with pneumonia in the rural facility and 213 in the remote facility. Of these patients with pneumonia, 96.7% and 94.8% were prescribed antibiotics in the rural and remote sites, respectively. The most commonly prescribed antibiotic in the rural facility was co-amoxiclav (26.7%), while amoxicillin (51.6%) was the most common in the remote facility. Adherence to the CPG in the rural site was lower at 23.3% (n=8/30) compared to the remote site which was 55.9% (n=119/213). @*Conclusion@#Primary care physicians prescribed antibiotics in over 90% of the time upon the diagnosis of pneumonia in children aged one month to 59 months old, despite viral pneumonia being the more common in primary care setting. Adherence to recommended antibiotics was higher in the remote setting than in the rural setting. Use of EMR to monitor quality of care can improve patient outcomes and safety, pointing out the importance of improving the quality of documentation in the study sites.

To study the effect of 'Covishield' vaccination on pre-donation platelet counts of plateletpheresis donors

ABSTRACT Introduction: Approximately 55.52% of the Indian population had been fully vaccinated by Jan. 2022, since its first roll out on January 16, 2021. A few concerns were raised concerning the Covishield vaccination related to thrombotic thrombocytopenia. Apheresis-derived platelet concentrates are frequently required in a plethora of clinical situations and post-vaccination decrement of platelet counts might lead to increased deferral of the plateletpheresis donors. Objectives. The aim of the study was to discover the effect of the Covishield vaccination on deferral rates of plateletpheresis donors. Methods: Blood samples were collected from the potential platelet donors for the completion of the standard questionnaire for the complete blood count. The data collected were tabulated in the MS Excel spreadsheet and the biostatistical analysis was performed with the SPSS v23. A p-value of < 0.05 was taken as significant. We compared this data with age-and sex-matched controls. Results: The mean age of cases and controls was 29.69 ± 8.57 and 30.15 ± 7.11, respectively. There was a significant difference in platelet counts of cases (188496.35 ± 72065.66/cumm) and controls (269524.50 ± 53981.60/cumm). Furthermore, donors who received one dose had higher platelet counts of 248676.47 ± 80075.24/cumm than those who received both doses of vaccine (179970.83 ± 66773.73/cumm). The difference in deferral rates between the two groups was remarkable (34.7% vs. 0.9%, with the p-value < 0.001). Conclusion: Vaccination certainly increased the deferral rates of plateletpheresis donors due to low platelet counts. Average platelet counts were low in fully vaccinated individuals, however, the platelets returned to normal counts as the post-vaccination days progressed.

Assessment of quality-of-life in cancer patients at tertiary care hospital in North India

Introduction: Cancer is a disease that emerges as a result of abnormal cell proliferation and their propensity to spread from one bodily region to another. There are over a hundred different types of cancer that impact individuals all over the world. It is difficult to identify in the early stages, but there are certain warning signals that the cells will turn malignant. Quality of life (QOL) is described by the World Health Organisation as "individuals' perception of life, values, objectives, standards, and interests within the cultural framework of the social environment in which they live and in relation to their goals, expectations, standards, and concerns." QOL assessment in health system is a multidimensional construct that can be measured by evaluating objective levels of health status filtered by the subjective perceptions and expectations of the individual. Aim and Objective: To assess socio-demographic factors and quality of life among cancer patients in tertiary care hospital. Materials and Methods: A hospital-based prospective observational study was conducted at Guru Gobind Singh Medical College and Hospital Faridkot district, Punjab (India). The study was conducted for a period of six months after getting approval from Institutional Ethical Committee (IEC). Generic instrument, SF-36 was used to assess the QOL. The study was analyzed on SPSS version 26.0 software. Descriptive and analytical analysis was used to describe the results. Results: Linear regression was conducted to see the relationship of physical functioning score with age and weight of the patients. The descriptive statistics shows the mean and standard deviation of the variable. The mean of physical functioning score was found to be (M = 27.82, SD = 15.635). The physical functioning score and age, weight of the patients in linear regression shows that the age and weight explain 17.5% Conclusion: Treatment revealed that severe and moderate activities restricted nearly half of the assessed patients, with body pain interfering with employment and routine activities. According to the findings of the current study, QOL deteriorates as the disease progresses. Cancer unquestionably has a detrimental influence on patients' quality of life, which is connected to the illness process itself, the therapy administered, and the length of the disease. (AU)

ChatGPT for Veterinary Anatomy Education: An Overview of the Prospects and Drawbacks / ChatGPT para la Educación en Anatomía Veterinaria: Una Descripción General de las Perspectivas y los Inconvenientes

SUMMARY: The integration of artificial intelligence in veterinary medical education has the potential to revolutionize the way students learn veterinary anatomy. ChatGPT, launched by OpenAI in November 2022, has been the fastest-growing artificial intelligence (AI) application as a learning tool in the past few months. ChatGPT is a virtual assistant that provides students with detailed and relevant anatomical knowledge based on internet sources. Apart from the advantages of ChatGPT in veterinary anatomy education, the challenges and limitations must also be considered, as highlighted in this letter. Further research and evaluation are necessary to ensure the optimal integration of the ChatGPT tool into veterinary anatomy education. ChatGPT can provide students with valuable insights and educational support but cannot replace hands-on experiences; dissection-based laboratory sessions remain essential for developing practical skills and spatial understanding in veterinary anatomy education.

La integración de la inteligencia artificial en la educación médica veterinaria tiene el potencial de revolucionar la forma en que los estudiantes aprenden anatomía veterinaria. ChatGPT, lanzado por OpenAI en noviembre de 2022, ha sido la aplicación de inteligencia artificial (IA) de más rápido crecimiento como herramienta de aprendizaje en los últimos meses. ChatGPT es un asistente virtual que brinda a los estudiantes conocimientos anatómicos detallados y relevantes basados en fuentes de Internet. Además de las ventajas de ChatGPT en la educación en anatomía veterinaria, también se deben considerar los desafíos y las limitaciones, como se destaca en esta carta. Se necesitan más investigaciones y evaluaciones para garantizar la integración óptima de la herramienta ChatGPT en la educación en anatomía veterinaria. ChatGPT puede proporcionar a los estudiantes información valiosa y apoyo educativo, pero no puede reemplazar las experiencias prácticas. Las sesiones de laboratorio basadas en disecciones siguen siendo esenciales para desarrollar habilidades prácticas y comprensión espacial en la educación de la anatomía veterinaria.

The Efficacy of Different Triptans for the Treatment of Acute Headache in Pediatric Migraine: A Systematic Review

Background: Serotonin receptors 5-HT1B and 5-HT1D in the cerebral arteries are activated by the 5-hydroxytryptophan agonists (triptans) to relieve the discomfort associated with migraines. Even though triptans are often used to treat acute migraines, there is some debate over their effectiveness. Objective: Our systematic review aimed to evaluate the effectiveness of triptans for acute treatment of migraine in young individuals. Methods: Utilizing the databases of Google Scholar, Cochrane Library, and PubMed, a literature search was conducted, and all papers published till July 2022 were included. This systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. In addition to the Boolean operators AND, OR, and NOT, the following descriptive terms were also used: “Triptans,” “Pediatric Migraine,” “Migraine disorders,” “Headache,” “Children,” and “Adolescent.” Results: A total of 1047 studies were identified, and 25 articles were finally included in the study. 17 of them were RCTs while the remaining were non-randomized trials. Most studies recruited participants aged between 12-17 years. Among 25 studies, 7 reported sumatriptan use, 3 assessed a combination of sumatriptan and naproxen, 4 were on almotriptan, 1 on eletriptan, 6 on rizatriptan, and 4 on zolmitriptan use. Conclusion: We found that rizatriptan (good tolerability profile with a dose of 5 mg) and sumatriptan (nasal spray, 10 mg and 20 mg) had higher efficiency as compared to other triptans. Regardless of type or dose, all triptans are generally well tolerated by patients, but a few adverse effects such as light-headedness (sumatriptan), nasopharyngitis, and, muscular spasms (sumatriptan/ naproxen), somnolence, and dry mouth (rizatriptan), and dizziness (zolmitriptan group) were reported with the triptans.

A comparative study on surgical outcomes of trabeculectomy with and without anti-metabolites in juvenile open-angle glaucoma

Purpose: To compare the surgical outcomes of trabeculectomy with and without anti?metabolites in patients with juvenile open?angle glaucoma (JOAG). Methods: This retrospective comparative case series included 98 eyes of 66 patients with JOAG who underwent either trabeculectomy without anti?metabolites (group A, n = 53 eyes) or with anti?metabolites (group B, n = 45 eyes) with a minimum of 2 years follow?up. The main outcome measures were intra?ocular pressure (IOP), number of glaucoma medications, visual acuity, additional surgical interventions, surgical complications, and risk factors for failure. Surgical failure was defined as IOP >18 mmHg or failure to reduce IOP by <30% from the baseline value or IOP ?5 mmHg or re?operation for refractory glaucoma or a complication or loss of light perception vision. Results: The mean post?operative IOP reduced significantly from baseline at all post?operative visits until 6 months and thereafter. The cumulative probability of failure at 2 years was 28.7% in group A [95% confidence interval (CI) = 17.6–44.8%] and 29.1% in group B (95% CI = 17.1–46.7%) (P = 0.78). Surgical complications occurred in 18 eyes (34%) in group A and 19 eyes (42%) in group B. Re?operations for glaucoma or complications were performed in two eyes (3.8%) in group A and two eyes (4.4%) in group B. Cox?hazard regression model revealed male gender (HR = 0.29; P = 0.008), baseline high IOP (HR = 0.95; P = 0.002), and an increased number of pre?operative glaucoma medications (HR = 2.08; P = 0.010) as significant factors associated with failure. Conclusion: Our study results on trabeculectomy in JOAG revealed a success of 71% in both groups at 2 years follow?up. There was no significant difference in success or failure rates between the two groups. The risk factors for poor surgical outcome in JOAG were male gender, baseline high IOP, and an increased number of glaucoma medications

DIGITAL SEARCH ADVERTISING – THE ROLE OF POST-CLICK FACTORS IN GENERATING PURCHASE CONVERSIONS

A lot of research is available on the effectiveness of search as an advertising channel. Most of these studies tend to treat a click on a search ad as a binary event. All of them study the events leading to the click. This paper goes beyond this to study the post click actions taken by a user subsequent to clicking on a search ad, and refers to those actions as depth of interaction, and testing the variables that have an effect on the nal outcome. We use a prescriptive research design employing binary logistic regression analysis. Results indicate that the duration of time spent, device used, and recency of visit have a very high positive effect on the nal outcome.

New cost-effective human leukocyte antigen testing algorithm for screening of human leukocyte antigen-matched related donor in thalassemia major patient pretransplant workup: A single-center study from resource-constrained settings

Introduction: India has a huge disease burden of thalassemia major with an estimated 40 million carriers and over a million thalassemia major patients. Very few patients are optimally treated, and the standard of care “hematopoietic stem cell transplant” (HSCT) is out of reach for most patients and their families. The cost of HSCT is significant, and a substantial proportion of it goes to human leukocyte antigen (HLA) testing of family members (HLA screening) in hope of getting a matched related donor (MRD) for HSCT. The aim of this study was to establish that a new proposed testing algorithm of HLA typing would be more cost-effective as compared to the conventional HLA screening within MRD families for possible HSCT. Material and Methods: Buccal swab samples of 177 thalassemia patients and their prospective family donors (232) were collected. Using a new HLA testing algorithm, samples were tested for HLA typing in a sequential manner (first HLA-B, then HLA-A, and finally HLA-DR) using the sequence-specific oligonucleotide probe method on the Luminex platform. Results: The new sequential HLA-A, HLA-B, and HLA-DRB1 testing algorithm showed a 49.1% reduction in cost compared to the conventional HLA testing algorithm. Furthermore, 40 patients (22.59%) were found to have HLA-MRD within the family among other samples that were tested. Conclusion: The new HLA testing algorithm proposed in the present study for identifying MRD for HSCT resulted in a substantial reduction in the cost of HSCT workup.

A CASE REPORT OF RIGHT UNILATERAL PULMONARY ARTERY ATRESIA (UPAA) MISDIAGNOSED AS RIGHT CHRONIC PULMONARY THROMBO-EMBOLISM

Unilateral pulmonary artery atresia is a rare condition with clinical presentation as exercise intolerance, recurrent infections, hemoptysis to asymptomatic state with incidental diagnosis. Common modalities of management include medical management for pulmonary hypertension , angioembolisation of collaterals followed by pneumonectomy. However surgical reconstruction of atretic pulmonary artery segment is an uncommon surgical management strategy employed in our case with satisfactory outcome

A Comparative Study Of Physiological Variables Among Rural And Urban Football Players Of Murshidabad District

Fitness is the term, which is universally used in the present-day health responsive society. The people have realized the importance of fitness in day-to-day routines and also in achieving sports of high quality. The main purpose of the study was to find out some Physiological Variables of Rural and Urban Football Players Only college level male subjects were selected the age groups of the subjects were above 18 to 22 years. Some physiological variables (Vital capacity, Blood pressure, Pulse rate, Resting Heart rate, Haemoglobin, Breath holding Capacity) were measured. For the present study 20 subjects from each group were selected as subjects. The result shows that rural football players are larger than urban football players in terms of physiological variables.

Effect Of Aerobic Training On Selected Physiological Variables Amongst Inter Collegiate Level Netball Players

This study explored the result of aerobic training on selected physiological variables amongst inter collegiate level netball players. Thirty male netball players were selected as subjects. Tre age of the subjects ranged from 20 to 25 years. The selected subjects were haphazardly separated into two groups with fifteen subjects in each group (n=15). The groups were named experimental group and control group The experimental group underwent an aerobic training program for the duration of six weeks. The collected data was statistically analysed through using request paired 't' tests. The results of the present study have powerfully indicated that participation in six weeks of aerobic training program resulted in important differences on selected physiological variables.

Profile of Cardiac Involvement in Children After Exposure to COVID-19

Objective: To evaluate the incidence and pattern of cardiac involvement in children postCOVID (coronavirus disease) infection in a tertiary care referral hospital in India. Methods: A prospective observational study was conducted including all consecutive children with suspected MIS-C referred to the cardiology services. Results: Of the 111 children with mean (SD) age 3.5 (3.6) years, 95.4% had cardiac involvement. Abnormalities detected were coronary vasculopathy, pericardial effusion, valvular regurgitation, ventricular dysfunction, diastolic flow reversal in aorta, pulmonary hypertension, bradycardia and intracardiac thrombus. The survival rate post treatment was 99%. Early and short-term follow-up data was available in 95% and 70%, respectively. Cardiac parameters improved in the majority. Conclusion: Cardiac involvement post COVID-19 is often a silent entity and may be missed unless specifically evaluated for. Early echocardiography aids in prompt diagnosis, triaging, and treatment, and may help in favorable outcomes.

Assessment of intraocular pressure measurement between Goldman applanation tonometer, rebound tonometer, non-contact tonometer, and its correlation with central corneal thickness

Purpose: To compare readings of intraocular pressure (IOP) taken with the Goldmann applanation tonometer (GAT), the non?contact tonometer (NCT), and the rebound tonometer (RBT), and to compare their correlation with central corneal thickness (CCT). Methods: This was a prospective, cross?sectional, observational study to which patients above 18 years of age were enrolled. A total of 400 eyes of 200 non?glaucomatous patients underwent IOP recordings using the GAT, NCT, and RBT, and CCT was also noted. Informed consent of the patients was taken. The IOP readings taken via the three methods were compared and correlated with CCT. Paired t test was used to compare the two devices. Simple and multivariate linear regression analyses were used to study the relationship between factors. A P value less than 0.05 was considered significant. Correlation was determined using the Pearson correlation coefficient, and a Bland–Altman graph was plotted. Results: Mean IOP measured by the NCT was 15.65 ± 2.80 mmHg, by the RBT was 14.23 ± 3.05 mmHg, and by the GAT was 14.69 ± 2.97 mmHg. The mean CCT was 510.61 ± 33.83 microns. The difference between mean IOP recorded by the NCT and that by the RBT was 1.41 ± 2.39 mmHg, between the NCT and GAT was 0.95 ± 2.03 mmHg, and between the GAT and RBT was 0.45 ± 2.22 mmHg. The difference between the IOP values was statistically significant (P < 0.005). All tonometers showed a statistically significant correlation with CCT, but it was observed that the NCT had a stronger correlation (0.4037). Conclusion: The IOP readings taken by all the three methods were comparable; however, RBT values were closer to GAT values. CCT did influence the IOP values, and this should be kept in mind while evaluating.

ARDS with septic shock managed successfully using a multidisciplinary approach: A case report

Acute respiratory distress syndrome (ARDS) is an inflammatory process in the lungs that results in hypoxemia and decreased lung compliance. Invasive mechanical ventilation and prone positioning have proven benefits in the management of patients with severe ARDS. Post-extubation rehabilitation programs are equally important for the recovery of these patients. We are reporting the case of a 30-year-old male with severe ARDS where lung protective ventilation, timely intubation, early prone positioning, multidisciplinary communication, and post-discharge follow-up with teleconsultation were used under expert supervision in the successful management of the case

Metronidazole: A culprit to balance and speech

In a country like India, oral metronidazole is the commonly prescribed drug of choice for entities such as amebiasis and visceral abscesses. Oral such cases, it is usually well tolerated and safe but can cause serious neurological adverse events. Peripheral neuropathy commonly encounters in practice but central nervous system toxicity is also well documented as it crosses the blood–brain barrier easily. Neurological toxicity of metronidazole may be due to prolonged administration, high doses, or high cumulative doses. Magnetic resonance imaging (MRI) of brain is the modality of choice to evaluate brain involvement. In the brain, the splenium of the corpus callosum, dentate nucleus of the cerebellum, and posterior pons involvement are commonly seen and diagnostic. Here, we have an interesting case report of a patient who was on oral metronidazole treatment for his large liver abscess, presenting with a complaint of neurological symptoms of unsteady gait, vertigo, dysdiadochokinesia, and difficulty in speech. Moreover, thus suspected as metronidazole drug toxicity and further investigated for the same, and MRI typically shows cerebellar and posterior corpus callosal involvement

Stiff-Person syndrome: A rare neurological disorder

The Stiff-person syndrome (SPS) is an uncommon disorder characterized by progressive rigidity, muscle stiffness, and spasm involving the axial muscles, resulting in severe impairment of ambulation. We present the case of a 49-year-old gentleman with recent onset of progressive asymmetric spastic ataxia, subsequently diagnosed with SPS.

Left paratesticular mass mimicking polyorchidism: A case report

We report a rare case of primary scrotal lipoma in a 20-year-old patient which clinically mimics a left triorchidism. The patients presented with the left testicular swelling and the ultrasonography of the scrotum revealed an inhomogeneous hyperechoic mass with an inconclusive report. The left scrotal hemi exploration was planned, and intraoperatively, it was found to be a paratesticular mass with an equivalent size corresponding to the left testicle, separate from the left testicle. The histopathology confirms the lipomatous swelling. The post-operative period remains uneventful and the patient has been on follow-up for the past 1 year with no relapse

Ocular conjunctival microbiome profiling in dry eye disease: A case control pilot study

Purpose: Keratoconjunctivitis sicca (KCS) or dry eye disease (DED) is a multifactorial disease that results in discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. A pilot study was undertaken to determine if there were any major substantial differences in the ocular microbiome in DED patients versus healthy controls. Methods: The bacterial communities residing in the conjunctiva of patients with DED (n = 4) and healthy controls (n = 4) were assessed by 16S ribosomal RNA (rRNA) gene sequencing of the V4–V5 region. Results: The phyla Proteobacteria, Actinobacteria, Bacteroidetes, and Firmicutes were most dominant and accounted for 97% and 94.5% of all bacterial sequences in patients and controls, respectively. At the genus level, 27 bacterial genera were found with more than two?fold difference between patients and controls. Four of these – Acinetobacter, Corynebacterium, Lactobacillus, and Pseudomonas spp. – dominated the ocular microbiome of all subjects, but were proportionately lower in DED (16.5%) compared to controls (37.7%). Several bacterial genera were found to be unique in DED (34) and controls (24). Conclusion: This pilot study is an attempt to profile the ocular microbiome in patients with DED that demonstrated a higher concentration of microbial DNA compared to controls, with Firmicutes phyla dominating the bacterial population in patients with DED.