Category: Nevin Manimala

Cureus. 2024 May 22;16(5):e60826. doi: 10.7759/cureus.60826. eCollection 2024 May.

ABSTRACT

Background Chronic liver disease (CLD) is associated with a variety of consequences, including thrombocytopenia and esophageal varices, which significantly impact patient prognosis and management. Thrombocytopenia, frequently observed in patients with CLD, may correlate with the severity of esophageal varices, a critical complication leading to variceal bleeding. Methodology A cross-sectional study was carried out in the Department of Medicine and Gastroenterology, Pak Emirates Military Hospital, Rawalpindi, from October 2021 to March 2022. The study enrolled 94 patients, aged 18-70 years, diagnosed with CLD, regardless of the cause. These patients were categorized into four groups based on platelet count: <50,000/uL, 50,000-99,999/uL, 100,000-150,000/uL, and >150,000/uL. Pearson’s correlation was utilized to evaluate the association between the severity of thrombocytopenia and the grading of esophageal varices. Results A total of 94 patients were enrolled in the study, with 53 (56.4%) males and 41 (43.6%) females. The mean age of patients was 51.06 ±11.09 years. Seventeen (18.1%) had no esophageal varices, 16 (17.0%) were diagnosed with Grade I varices, 35 (37.2%) with Grade II varices, and 26 (27.7%) had Grade III varices. Most patients without varices had a platelet count above 150 x 10³ (17, 18.1%). Conversely, most patients with Grade III varices (19, 20.2%) had platelet counts below 50 x 10³. Patients with no esophageal varices had a mean platelet count of 173.70 ± 37.48 x 10³. Among the patients, those with Grade III esophageal varices exhibited the lowest mean platelet count, recorded at 78.54 ± 24.14 x 10³. These findings indicate a statistically significant difference in mean platelet counts across the various esophageal varices grades (P = 0.000). There was an inverse correlation of platelet count with the grading of esophageal varices (r = -0.645, P < 0.000). Conclusions A negative correlation was observed between the platelet count and the grading of esophageal varices, implying that as the severity of esophageal varices increased, the platelet counts proportionally decreased.

PMID:38916026 | PMC:PMC11195516 | DOI:10.7759/cureus.60826

Cureus. 2024 May 25;16(5):e61033. doi: 10.7759/cureus.61033. eCollection 2024 May.

ABSTRACT

Background and objective Procrastination, which refers to the act of unnecessarily delaying the beginning or completion of an assigned task, is a widespread but often neglected problem among college students. Postponing a task can impair academic performance or lead to stress and poor mental well-being. A knowledge gap exists in understanding the cyclical nature of the relationship between anxiety and procrastination, wherein anxiety leads to procrastination, which in turn exacerbates anxiety. In light of this, we aimed to assess the level of procrastination and anxiety among college students and to correlate the relationship between their procrastination and anxiety status. Methodology A cross-sectional analytical study was conducted among 347 graduate students from various disciplines at a tertiary care hospital in Puducherry, India. A convenient sampling technique was employed to recruit the participants, and data were collected using the validated Procrastination Assessment Scale for Students (PASS) and the Hamilton Anxiety Rating Scale (HAM-A). Results Our findings showed that about 124 (35.7%) participants reported weekly reading assignments as the most frequently procrastinated task, with a mean score of 3.15 ± 1.02, followed by studying for exams and writing term papers. The most commonly reported reason for procrastination was evaluation anxiety, followed by low self-esteem and perfectionism. A significant number of students (157, 45.2%) had mild anxiety, and 58 (16.7%) students were found to have severe anxiety. A Spearman correlation coefficient of 0.26 (95% CI: 0.16 – 0.36) was observed between the overall procrastination score and HAM-A score, which indicated a weak positive correlation and was statistically significant (p<0.05). Similarly, a weak positive correlation was found between task aversiveness, fear of failure, and anxiety levels. Conclusions Procrastination is positively related to anxiety but the relationship is weak. Understanding and addressing the underlying anxiety or stress can be a key to managing procrastination among college students.

PMID:38916017 | PMC:PMC11194534 | DOI:10.7759/cureus.61033

Cureus. 2024 May 25;16(5):e61041. doi: 10.7759/cureus.61041. eCollection 2024 May.

ABSTRACT

OBJECTIVE: To compare the bond strength of two types of resin cement to that of additive manufacturing (AM) or cast cobalt-chromium (Co-Cr) alloys.

MATERIALS AND METHODS: Two types of resin luting cement, composite resin and methyl methacrylate (MMA), were bonded to AM or cast Co-Cr alloys, and shear bond tests were performed after seven days of storage in distilled water at 37°C. Co-Cr alloy adhesive elements AM to the enamel surface of the labial aspect of a bovine mandibular central incisor crown were bonded with two types of resin luting cement and subjected to 1,000 cycles of storage in water for one day and 28 days or thermal cycling, followed by shear bonding tests. Residual cement on the metal and enamel surfaces after the bonding tests was evaluated using an optical microscope. The normality of the results was evaluated using statistical software Statcel4, analysis of variance, or Kruskal-Wallis test, depending on normality, and multiple comparison tests were performed using the Tukey-Kramer or Steel-Dwass tests.

RESULTS: After one day, the shear bond strength (SBS) was 25.9 MPa for Panavia V5 (PV; Kuraray Noritake Dental Corporation, Niigata, Japan) and 23.5 MPa for Super-Bond (SB; Sun Medical Corporation, Shiga, Japan), with no significant difference between the two cement types (P > 0.05). After 28 days, the SBS decreased to 4.1 MPa for PV and 6.7 MPa for SB, showing a significant difference between the two cements (P < 0.05). Following 1,000 thermal cycles, the SBS was 2.0 MPa for PV and 5.6 MPa for SB, with SB exhibiting a significantly higher value (P < 0.05). The adhesive strength was significantly lower after 28 days of storage and thermal cycling compared to after one day of storage (P < 0.05). The Co-Cr alloy exhibited more residual cement on the enamel surface due to interfacial fracture with the resin cement. The Co-Cr alloy showed more residual cement on the enamel surface due to interfacial fracture with the resin cement.

CONCLUSION: MMA-based resin cement showed optimal bond strength and may be suitable for clinical use in computer-aided design (CAD)/computer-aided manufacturing (CAM) orthodontic appliances.

PMID:38916016 | PMC:PMC11194759 | DOI:10.7759/cureus.61041

Cureus. 2024 May 25;16(5):e61040. doi: 10.7759/cureus.61040. eCollection 2024 May.

ABSTRACT

Background Knee osteoarthritis (KOA) is the most typical cause of knee pain and impairment worldwide. It is typified by slow and progressive degeneration of the articular cartilage of the knee joint. Although KOA is being managed with a variety of therapies, the comparison of the effectiveness of different intra-articular injections in KOA treatment in Pakistan is still not thoroughly investigated. Therefore, the purpose of this current study is to compare the efficacy of intra-articular administration of platelet-rich plasma (PRP) and corticosteroids (CSs) in the treatment of KOA. Methods This prospective comparative study was performed among one hundred patients diagnosed with KOA in Benazir Bhutto Hospital, Rawalpindi, for one year from April 2022 to March 2023. Specified inclusion and exclusion criteria were employed for patient enrollment. Patients were divided into two equal groups through simple random sampling. Group A patients received an intra-articular injection of PRP solution whereas group B patients received an intra-articular injection of CSs. Informed consent and ethical approval were also acquired prior to data collection. A self-designed proforma based on interviews was used to collect data. The data analysis in Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk, NY) was carried out via descriptive statistics and an independent t-test. Results Women (N=71, 71%) had a higher prevalence of KOA than men (N=29, 29%). The means of study variables like age, Visual Analog Scale (VAS) score, and Western Ontario and McMaster Universities (WOMAC) score were 56.10 ± 8.70 years, 8.08 ± 1.6, and 70.08 ± 8.76 respectively. The frequency of KOA on the right side was 62% (N=62) while it was 38% (N=38) on the left side. In the study population, 69% (N=69) patients had grade II KOA, and 31% (N=31) patients had grade III KOA. At the first-month, second-month, and third-month follow-up visits, there were statistically significant differences in the mean scores of the WOMAC and VAS between the study groups. However, at the first-month follow-up visit, mean scores of VAS and WOMAC were lower in group B than in group A while these were lower in group A as compared to group B, at the second-month and third-month follow-up appointments. Conclusions Intra-articular infiltration of both PRP and CSs was efficacious in the treatment of KOA-related pain and functional limitations; however, overall improvement in the PRP group was higher than CS group.

PMID:38916012 | PMC:PMC11194758 | DOI:10.7759/cureus.61040

Cureus. 2024 May 22;16(5):e60873. doi: 10.7759/cureus.60873. eCollection 2024 May.

ABSTRACT

Background Thyroidectomy is a routinely performed surgical procedure used to treat benign, malignant, and some hormonal disorders of the thyroid that are not responsive to medical therapy. Voice alterations following thyroid surgery are well-documented and often attributed to recurrent laryngeal nerve dysfunction. However, subtle changes in voice quality can persist despite anatomically intact laryngeal nerves. This study aimed to quantify post-thyroidectomy voice changes in patients with intact laryngeal nerves, focusing on fundamental frequency, first formant frequency, shimmer intensity, and maximum phonation duration. Methodology This cross-sectional study was conducted at a tertiary referral center in central India and focused on post-thyroidectomy patients with normal vocal cord function. Preoperative assessments included laryngeal endoscopy and voice recording using a computer program, with evaluations repeated at one and three months post-surgery. Patients with normal laryngeal endoscopic findings underwent voice analysis and provided feedback on subjective voice changes. The PRAAT version 6.2 software was utilized for voice analysis. Results The study included 41 patients with normal laryngoscopic findings after thyroid surgery, with the majority being female (85.4%) and the average age being 42.4 years. Hemithyroidectomy was performed in 41.4% of patients and total thyroidectomy in 58.6%, with eight patients undergoing central compartment neck dissection. Except for one patient, the majority reported no subjective change in voice following surgery. Objective voice analysis showed statistically significant changes in the one-month postoperative period compared to preoperative values, including a 5.87% decrease in fundamental frequency, a 1.37% decrease in shimmer intensity, and a 6.24% decrease in first formant frequency, along with a 4.35% decrease in maximum phonatory duration. These trends persisted at the three-month postoperative period, although values approached close to preoperative levels. Results revealed statistically significant alterations in voice parameters, particularly fundamental frequency and first formant frequency, with greater values observed in total thyroidectomy patients. Shimmer intensity also exhibited slight changes. Comparison between hemithyroidectomy and total thyroidectomy groups revealed no significant differences in fundamental frequency, first formant frequency, and shimmer. However, maximum phonation duration showed a significantly greater change in the hemithyroidectomy group at both one-month and three-month postoperative intervals. Conclusions This study on post-thyroidectomy patients with normal vocal cord movement revealed significant changes in voice parameters postoperatively, with most patients reporting no subjective voice changes. The findings highlight the importance of objective voice analysis in assessing post-thyroidectomy voice outcomes.

PMID:38916010 | PMC:PMC11195517 | DOI:10.7759/cureus.60873

Cureus. 2024 May 23;16(5):e60957. doi: 10.7759/cureus.60957. eCollection 2024 May.

ABSTRACT

Background and aim The majority of acne has the potential to transform into facial scars, which have a physical and psychological effect on the individual. There are plenty of treatment options to manage such scars. The aim of this study is to assess the comparative effect of the injection of platelet-rich plasma (PRP) alone, with that of the injection of PRP with microneedling, in the reduction of atrophic facial acne scars. Methods A total of 30 participants were included in this study, divided into two groups (n = 15). Patients in Group I received intradermal injection of PRP only, and Group II included patients receiving intradermal injection of PRP with microneedling. The scar appearance was evaluated at baseline, after one, two, and three months using Goodman Baron’s scar scale. The statistics were analysed using the Chi-square and Student’s t-tests. Results Patients in the PRP with microneedling group had lower acne scar scores on the Goodman Baron scale compared to those who received only PRP. The acne scores were statistically significant (p-value < 0.05) in the second and third months of treatment in Group II. Conclusion The addition of microneedling to PRP has proven to be effective in the reduction of facial acne scars. However, different types of scars require different modalities of treatment, and the final decision lies in the hands of the operator and the requirements of the patients.

PMID:38916005 | PMC:PMC11194131 | DOI:10.7759/cureus.60957

Cureus. 2024 May 24;16(5):e61028. doi: 10.7759/cureus.61028. eCollection 2024 May.

ABSTRACT

INTRODUCTION: The burden of chronic liver disease (CLD) is increasing globally and the ultimate treatment is a liver transplant. As Pakistan is a developing country, liver transplantation is not easily available due to limited resources. This study aims to assess the patients with CLD for liver transplantation and to find the frequency of eligible candidates for liver transplantation.

METHODS: A cross-sectional observational study was conducted on patients with CLD from June 2022 to December 2022. Total bilirubin, serum creatinine complete blood count, serum electrolytes, and international normalised ratio (INR) were done. The Model for End-Stage Liver Disease (MELD) score was calculated and the frequency of eligible patients for liver transplant was determined. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY, USA).

RESULTS: In our study, 149 patients were enrolled with a mean age of 46.81±15.7 years. There were 58.7% male and 41.6% female patients. The mean duration of liver cirrhosis was 18.22±11.7 months. The mean MELD score was 20.71±5.2. The common liver cirrhosis stages were stage II and stage II was found in 32.2% of each. Hepatocellular carcinoma (HCC) was present in 15.4% of patients. There were 25.5% of patients eligible for liver transplants.

CONCLUSION: In our study, we found that significant numbers of patients with CLD were eligible for liver transplantation.

PMID:38916000 | PMC:PMC11194463 | DOI:10.7759/cureus.61028

Cureus. 2024 May 24;16(5):e61027. doi: 10.7759/cureus.61027. eCollection 2024 May.

ABSTRACT

BACKGROUND: Cognitive communication abilities, such as working memory (WM), are vital for accomplishing daily activities and are also important for higher-order processes such as planning and problem-solving. The current study investigates the simultaneous effect of kapalabhati (KBH) on WM and phasic heart rate variability (HRV).

METHODS: Twenty participants who fulfilled the inclusion and exclusion criteria, with an average age of 23.65±3.07 years (mean±SD), were recruited for the study. Prior to data collection, the participants underwent a seven-day orientation to maintain uniformity in KBH practice. EKGs were assessed using a 16-channel polygraph system arranged in a standard limb lead II configuration. WM was assessed using E-Prime version 2.0 (Psychology Software Tools, Sharpsburg, PA, USA).

RESULTS: There was a significant increase in accuracy after the immediate KBH practice in all three conditions of the WM task (i.e., n-back task: 0-back, 1-back, and 2-back). However, there was also an increase in reaction time. Repeated measures ANOVA of HRV measures showed statistically significant changes in mean rhythm-to-rhythm (RR) intervals, heart rate (HR), number of adjacent N-N intervals over 50 milliseconds (NN50), percentage of successive normal sinus RR intervals greater than 50 milliseconds (pNN50 RR), low frequency (LF), and high frequency (HF), with HR, NN50, pNN50, LF, and HF all significant at p<0.001 and the LF/HF ratio significant at the p<0.01 level.

CONCLUSION: The results of the current study suggest that KBH practice can modulate vagal tone or parasympathetic activity and improve WM performance. Furthermore, the parasympathetic shift found in the present study may promote better cardioprotective health and longevity.

PMID:38915978 | PMC:PMC11194464 | DOI:10.7759/cureus.61027

Cureus. 2024 May 25;16(5):e61048. doi: 10.7759/cureus.61048. eCollection 2024 May.

ABSTRACT

BACKGROUND AND AIM: The coronavirus disease 2019 (COVID-19) pandemic necessitates continuously evaluating antiviral treatments, especially for high-risk groups, including older individuals. This study aimed to compare the efficacy of three antiviral drugs, including remdesivir, molnupiravir, and ensitrelvir, in hospitalized patients as measured by our own institution’s antigen test, focusing on outcomes, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen levels, hospitalization duration, and fever resolution.

METHODS: This retrospective observational study was conducted at Yoshida Hospital, Asahikawa City, Japan, enrolling 154 patients who received antiviral treatment upon COVID-19 diagnosis from July 1, 2022, to September 15, 2023. The diagnosis was confirmed by proprietary antigen tests or loop-mediated isothermal amplification assays. Patients who received treatment outside the hospital or with consistently negative antigen results were excluded. Drug administration was determined by attending physicians, considering oral administration challenges and renal dysfunction. The data were statistically analyzed using an unpaired two-tailed Student’s t-test and one-way analysis of variance complemented by the Tukey post-hoc test for detailed group comparisons.

RESULTS: No significant differences were observed in the initial antigen levels among the treatment groups. By day 10, the ensitrelvir group showed lower antigen levels than the other groups, but not significantly. The ensitrelvir group had a higher antigen-negative conversion rate and a significantly shorter hospital stay than the molnupiravir group. However, no significant differences were noted in the fever resolution time among the groups.

CONCLUSION: This study suggests the potential benefits of ensitrelvir in reducing antigen levels and hospitalization duration. However, the overall efficacy of the antiviral agents for symptomatic relief appears similar. These findings underscore the need for further research to optimize COVID-19 management by considering personalized treatment approaches and long-term outcomes.

PMID:38915977 | PMC:PMC11195001 | DOI:10.7759/cureus.61048

Cureus. 2024 May 24;16(5):e60976. doi: 10.7759/cureus.60976. eCollection 2024 May.

ABSTRACT

Introduction Oral presentation and public speaking skills are poorly emphasised in the medical school curriculum. The student grand round was created to tackle this deficiency by changing the way in which students are taught, from traditional lecture-based learning to interactive small-group peer-to-peer teaching. This approach encourages students to become responsible for their own learning, develop their public speaking and teaching skills, as well as identify and address gaps in their knowledge. Aims The primary aims of this study were to determine the understanding of students before and after peer teaching, including retention of concepts via quiz scores and confidence of students in giving SBAR (Situation, Background, Assessment, Recommendation) handovers. The secondary aim is to determine the place of student-led grand round teaching in the medical curriculum as a means of developing teaching skills and encouraging active learning. Methods A cohort of 21 third-year medical students from Leicester University attended a weekly peer teaching programme where students presented a case they had encountered during their clinical attachment. Peer teachers were required to research some background and pathophysiology regarding the topic and teach in an interactive manner and create discussion regarding the topic. The students then summarised the case and practised the skill of concise handovers using the SBAR format. Knowledge and understanding were assessed with an interactive quiz, and feedback via a survey was gathered before and after sessions. Each student engaged in case discussion and received input from a specialty registrar regarding their presentation skills, case knowledge, and SBAR handover. Results Individual and combined session analysis demonstrated a significant improvement in scores across understanding the topic and confidence in SBAR. Student recommendation for the session cumulatively was significant (p=0.02); however, comparison of medical student recommendations of individual sessions did not yield statistically significant results. There was a significant improvement in the overall quiz score (p=0.045), and average scores improved from 51% to 70% (p=0.043). There was a significant increase in the mean quiz result after the first two sessions (28-55% (p=0.002) and 56-85% (p=0.0001), respectively). Summary The student grand round is a promising teaching initiative that capitalises on peer teaching, a valuable learning theory that centres around students taking on the role of teachers to instruct their peers. Results from this study have shown that this method of collaborative teaching is effective in improving the understanding of medical topics, increases confidence in public speaking and precise handover skills, and therefore better prepares medical students for their career as future clinicians.

PMID:38915976 | PMC:PMC11194139 | DOI:10.7759/cureus.60976