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   Table of Contents - Current issue
January-March 2023
Volume 15 | Issue 1
Page Nos. 1-107

Online since Friday, March 31, 2023

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The Effects of Consuming Almonds and Almond Oil on Blood Lipids: A Systematic Review p. 1
Muhamed T Osman, Redhwan Ahmed Al-Naggar
Introduction: Pharmacological approaches to hyperlipidemia are used in practice to lower lipids, but the benefits in lowering lipid levels also lead to some adverse effects. Therefore, the aim of this systematic review is to find out how almonds and almond oil affect blood lipids. Methodology: The studies in this systematic review were chosen systematically by searching Cochrane, PubMed, Scopus, Web of Science, and Embase from the earliest date to March 2021. Two authors independently screened titles and abstracts, followed by screening. Search strategy was conducted using the following keywords: Almond, Prunus, Prunus dulcis, amygdalus, oleum amygdalae, P. amygdalus, Prunus dulcis, Prunus amygdalus dulcis, and P. dulcis; human, person, subject, people, patient, participant, individual, volunteer, elder, senior, geriatric, women, men, adult, woman, and man; and LDL, Lipid, Lipid Profile, blood profile, HDL, Low Density Lipoprotein, TAG, Triglyceride, Triacylglycerol, High Density Lipoprotein, Cholesterol, Lipid regulation, TG Lipid Distribution, Total Cholesterol, Cholesterol, TC Lipid Distribution, cholesterol, total cholesterol, HDL-C, LDL, LDL-C, lipoprotein, hyperlipidaemia, hypercholesterolaemia, and hyperlipaemia. Results: Overall, the studies demonstrate a significant outcome of almond or almond oil on lowering blood lipid levels, except in three studies. We included 40 clinical trials. In all studies, the average daily intake of almonds was between 10 and 100 g/day. For almond oil, it was 500 ml of almond oil daily. The duration of almond consumption ranged from 3 to 30 weeks. Sample sizes in all strata ranged from 12 to 128 participants. In the 17 strata, subjects were described as generally healthy and in 5 strata as overweight or obese. Conclusions: Consuming almonds or almond oil has a significant effect on lowering lipids.
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ClinicoPathological Overview of Ovarian Tumors and Diagnostic Utility of Imprint Cytology p. 11
Nirali Patel, Rupali Bavikar, Yaminy Pradeep Ingale, Yesha Parimalbhai Lad, Arpana Dharwadkar, Vidya Viswanathan
Introduction: For intra-operative diagnosis of ovarian tumors, imprint cytology is the method which gives result within 20 min. It does not affect the quality and utility of the specimen for histopathology. Despite advances in genetics and imaging, histopathological analysis remains the mainstay of ovarian tumor diagnosis. Aim: To describe incidence, age distribution, histological characteristics and whenever feasible, correlate the histopathological diagnosis of ovarian tumors with the imprint cytology technique. Materials and Methods: A total of 200 patients with ovarian tumors were included in this ambispective study from January 2017 to April 2022 at the Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri. Results: One hundred and forty-eight (74%) of the 200 cases were benign, while 52 (26%) were malignant. The peak age incidence of benign tumors was in the second to fourth decades and malignant ovarian tumors was in fourth to sixth decades. Ovarian tumors involved the left ovary (n = 104, 52%) more than the right ovary (n = 90, 45%). Out of 200 cases, 130 cases (65%) were surface epithelial ovarian tumors, followed by 50 cases (25%) were germ cell tumors, followed by 14 cases (7%) were sex cord stromal tumors followed by 3 cases (3%) were secondary/metastatic tumors of ovary. Imprint cytology technique done on 148 cases (74%) showed 100% correlation with the histopathological diagnosis. Conclusion: Imprint cytology diagnosis correlated with the histopathological diagnosis of ovarian tumors.
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Association between low back pain, pelvic floor dysfunction, and diastasis rectus abdominis in postnatal delivery women p. 16
Rishita Rai, Sudhakar Subramanian
Background: It is crucial to understand diastasis rectus abdominis (DRA) in postpartum women and how it affects them. DRA should be related to pelvic floor dysfunction (PFD) and low back pain (LBP). Prior researchers have contradictory findings in their studies. Objective: To estimate the prevalence of DRA and find the association between LBP, PFD, and DRA. Methodology: According to the eligibility criteria, 102 participants from Bengaluru were chosen for this study. The physical screening was performed to rule out DRA. Following informed consent, the participants have given the Oswestry Disability Index Questionnaire for LBP and Pelvic Floor Impact Questionnaire-7 for PFD. Subjects were divided into two classes: case and control. The data were analyzed using the Chi-square test and the Odds ratio using SPSS Software. Results: This analysis presents the findings of the prevalence of DRA and also the findings of rated LBP and PFD in both the groups. The degree of impact was determined to be P < 0.05. Conclusion: As an outcome, there is an association between LBP, PFD, and DRA.
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Drug-related Problems among Inpatients of General Medicine Department of a Tertiary Care Hospital in South India p. 22
Janice Jacson Mandumpala, Aleena Manoj, Neha Baby, Sneha Elizabeth Mathai, Siji Antony, Antriya Annie Tom
Background: Identification of drug-related problems (DRPs) is a medication management service that can add value to individual patient care. Determination of DRPs daily is a promising approach for optimizing treatment. Objective: The objective of this study was to analyze the incidence of DRPs identified along with the risk factors that contribute to its development. Setting: This study was conducted in a tertiary care hospital in Central Kerala, India. Methods: A cross-sectional study was conducted among 300 newly admitted patients to the general medicine department. Patient medical records were reviewed in 3 stages – medication reconciliation, medication order review, and discharge summary review, and DRPs were categorized based on the Pharmaceutical Care Network Europe V9.1. Patient characteristics such as age, gender, polypharmacy, comorbidities, nonadherence, and type of illness were recorded. Results: Out of 300 patients, 78.7% had DRPs. The incidence of DRPs was found to be 0.26 cases/people-months. Although age >60 years, gender, polypharmacy, nonadherence, comorbidities, and chronic ailments were risk factors for DRPs, only polypharmacy and comorbidities could be proven statistically. Conclusion: DRPs are an emerging issue within the confines of the health-care system and should be scrutinized to avoid negative outcomes. A stage-wise analysis of patients who are at risk will ensure better patient care.
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Effect of neck rehabilitation exercise and breathing exercise on visual complaints in individuals with idiopathic chronic neck pain p. 29
JR Abishek, D Vincent Jeyaraj
Background: Neck pain is one of the most common musculoskeletal disorders and a leading cause of disability. Chronic neck pain causes hyperalgesia in soft tissues around the neck, and in severe cases, it leads to restriction of daily life activities. The excessive stress caused by the chronic pain leads to cervico-ocular gain, leading to a mismatch of reflexes that determine the gaze and vision. Chronic neck pain also alters the cervicothoracic kinematic change and length-tension changes in neck muscles and leads to decreased thoracic cage mobility. This leads to respiratory insufficiency in patients with chronic neck pain, which is similar to the changes that occur in cases of a neuromuscular disorder. Objective: The objective of this study was to find the effect of neck rehabilitation exercises and breathing exercises on visual complaints in individuals with idiopathic chronic neck pain. Materials and Methods: Thirty individuals with idiopathic chronic neck pain of both sexes ranging from 20 to 35 years were included according to the selection criteria and divided into two groups. Group A (n = 15) received the intervention for neck pain, whereas Group B (n = 15) did not receive any interventions. Outcome Measures: Neck disability Index, Visual Complain Index and NPRS are used as outcome measures. Results: Statistical analysis was done using SBM SPSS software version 20, which showed that there was a significant improvement in NDI in the experimental group (P < 0.05). Conclusion: This study concludes that there is a significant effect of neck rehabilitation exercises and breathing exercises on visual complaints in individuals with idiopathic chronic neck pain.
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Perspectives of Medical Students on E-Learning in the Surgery Module p. 34
Anas Abdulqader Fathuldeen, Ahmed Onayzan Alshammari, Eyad Mohammed Khalifah, Fauwaz Fahad Alrashid, Abdulaziz Saad Alqahtani, Fahaad Saleh Alenazi, Sager Holyl Alruwaili, Mohammed Anizan Alshmmri, Saadeldin Ahmed Idris
Objectives: The goal of this study was to explore medical students' perceptions, assess their experiences, and identify obstacles to e-learning during the COVID-19 pandemic, as well as to understand the factors behind its adoption and application as a learning means in the surgery module. Materials and Methods: Data were gathered from undergraduate medical students, at the University of Hail, KSA, in their surgery module using an electronic questionnaire. Subsequently, SPSS version 25.0 (IBM, Armonk, NY, USA) has been used for analysis. Results: The study included 72 students, with a participation rate of 85.7%. Students positively perceived technology (M = 4.024 ± 0.94 and P < 0.001). Most respondents (79.5%) claimed that e-learning required less time for studying than the conventional learning technique (M = 4.14 ± 1.052 and P < 0.001). They had positive perceptions of the implications of e-learning (M = 3.92 ± 0.89 and P < 0.001). Regarding the perception toward instructors, 53.9% admitted that when instructors use computer technologies, it adequately met their needs. The mean agreeability to online quizzes was high (M = 3.8264 ± 0.910). More than half preferred the blended style of learning. A-70.9% interested in using e-learning (M = 3.83 ± 1.278 and P < 0.001). There was no statistical difference among genders (P > 0.05). Conclusion: This study addresses the determinants behind the adoption and use of e-learning within the surgery module. Therefore, it will support the event of a rational approach to an effective application of e-learning and look at it as a positive initiative toward development and alteration.
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Rocking the boat but keeping it steady: Lockdown, online classes, emotional intelligence and burnout among students p. 42
Priyanka Krishnamoorthy, Kalpana Kosalram
Background: Burnout is a stress-induced syndrome that predominantly affects adolescents. Some environmental and personal factors can contribute to the onset of burnout and its severe consequences, including attrition, sleep disorders, and depression. Objective: Our study examined the impact of the COVID lockdown on emotional intelligence, academic burnout, and academic performance. Materials and Methods: Data were collected from a sample of 471 school-going students. Participants are selected by simple random sampling by the randomization table technique. Participants completed questionnaires, including the evaluation of academic burnout (exhaustion, cynicism, and efficacy). Results: Among the study population, 59% were females, and 41% were males. The mean age was 15.5 ± 1.26 years. The mean score for Cynicism was 10.06 ± 3.8. The mean score for Academic Efficacy was 20.71 ± 4.63. The mean difference in Emotional Exhaustion Score between males and females was not statistically significant (P = 0.063). The mean difference in Cynicism Score between males and females was not statistically significant (P = 0.730). The mean difference between males and females was statistically significant in the Academic Efficacy and Total scores (P < 0.001). Conclusion: The findings suggest that emotional intelligence strongly correlates with burnout during the COVID-19 lockdown. Adaptive coping, mental health, and optimism help prevent academic burnout and consequently positively affect academic performance. Intervention and future research implications should be discussed.
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Metabolite fingerprinting and profiling of selected medicinal plants using nuclear magnetic resonance p. 47
Manas Ranjan Sahoo, Marakanam Srinivasan Umashankar
Background: Medicinal herbs are well known for their therapeutic effects and are traditionally used in the treatment and prevention of numerous diseases. Further plant-derived natural products have also been a valuable source of lead compounds for drug discovery and development. As the bioactivity of natural extracts is due to synergism between hundreds of metabolites present in the plant extract, the complete metabolomic analysis can be used for the quality control of phytomedicine. The 1H-nuclear magnetic resonance (NMR) fingerprint of the herbal extract can be used as a promising approach for comprehensive analysis of secondary metabolites to obtain a holistic view. The 1H-NMR spectroscopy has the advantage that it requires little quantity of samples and simple sample preparation method. Objectives: The study aimed to study the secondary metabolites of seven selected herbs, namely Abies webbiana, Cuminum cyminum, Elettaria cardamomum, Zingiber officinale, Glycyrrhiza glabra, Piper longum, and Terminalia chebula. Materials and Methods: The secondary metabolites of the herbal extracts were studied by recording the 1H-NMR spectra using NMR spectrometer in suitable solvent. Results: The putative metabolites that have been identified were 4-methoxy quercetin, luteolin, cuminaldehyde, 1,8-cineole, elettarins, gingerol, shogaol, glycyrrhizin, liquiritigenin, glabridin, betulinic acid, oleanolic acid, arabinogalactan, chebulagic acid, and gallic acid. Conclusion: The study highlighted the potential of NMR metabolomics in the study of plant extracts and their application for the quality control of phytomedicine.
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Formulation optimization of solid dispersion of candesartan cilexetil p. 59
Sachin Namdeo Kothawade, Vishal Vijay Pande
Context: Antihypertensive effects were achieved by quickly hydrolyzing candesartan cilexetil (CC), an inactive prodrug of candesartan, into active candesartan during absorption in the gastrointestinal tract. Due to its weak water solubility, CC has an inadequate intestinal absorption and a low oral bioavailability. Aim: The goal of this study was to make the medication CC more soluble in water. Materials and Methods: Low viscosity hydroxypropyl methylcellulose (HPMC) E5LV was used to prepare the solid dispersions through spray drying. Results: Study of dissolution, Fourier transform infrared spectroscopy, scanning electron microscopy (SEM), differential scanning calorimeter (DSC), and X-ray diffraction characterized the prepared solid dispersions. CC amorphized from its crystallized state, as shown by the findings from the SEM, DSC, and X-ray powder diffraction experiments. Comparing pure CC and solid dispersion, the dissolution rate was higher with the former. The surfactant and wetting property of HPMC E5LV slowed devitrification and had an anti-plasticization impact, increasing the solubility and stability of the solid dispersion. Conclusion: The final results indicated that the CC, a weakly water-soluble medication, dissolved much better in the solid dispersions.
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Drug Safety Alerts Issued by the National Coordination Centre for Pharmacovigilance Programme of India: Current Practices and Future Recommendations p. 64
Dasaraju Rajesh, Muppala Thejaswini
Background: Adverse drug reactions (ADRs) due to drug therapy are inevitable and prior knowledge of their causative agents can avoid unnecessary economic burden on patients as well as on the health-care system. Objectives: To create awareness among health-care professionals about the drug safety alerts (DSAs) issued by the National Coordination Centre for Pharmacovigilance Programme of India (NCC-PvPI) till December 2022 and to reiterate the importance of spontaneous reporting of adverse events for better patient care. Methodology: A retrospective analysis of 141 DSAs issued from March 2016 to December 2022 was done. The ADRs were analyzed for the type of reactions, system organ class, and according to drug class. Microsoft Office 2007 was used to formulate the data and presented it in a descriptive manner using numbers and percentages. Results: Out of 141 DSAs under analysis, 101 individual drugs, 2 drug classes, and 7 drug combinations have developed 144 ADRs. These ADRs were compressed into 86 different types as similar ADRs were caused by more than one drug. Drug Reaction with Eosinophilia and Systemic Symptoms is the most common ADR noticed, followed by skin manifestations such as toxic epidermal necrolysis, acute generalized exanthematous pustulosis, skin hyperpigmentation, fixed drug eruption, symmetrical drug-related intertriginous and flexural exanthema, and photosensitivity reaction. The most common causative drugs for ADRs were antimicrobial agents, cephalosporins being the most commonly implicated medication class. Conclusions: Most of the ADRs advised to closely monitor by the NCC-PvPI through DSAs were treatable by early and appropriate management. Due to the high number of skin manifestations observed in the analysis, the role of dermatologists in taking detailed drug history is critical when making a differential diagnosis of skin lesions. Motivation and creating awareness among health-care professionals and patients to spontaneously report adverse events can only strengthen the pharmacovigilance system in India.
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Analysis of severe acute respiratory syndrome coronavirus 2 antibodies response in COVID-19 patients and health-care workers p. 70
Yaminy Pradeep Ingale, Shirish Sahebrao Chandanwale, Payal Patel, Rakesh Kumar Rashmi, Narendra Chindhu Kale, Tushar Jalindar Kambale, Vikram Bhausaheb Vikhe
Background: COVID-19 epidemic causes destructive consequences on human beings and on the global economy. Aim: The purpose of this study was to evaluate the severe acute respiratory syndrome coronavirus 2 antibodies response in COVID-19 patients and health-care providers to them in different categories and with respect to age, sex, and symptoms. Materials and Methods: Analysis of immunoglobulin (Ig) G and total COVID antibodies was done by chemiluminescent microparticle immunoassay (CMIA) and IgM antibodies by rapid card test method in 300 cases. Results: Out of 300 cases, asymptomatic were 29%, mild 26.66%, moderate 17.66%, and severe were 28.33%; percentage of males were higher than females in all. The most common age group involved was 30–40 years (20%). The most common symptom was fever (51.33%), followed by cough (38.66%), and the most common comorbidity was hypertension (16.33%). We observed that severe category had a higher percentage of symptoms as well as comorbidities. Out of 300 cases, 56.66% were IgG positive, and 89.6% were total COVID antibody positive. In rapid IgM antibodies, out of 50 cases, 13 were positive. We observed that IgM was positive mainly in severe cases compared to mild cases, while IgG level was lower in severe cases than those of mild cases. In our study, majority of cases (97 cases) are IgG positive approximately in 8–14 days after onset of symptoms. Conclusion: Quantitative analysis of antibodies is a simple, quick, and cheap method and could play major role in diagnosis and prognosis of COVID-19, and also used to pick up silent carriers (asymptomatic patients) who missed in false-negative reverse transcription polymerase chain reaction in such epidemic.
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Development of a new validated stability-indicating high-performance thin-layer chromatography method for determination of dosulepin HCl in bulk and marketed formulation with characterization of its degradants by liquid chromatography–Mass spectrometry p. 76
Aishwarya Ramchandra Balap, Ravina R Waghmare
Aim: Dosulepin hydrochloride is a tricyclic antidepressant. It acts by inhibition of the reuptake of biogenic amine and increasing available neurotransmitter levels at the synaptic cleft. The objective of this work is to develop a new validated stability-indicating high-performance thin-layer chromatography (HPTLC) method for the determination of dosulepin hydrochloric acid (HCl) in bulk and marketed formulation and characterization of the degradation products by liquid chromatography–mass spectrometry (LC–MS). Materials and Methods: The HPTLC method development of dosulepin HCl was performed on aluminum plates precoated with silica gel 60 F254 using dichloromethane: toulene: methanol: glacial acetic acid (GAA) (4:4:2:0.2 v/v) with densitometric detection at 220 nm. The method validation was done using linearity, precision, accuracy, and robustness parameter. Results: Linearity range for dosulepin HCl was found in between 150 and 900 ng/band correlation coefficient was 0.996. The % relative standard deviation for accuracy and precision was found <2%. The developed and validated HPTLC method is simple, accurate, precise, and specific. Conclusion: This study concludes that the dosulepin HCl undergoes degradation to different extent under different stress conditions. From the peak purity profile studies, it was confirmed that the peak of the degradation product was not interfering with the peak of drugs. Major acidic and oxidation degradation products were isolated and characterized by LC–MS and probable degradation pathway for dosulepin HCl was determined.
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Evaluation of increased antibody titer COVID-19 after astrazeneca vaccination based on the age at UTA'45 Jakarta Vaccine Center p. 83
Stefanus Lukas, Diana Laila Ramatillah, Yufri Aldi, Fatma Sri Wahyuni, Kashifullah Khan
Background: Vaccine is an essential tool to limit the health of the COVID-19 pandemic. AstraZeneca vaccine already provided promising effectiveness data. Still, the study must check the correlation between vaccination and antibody titer. Aim: This study aims to evaluate antibody titer after AstraZeneca vaccination based on the age group. Materials and Methods: This study used a prospective cross-sectional method with convenience sampling. Inclusion criteria were all Indonesian citizens above 18 years old who were vaccinated at UTA'45 Jakarta Vaccine Center with no history of COVID-19 before the vaccination and had filled up the informed consent. Results: This study's total sample was 102 females; 51.90%, residents of Java Island; 91.17% had comorbidities; 50,98%, smokers; 9,80%, alcohol drinker; 9,80%, exercise; 80,39%, blood pressure; 128/73, SpO2: 97,82. Most participants aged around 30 years had a body mass index of 23.33. Age, comorbidity, smoking, alcohol, and exercise habit significantly correlate with the increase of the participants' antibodies (P < 0.001). The age shows that the younger the participant, the higher the titer antibody 2 will be (P = 0.001, 95% confidence interval [CI], −1.935, −0.694). The exercise shows that the participant with the routine practice will have a higher titer antibody 2 (P = 0.002, 95% CI, 12.016, 51.791). Antibody titer for participants younger than 35 years old increased 5.7 times while for participants between 35 and 45 years old was 3.9 times. Another group (>45–55 years old) has shown an improvement in antibody titer at 1.7 times, but the last group (>55 years old) described an increase in antibody titer at 232.3 times. Conclusions: Age, comorbidity, smoking, alcohol, and exercise contributed to the increase in titer antibody 2 value of the AstraZeneca vaccine participants. Participants in the age group <35 years have an excellent immune system.
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Dentists' perspective on tobacco cessation and counseling in Jeddah p. 91
Shanthi Vanka, Dalya Nabil Afandi, Rana Hassan Otaif, Anan Adel Sharbatly, Raghad Emad Hejazi, Raghad Sultan Aljohani, Othman Wali, Amit Vanka
Introduction: A major cause of death on a global scale is tobacco and in fact the biggest preventable cause of mortality and illness worldwide. The World Health Organization estimates that there are 1100 million regular smokers worldwide and they are increasing alarmingly. Dentists play a pivotal role in the prevention of tobacco use as patients approach dentists for cosmetic reasons. We planned this study to find the experience of dentists on tobacco cessation and counseling. Methods: We designed the study as an analytical cross-sectional study. The data were collected through a questionnaire using Google Forms targeting all the dentists in Jeddah. The questionnaire Google link was sent to their WhatsApp and other electronic means. Consent from the dentists was obtained prior to collecting information from the dentists. Results: 89.9% of dentists agreed that it is the duty of every dentist to advise the patient on tobacco cessation and 10.1% disagreed. 81.7% of dentists agreed that all dentists have the capability of doing tobacco cessation practices. Seventy-eight percent of dentists agreed that dentists are not presently well prepared to assist patients with tobacco cessation in contrast with 22% who disagree. The scientific evidence relating to the burden of oral diseases has always been attributable to tobacco use, and a well-structured dental teaching curriculum for the dentists and the auxiliaries concentrating on oral cancer education and tobacco cessation interventions has to be emphasized in the Kingdom for the dentists (28). Dentists require formal training to do tobacco cessation successfully to reach a major goal of a “tobacco-free society.” Conclusion: There should be an emphasis on formal training being an effective tool to provide guidelines to the dentist and auxiliaries in tobacco cessation and counseling of the patients in the dental clinic.
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Factors of venous thromboembolism among COVID-19 patients p. 97
Lee Fern Low, Farida Islahudin, Shamin Mohd Saffian
Context: Anticoagulants are used to prevent and treat venous thromboembolism (VTE), such as deep-vein thrombosis (DVT) and pulmonary embolism (PE) in COVID-19 for better outcomes. Aim: This study aims to explore clinical outcomes and factors affecting VTE among COVID-19 patients. Settings and Design: The study design involved a retrospective cohort study. Study Methods: Hospitalized COVID-19 patients in a tertiary hospital prescribed subcutaneous (SC) anticoagulants were included. Statistical Analysis Used: Multiple logistic regression was performed to determine factors affecting VTE among subjects. Results: A total of 450 patients were included. Types of anticoagulants include fondaparinux (n = 114, 38.1%), enoxaparin (n = 113, 37.8%), and heparin (n = 72, 24.1%). 423 (94.0%) patients were discharged well, 27 (6.0%) patients were admitted to the intensive care unit (ICU). The primary outcome was the prevalence of VTE, which occurred in 19.3% (n = 87) patients, with 80 (92.0%) reporting DVT and 7 (8.0%) reporting PE. The secondary outcome, which was the average length of hospital stay was 9.9 (±4.7) days. Factors of VTE occurrence were likely in patients not prescribed SC anticoagulants compared to those prescribed with SC anticoagulants (adjusted odds ratio [aOR] 54.330, 95% confidence interval [CI]: 7.086, 416.526), treatment with fondaparinux compared to heparin (aOR 2.502, 95% CI: 1.175, 5.327), and less likely in those discharged well compared to patients in the ICU (aOR 0.139, 95% CI: 0.053, 0.361). Conclusions: Careful monitoring is required to reduce VTE risk in COVID-19 patients.
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Methotrexate-induced Neutropenia p. 105
Kesha Ajaykumar Parmar, Maulin D Mehta
Various malignancies, autoimmune disorders such as rheumatoid arthritis (RA), and elective abortions commonly use methotrexate (MTX) for their treatment, which is a folate antagonist. Although many cases of the common side effects of MTX such as nausea, vomiting, and stomatitis have been reported, very few cases of MTX-induced neutropenia have been found in the literature. We have taken a case of neutropenia that developed after the patient took tablet MTX for RA. The case was studied and the causality assessment of the reported adverse drug reaction showed it to be in the category of “probable” according to the WHO-UMC causality categories.
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