Background: The application of the Six Sigma (σ) metric in biochemical laboratories is a powerful tool for reducing the occurrence of errors and prioritizing important improvements in laboratory quality control. The National Accreditation Board for Testing and Calibration Laboratories (NABL) is an accreditation body with an accreditation system established in accordance with ISO/IEC 17011, providing specialty- or scope-based certification based on the conformance of quality indices to medical laboratories. In this context, a study has been designed that considers the quality guidelines set by NABL as well as the sigma metric rule in the assessment of analytical performance. Aims and Objectives: The aims of this study were to identify the gaps and need for strategy modification for quality improvement by assessing the performance of two NABL-accredited medical testing laboratories on a Sigma metric scale. Materials and Methods: A retrospective analytical study was conducted over 6 months (January–June 2021). Internal quality control (IQC) and EQAS data were obtained from third-party QC providers (Bio-Rad, India) and analyzed by calculating sigma (σ) values based on the coefficient of variation, bias, and total error allowable in two NABL-accredited medical testing laboratories. To identify potential problems for analytes with poor sigma values, a quality goal index (QGI) analysis was performed. Results: By analyzing the sigma values obtained by both NABL-accredited laboratories, we can see that laboratory 2 performed better than laboratory 1. After calculating the QGI, there was a problem of inaccuracy and imprecision in laboratory 1, and laboratory 2 had QGI values that indicated only imprecision. Conclusion: Diagnostic laboratories should incorporate Six Sigma metrics to identify gaps in their performance to ensure better quality control and patient safety.
{"title":"Sigma metrics application in clinical biochemistry: Practical requisite or unfeasible misadventure","authors":"Debojyoti Bhattacharjee, Bithika Ghosh, Arghya Ray Chaudhuri, Sebanti Chakrabarty, Sourav Naskar, Kheya Mukherjee","doi":"10.3126/ajms.v15i6.63624","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.63624","url":null,"abstract":"Background: The application of the Six Sigma (σ) metric in biochemical laboratories is a powerful tool for reducing the occurrence of errors and prioritizing important improvements in laboratory quality control. The National Accreditation Board for Testing and Calibration Laboratories (NABL) is an accreditation body with an accreditation system established in accordance with ISO/IEC 17011, providing specialty- or scope-based certification based on the conformance of quality indices to medical laboratories. In this context, a study has been designed that considers the quality guidelines set by NABL as well as the sigma metric rule in the assessment of analytical performance.\u0000Aims and Objectives: The aims of this study were to identify the gaps and need for strategy modification for quality improvement by assessing the performance of two NABL-accredited medical testing laboratories on a Sigma metric scale.\u0000Materials and Methods: A retrospective analytical study was conducted over 6 months (January–June 2021). Internal quality control (IQC) and EQAS data were obtained from third-party QC providers (Bio-Rad, India) and analyzed by calculating sigma (σ) values based on the coefficient of variation, bias, and total error allowable in two NABL-accredited medical testing laboratories. To identify potential problems for analytes with poor sigma values, a quality goal index (QGI) analysis was performed.\u0000Results: By analyzing the sigma values obtained by both NABL-accredited laboratories, we can see that laboratory 2 performed better than laboratory 1. After calculating the QGI, there was a problem of inaccuracy and imprecision in laboratory 1, and laboratory 2 had QGI values that indicated only imprecision.\u0000Conclusion: Diagnostic laboratories should incorporate Six Sigma metrics to identify gaps in their performance to ensure better quality control and patient safety.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"60 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141280812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.3126/ajms.v15i6.63130
Dr. Kanika Agarwal, Dr. Nidhi Sharma, Dr. Aseem Sharma, Dr. Manish Banjare
Chronic kidney disease (CKD), especially in stages III, IV, V patients presenting for surgical removal of parathyroid glands, has special concerns regarding anesthesia. Their renal disease restricts the choice of drugs that can be used for general anesthesia induction and management. Bilateral superficial cervical plexus block (SCPB) under ultrasound guidance can be an alternative mode of anesthesia in parathyroid surgeries in these patients. The aim of the present case series was to evaluate the effectiveness of bilateral SCPB in CKD (stages III, IV, V) patients undergoing parathyroid surgeries in terms of hemodynamic stability, intraoperative and post-operative analgesia, and surgeon’s satisfaction. In the present case series, USG-guided bilateral SCPB was performed under aseptic precautions and 10 mL of local anesthetic was injected on each side. Effect was confirmed with wet swab and blunt pin prick. Then, patient was handed over to the surgeon. Continuous hemodynamic monitoring was done and time of first rescue analgesia was noted. Bilateral SCPB proved to be a good alternative mode of anesthesia for CKD (stages III, IV, V) patients undergoing parathyroid surgeries.
{"title":"Bilateral superficial cervical plexus block as sole anesthesia for parathyroid surgeries in chronic kidney disease patients","authors":"Dr. Kanika Agarwal, Dr. Nidhi Sharma, Dr. Aseem Sharma, Dr. Manish Banjare","doi":"10.3126/ajms.v15i6.63130","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.63130","url":null,"abstract":"Chronic kidney disease (CKD), especially in stages III, IV, V patients presenting for surgical removal of parathyroid glands, has special concerns regarding anesthesia. Their renal disease restricts the choice of drugs that can be used for general anesthesia induction and management. Bilateral superficial cervical plexus block (SCPB) under ultrasound guidance can be an alternative mode of anesthesia in parathyroid surgeries in these patients. The aim of the present case series was to evaluate the effectiveness of bilateral SCPB in CKD (stages III, IV, V) patients undergoing parathyroid surgeries in terms of hemodynamic stability, intraoperative and post-operative analgesia, and surgeon’s satisfaction. In the present case series, USG-guided bilateral SCPB was performed under aseptic precautions and 10 mL of local anesthetic was injected on each side. Effect was confirmed with wet swab and blunt pin prick. Then, patient was handed over to the surgeon. Continuous hemodynamic monitoring was done and time of first rescue analgesia was noted. Bilateral SCPB proved to be a good alternative mode of anesthesia for CKD (stages III, IV, V) patients undergoing parathyroid surgeries.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"43 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141276248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.3126/ajms.v15i6.64582
Ruby Dhar, Arun Kumar, Subhradip Karmakar
Semaglutide (Ozempic acid) belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists. These medications mimic the action of a hormone called GLP-1, which helps regulate blood glucose and promotes weight loss. One role of GLP-1 is to prompt the body to produce more insulin, which reduces blood sugar (glucose). Because of this, doctors have been treating type 2 diabetes with semaglutide for more than 15 years. Higher doses of GLP-1, however, also cause anoxia by interacting with the brain regions responsible for appetite suppression. When combined with diet and exercise, it can help people who are obese or overweight lose a significant amount of weight and lower their risk of developing diabetes, heart disease, and cancer. This effect of Semaglutide made it an appropriate candidate for weight loss. At present, semaglutide is only approved for weight loss under the brand name Wegovy. Public demand and craze for weight loss have prompted the usage and misusage of semaglutide. As interest and obsession with weight loss programs continue to grow, health-care professionals are forced to improvise their strategy to manage the demand. One way to meet needs is to prescribe other brands of semaglutide, such as Ozempic and Rybelsus (using a Food and Drug Administration [FDA]-approved drug for a different reason). The FDA recommends Wegovy for weight loss if you meet one of the following criteria: The FDA guidelines for semaglutide usage only if body mass index (BMI) is 27 kg/m2 or greater along with other co-morbidities such as high blood pressure, type 2 diabetes, or high cholesterol or a BMI >30 kg/m2. This has become so rampant that genuine users of semaglutide who need it for managing their blood sugar are finding it missing from the shelf. Overuse or improper use often comes with adverse consequences, such as hypoglycemia, confusion, dizziness, seizures, headache, and even loss of consciousness. The craze for semaglutide needs to be cautiously weighed before consumption.
{"title":"The craze with semaglutide","authors":"Ruby Dhar, Arun Kumar, Subhradip Karmakar","doi":"10.3126/ajms.v15i6.64582","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.64582","url":null,"abstract":"Semaglutide (Ozempic acid) belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists. These medications mimic the action of a hormone called GLP-1, which helps regulate blood glucose and promotes weight loss. One role of GLP-1 is to prompt the body to produce more insulin, which reduces blood sugar (glucose). Because of this, doctors have been treating type 2 diabetes with semaglutide for more than 15 years. Higher doses of GLP-1, however, also cause anoxia by interacting with the brain regions responsible for appetite suppression. When combined with diet and exercise, it can help people who are obese or overweight lose a significant amount of weight and lower their risk of developing diabetes, heart disease, and cancer. This effect of Semaglutide made it an appropriate candidate for weight loss. At present, semaglutide is only approved for weight loss under the brand name Wegovy. Public demand and craze for weight loss have prompted the usage and misusage of semaglutide. As interest and obsession with weight loss programs continue to grow, health-care professionals are forced to improvise their strategy to manage the demand. One way to meet needs is to prescribe other brands of semaglutide, such as Ozempic and Rybelsus (using a Food and Drug Administration [FDA]-approved drug for a different reason). The FDA recommends Wegovy for weight loss if you meet one of the following criteria:\u0000The FDA guidelines for semaglutide usage only if body mass index (BMI) is 27 kg/m2 or greater along with other co-morbidities such as high blood pressure, type 2 diabetes, or high cholesterol or a BMI >30 kg/m2. This has become so rampant that genuine users of semaglutide who need it for managing their blood sugar are finding it missing from the shelf. Overuse or improper use often comes with adverse consequences, such as hypoglycemia, confusion, dizziness, seizures, headache, and even loss of consciousness. The craze for semaglutide needs to be cautiously weighed before consumption.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"56 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141279733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.3126/ajms.v15i6.65037
Noor Mohamed Rasik B, Sakthi Suganya ST, Vikram Manamala Sudhakar, Vignesh C
Background: An increased chance of developing chronic kidney disease (CKD), which has higher morbidity and mortality, exists among patients with Type 2 diabetes (T2D). Aims and Objectives: Our goal was to determine and classify the anthropometric, physiological, and demographic risk factors for CKD in individuals with T2D. Materials and Methods: A cross-sectional research study was conducted at a tertiary care hospital involving 218 participants. Data were collected on various parameters including age, gender, education level, employment status, height, weight, blood pressure, hemoglobin levels, and estimated glomerular filtration rates (eGFRs). Participants were selected based on specific inclusion and exclusion criteria, and rigorous statistical analyses were applied to the collected data. Using the SPSS program, we analyzed the data, and when the P<0.05, we declared the results statistically significant. Results: There were 218 people in the research, 58.3% of whom were male and 41.7% of whom were female. The mean age group was between 51 and 60 at 36.2%. The age group distribution among the patients showed significant value (P<0.0001). About 87.6% of the patients had normal weight. 49.5% were recorded in Stage 1 CKD. Fasting blood sugar has a negative correlation (−182) with glomerular filtration rate (GFR) and shows a significant result. The post-prandial blood sugar value is also statistically significant and negatively relates to GFR. In addition, random blood sugar and glycated hemoglobin also reported statistically significant values. Conclusion: In individuals with T2D, it was determined that significant risk factors for the onset of CKD include eGFR, age, and the duration of diabetes. Males had a considerably greater incidence of CAD, peripheral neuropathy, and diabetic foot.
{"title":"Prevalence of chronic kidney disease and its risk factors among Type 2 diabetes patients in a tertiary care hospital","authors":"Noor Mohamed Rasik B, Sakthi Suganya ST, Vikram Manamala Sudhakar, Vignesh C","doi":"10.3126/ajms.v15i6.65037","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.65037","url":null,"abstract":"Background: An increased chance of developing chronic kidney disease (CKD), which has higher morbidity and mortality, exists among patients with Type 2 diabetes (T2D).\u0000Aims and Objectives: Our goal was to determine and classify the anthropometric, physiological, and demographic risk factors for CKD in individuals with T2D.\u0000Materials and Methods: A cross-sectional research study was conducted at a tertiary care hospital involving 218 participants. Data were collected on various parameters including age, gender, education level, employment status, height, weight, blood pressure, hemoglobin levels, and estimated glomerular filtration rates (eGFRs). Participants were selected based on specific inclusion and exclusion criteria, and rigorous statistical analyses were applied to the collected data. Using the SPSS program, we analyzed the data, and when the P<0.05, we declared the results statistically significant.\u0000Results: There were 218 people in the research, 58.3% of whom were male and 41.7% of whom were female. The mean age group was between 51 and 60 at 36.2%. The age group distribution among the patients showed significant value (P<0.0001). About 87.6% of the patients had normal weight. 49.5% were recorded in Stage 1 CKD. Fasting blood sugar has a negative correlation (−182) with glomerular filtration rate (GFR) and shows a significant result. The post-prandial blood sugar value is also statistically significant and negatively relates to GFR. In addition, random blood sugar and glycated hemoglobin also reported statistically significant values.\u0000Conclusion: In individuals with T2D, it was determined that significant risk factors for the onset of CKD include eGFR, age, and the duration of diabetes. Males had a considerably greater incidence of CAD, peripheral neuropathy, and diabetic foot.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"28 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141234228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.3126/ajms.v15i6.63346
Mohamed Ibrahim Wahid, Nurul Alia Azmi, Pei Yun Tan, Bao Jing Chen
Background: Breast cancer is a significant health issue affecting women worldwide, including Malaysia, where the incidence of breast cancer is increasing. Early detection of breast cancer plays a crucial role in improving treatment outcomes and reducing mortality rates. Aims and Objectives: This study examines the impact of adjunctive breast ultrasound (BUS) on screening for Malaysian women, offering evidence to enhance future protocols and decisions in the early detection. Materials and Methods: This study involved 5807 women aged 40 and above undergoing breast screening at Beacon Hospital from January to December 2022. Data collected included mammography and BUS results, categorized by breast imaging reporting and data system (BI-RADS) and diagnostic criteria. Suspicious cases on both modalities had histopathology examination (HPE) for confirmation. A subset of 1690 cases underwent both mammography and BUS screening and was compared to those who only had mammography using BI-RADS scores. Results: This study revealed that the majority of mammograms, 94.69% (5499 cases), were categorized as BI-RADS category 0, 1, 2, and 3, while 5.3% (307 cases) were classified as BI-RADS 4 and 5. Among the cases that underwent ultrasound (1688 cases), 23.43% of them were categorized as BI-RADS 4–5. Using ultrasound in addition to mammography increased the number of cases (BI-RADS 4–5) by 33.48%, resulting in a total of 460 cases identified compared to 307 cases, detected by mammography alone. Significantly, 39% (74 cases) of the 190 cases with confirmed malignancies (BI-RADS 6) by HPE were initially classified as negative mammography (BI-RADS 0–3) but were later identified as BI-RADS 5 on ultrasound. Conclusion: Ultrasound as a supplementary screening method holds the potential for boosting breast cancer detection sensitivity and reducing false negatives, thereby aiding in early detection and better treatment outcomes.
背景：乳腺癌是影响全世界妇女健康的一个重要问题，马来西亚也不例外。乳腺癌的早期发现在改善治疗效果和降低死亡率方面起着至关重要的作用：本研究探讨了辅助乳腺超声（BUS）对马来西亚妇女筛查的影响，为加强未来早期检测的方案和决策提供证据：本研究涉及 2022 年 1 月至 12 月期间在 Beacon 医院接受乳腺筛查的 5807 名 40 岁及以上女性。收集的数据包括乳腺 X 射线照相术和 BUS 结果，按照乳腺成像报告和数据系统（BI-RADS）和诊断标准进行分类。两种检查方式的可疑病例均需进行组织病理学检查（HPE）以进行确诊。1690 例病例中的一个子集同时接受了乳腺 X 线照相术和 BUS 筛查，并使用 BI-RADS 评分与只接受乳腺 X 线照相术的病例进行了比较。结果：该研究显示，大多数乳腺 X 光检查（94.69%，5499 例）被归类为 BI-RADS类别 0、1、2 和 3，5.3%（307 例）被归类为 BI-RADS 类别 4 和 5。在接受超声检查的病例（1688 例）中，有 23.43% 被归类为 BI-RADS 4-5 级。在乳腺 X 射线照相术的基础上使用超声波检查，BI-RADS 4-5 级病例的数量增加了 33.48%，与仅使用乳腺 X 射线照相术发现的 307 例病例相比，共发现了 460 例病例。值得注意的是，在通过 HPE 确诊为恶性肿瘤（BI-RADS 6）的 190 例病例中，有 39% （74 例）最初被归类为乳房 X 光检查阴性（BI-RADS 0-3），但后来在超声检查中被确定为 BI-RADS 5：结论：超声波作为一种辅助筛查方法，具有提高乳腺癌检测灵敏度和减少假阴性的潜力，从而有助于早期检测和更好的治疗效果。
{"title":"Effectiveness of adjunctive ultrasound after mammography in improving breast cancer screening findings from a study in Malaysian women","authors":"Mohamed Ibrahim Wahid, Nurul Alia Azmi, Pei Yun Tan, Bao Jing Chen","doi":"10.3126/ajms.v15i6.63346","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.63346","url":null,"abstract":"Background: Breast cancer is a significant health issue affecting women worldwide, including Malaysia, where the incidence of breast cancer is increasing. Early detection of breast cancer plays a crucial role in improving treatment outcomes and reducing mortality rates.\u0000Aims and Objectives: This study examines the impact of adjunctive breast ultrasound (BUS) on screening for Malaysian women, offering evidence to enhance future protocols and decisions in the early detection.\u0000Materials and Methods: This study involved 5807 women aged 40 and above undergoing breast screening at Beacon Hospital from January to December 2022. Data collected included mammography and BUS results, categorized by breast imaging reporting and data system (BI-RADS) and diagnostic criteria. Suspicious cases on both modalities had histopathology examination (HPE) for confirmation. A subset of 1690 cases underwent both mammography and BUS screening and was compared to those who only had mammography using BI-RADS scores.\u0000 Results: This study revealed that the majority of mammograms, 94.69% (5499 cases), were categorized as BI-RADS category 0, 1, 2, and 3, while 5.3% (307 cases) were classified as BI-RADS 4 and 5. Among the cases that underwent ultrasound (1688 cases), 23.43% of them were categorized as BI-RADS 4–5. Using ultrasound in addition to mammography increased the number of cases (BI-RADS 4–5) by 33.48%, resulting in a total of 460 cases identified compared to 307 cases, detected by mammography alone. Significantly, 39% (74 cases) of the 190 cases with confirmed malignancies (BI-RADS 6) by HPE were initially classified as negative mammography (BI-RADS 0–3) but were later identified as BI-RADS 5 on ultrasound.\u0000Conclusion: Ultrasound as a supplementary screening method holds the potential for boosting breast cancer detection sensitivity and reducing false negatives, thereby aiding in early detection and better treatment outcomes.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"10 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141229652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Fractures at the distal end of the radius, a prevalent orthopedic concern, challenge clinicians due to their complex nature and the diverse patient demographics they affect. Primary stability is key, especially in cases involving osteoporotic bones or younger patients. The Ellis plate with a locking screw mechanism offers a promising solution to achieve this stability, potentially preventing secondary displacement regardless of bone quality. Aims and Objectives: This study aims to rigorously assess the effectiveness of the Ellis volar locking compression plate in treating distal end radius fractures. It focuses on evaluating functional outcomes post-treatment, providing insights into the efficacy of this approach. Materials and Methods: This study evaluated the efficacy of the Ellis plate in managing distal radius fractures, under ethical approval number KMC/IEC/Ortho/2021-5. Twenty adult patients with unstable fractures were included based on specific criteria and provided informed consent. Exclusion criteria included unwillingness for surgery, medical unsuitability, osteoporosis, minors, and compound fractures with vascular injury. Surgical outcomes were assessed using the Gartland and Werley scoring system, with follow-up appointments scheduled over 1 year to monitor progress and adherence to physiotherapy plans. Results: The study encompassed 20 patients, with a gender distribution of 12 males and eight females and an average age of 43.3 years. Utilizing the Gartland and Werley demerit grading system, the study reported 45% superb outcomes, another 45% good outcomes, 10% fair outcomes, and no poor outcomes. This distribution highlights the potential of the Ellis plate technique in achieving positive results in fracture treatment. Conclusion: The study concludes that the Ellis plate technique is a viable and effective option for stabilizing distal end radius fractures. However, achieving the best possible outcomes depends on several factors, including strict adherence to AO principles, maintaining high standards of aseptic practice, following appropriate post-operative rehabilitation protocols, and ensuring comprehensive patient education. This multifaceted approach is crucial for the successful treatment of these fractures.
{"title":"Optimizing fracture management: The role of the Ellis plate in distal radius fractures","authors":"Kiran Kumar Banna, Srikanth Minumala, Dinesh Kannan, Swikrutha Badam, Lakshminarayana Seela","doi":"10.3126/ajms.v15i6.62678","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.62678","url":null,"abstract":"Background: Fractures at the distal end of the radius, a prevalent orthopedic concern, challenge clinicians due to their complex nature and the diverse patient demographics they affect. Primary stability is key, especially in cases involving osteoporotic bones or younger patients. The Ellis plate with a locking screw mechanism offers a promising solution to achieve this stability, potentially preventing secondary displacement regardless of bone quality.\u0000Aims and Objectives: This study aims to rigorously assess the effectiveness of the Ellis volar locking compression plate in treating distal end radius fractures. It focuses on evaluating functional outcomes post-treatment, providing insights into the efficacy of this approach.\u0000 Materials and Methods: This study evaluated the efficacy of the Ellis plate in managing distal radius fractures, under ethical approval number KMC/IEC/Ortho/2021-5. Twenty adult patients with unstable fractures were included based on specific criteria and provided informed consent. Exclusion criteria included unwillingness for surgery, medical unsuitability, osteoporosis, minors, and compound fractures with vascular injury. Surgical outcomes were assessed using the Gartland and Werley scoring system, with follow-up appointments scheduled over 1 year to monitor progress and adherence to physiotherapy plans.\u0000Results: The study encompassed 20 patients, with a gender distribution of 12 males and eight females and an average age of 43.3 years. Utilizing the Gartland and Werley demerit grading system, the study reported 45% superb outcomes, another 45% good outcomes, 10% fair outcomes, and no poor outcomes. This distribution highlights the potential of the Ellis plate technique in achieving positive results in fracture treatment.\u0000 Conclusion: The study concludes that the Ellis plate technique is a viable and effective option for stabilizing distal end radius fractures. However, achieving the best possible outcomes depends on several factors, including strict adherence to AO principles, maintaining high standards of aseptic practice, following appropriate post-operative rehabilitation protocols, and ensuring comprehensive patient education. This multifaceted approach is crucial for the successful treatment of these fractures.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"34 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141274556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.3126/ajms.v15i6.62844
Soumyya Mondal, Anwesha Mandal, Sipra Saha, P. Chakrabarty, Debalina Das
Background: The irrational use of antibiotics has led to the emergence of multidrug-resistant pathogens. The phenomenon of minimum inhibitory concentration (MIC) creeps occurs when organisms start showing raised MIC but within susceptible range giving an indication of the prevalence of rise in resistant pathogens in an area. Aims and Objectives: The aims and objectives of the study are to observe the susceptibility pattern among uropathogens and the possibility of MIC creeps among the Escherichia coli isolates sensitive to nitrofurantoin. Materials and Methods: This retrospective study was done in a tertiary care hospital in Kolkata to observe the susceptibility pattern among uropathogens and the possibility of MIC creeps. We took the data from all inpatient department and outpatient department patients sent for urine culture and sensitivity from October 1st, 2022, to September 30th, 2023. The antimicrobial susceptibility testing and MIC were conducted by VITEK Compact 2. The MIC of nitrofurantoin, one of the most widely used antibiotics for lower urinary tract infections, was calculated to investigate the phenomenon of MIC creep. All the statistical analyses were carried out using the Excel spreadsheet and OpenEpi version 3.01 platform. Results: In our study, a total of 631 urine samples were analyzed: 368 were positive with the most common isolate being E. coli (53%) followed by Klebsiella spp. (12%). Two percent of resistance was observed for fosfomycin and 8% for nitrofurantoin. Extended spectrum beta-lactamase (ESBL) producers E. coli was 127 (35%). Overall, 23/368 samples had a MIC ≥128 for nitrofurantoin. Among the ESBL producers, 13/127 had MIC ≥128 for nitrofurantoin. Conclusion: In the present study, it was observed that E. coli showed a reduced susceptibility for nitrofurantoin indicated by a creeping increase in MIC within normal range. Trends in rising MIC can be an alarming sign for using drugs such as nitrofurantoin judiciously. Antimicrobial stewardship practice should be strongly implemented in hospitals to curb rising resistance and for better prognosis of patients having infectious diseases.
背景：抗生素的不合理使用导致了耐多药病原体的出现。当生物体的最小抑菌浓度（MIC）开始升高，但仍在易感范围内时，就会出现最小抑菌浓度爬升现象，这表明一个地区的耐药病原体在普遍上升：本研究的目的和目标是观察泌尿系统病原体的药敏模式，以及对硝基呋喃妥因敏感的大肠埃希菌分离株的MIC爬升的可能性：这项回顾性研究是在加尔各答的一家三级护理医院进行的，目的是观察泌尿病原体的药敏模式以及 MIC 爬升的可能性。我们收集了 2022 年 10 月 1 日至 2023 年 9 月 30 日期间所有住院部和门诊部患者的尿液培养和药敏数据。抗菌药物药敏试验和 MIC 均由 VITEK Compact 2 进行。硝基呋喃妥因是治疗下尿路感染最广泛使用的抗生素之一，为研究 MIC 爬升现象，计算了硝基呋喃妥因的 MIC。所有统计分析均使用 Excel 电子表格和 OpenEpi 3.01 版平台进行：在我们的研究中，共分析了 631 份尿液样本：其中 368 份呈阳性，最常见的分离菌株是大肠杆菌（53%），其次是克雷伯氏菌（12%）。对磷霉素的耐药性为 2%，对硝基呋喃妥因的耐药性为 8%。产生广谱β-内酰胺酶（ESBL）的大肠杆菌有127个（35%）。总体而言，23/368 个样本对硝基呋喃妥因的 MIC 值≥128。在 ESBL 生产者中，13/127 的硝基呋喃妥因 MIC ≥128：在本研究中观察到，大肠杆菌对硝基呋喃妥因的敏感性降低，表现为 MIC 在正常范围内逐渐升高。MIC 的上升趋势可能是一个警示信号，需要谨慎使用硝基呋喃妥因等药物。医院应大力推行抗菌药物管理实践，以遏制耐药性的上升，并改善感染性疾病患者的预后。
{"title":"Minimum inhibitory concentration creep in Enterobacterales – A rising concern","authors":"Soumyya Mondal, Anwesha Mandal, Sipra Saha, P. Chakrabarty, Debalina Das","doi":"10.3126/ajms.v15i6.62844","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.62844","url":null,"abstract":"Background: The irrational use of antibiotics has led to the emergence of multidrug-resistant pathogens. The phenomenon of minimum inhibitory concentration (MIC) creeps occurs when organisms start showing raised MIC but within susceptible range giving an indication of the prevalence of rise in resistant pathogens in an area.\u0000Aims and Objectives: The aims and objectives of the study are to observe the susceptibility pattern among uropathogens and the possibility of MIC creeps among the Escherichia coli isolates sensitive to nitrofurantoin.\u0000Materials and Methods: This retrospective study was done in a tertiary care hospital in Kolkata to observe the susceptibility pattern among uropathogens and the possibility of MIC creeps. We took the data from all inpatient department and outpatient department patients sent for urine culture and sensitivity from October 1st, 2022, to September 30th, 2023. The antimicrobial susceptibility testing and MIC were conducted by VITEK Compact 2. The MIC of nitrofurantoin, one of the most widely used antibiotics for lower urinary tract infections, was calculated to investigate the phenomenon of MIC creep. All the statistical analyses were carried out using the Excel spreadsheet and OpenEpi version 3.01 platform.\u0000Results: In our study, a total of 631 urine samples were analyzed: 368 were positive with the most common isolate being E. coli (53%) followed by Klebsiella spp. (12%). Two percent of resistance was observed for fosfomycin and 8% for nitrofurantoin. Extended spectrum beta-lactamase (ESBL) producers E. coli was 127 (35%). Overall, 23/368 samples had a MIC ≥128 for nitrofurantoin. Among the ESBL producers, 13/127 had MIC ≥128 for nitrofurantoin.\u0000Conclusion: In the present study, it was observed that E. coli showed a reduced susceptibility for nitrofurantoin indicated by a creeping increase in MIC within normal range. Trends in rising MIC can be an alarming sign for using drugs such as nitrofurantoin judiciously. Antimicrobial stewardship practice should be strongly implemented in hospitals to curb rising resistance and for better prognosis of patients having infectious diseases.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"54 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141275303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.3126/ajms.v15i6.63425
Aritra Bandyopadhyay, Saswati Nath, U. Mandal, Sreeprova Ghoshal, Abhishek Dandapath, S. Mallick
Background: Sensory processing (SP) indicates the ability of the nervous system to receive, analyze, process, and respond to external sensory input and coordinates motor movements accordingly. Children with various neurodevelopmental disorders, like autism spectrum disorder, have SP issues. However, studies regarding SP issues in attention-deficit/hyperactivity disorder (ADHD) compared to typically developing children are relatively less. Aims and Objectives: To study the SP pattern of children with ADHD, to compare with the control group, and to study the correlation of symptom severity with SP deficit in children with ADHD. Materials and Methods: All children attending the child guidance clinic at R. G. Kar Medical College and Hospital were screened, and children with ADHD without any other comorbid disorder as diagnosed by Diagnostic and Statistical Manual 5 were selected. Their ADHD symptom severity was assessed using the ADHD test, and SP was assessed using the Short Sensory Profile (SSP). Results: The SSP mean score of the children with ADHD was significantly different than the mean score of the control group, and the percentage of children having a definite difference in SP was significantly different in the ADHD children group compared to the control group. The severity of the SP deficit also correlates with the severity of ADHD symptoms, as found by the correlation study. Conclusion: Children with ADHD have shown a definite difference in SP compared to controls, and the severity of the sensory problem is proportionate to the severity of the symptoms of ADHD.
背景：感觉处理（SP）是指神经系统接收、分析、处理和响应外部感觉输入并相应协调运动的能力。患有各种神经发育障碍（如自闭症谱系障碍）的儿童都有感官处理问题。然而，与发育正常的儿童相比，有关注意力缺陷/多动障碍（ADHD）儿童SP问题的研究相对较少：研究多动症儿童的 SP 模式，与对照组进行比较，并研究多动症儿童的症状严重程度与 SP 缺陷的相关性。材料与方法：对 R. G. Kar 医学院和医院儿童指导门诊的所有儿童进行筛查，挑选出根据《诊断与统计手册 5》确诊为多动症且无任何其他合并症的儿童。他们的ADHD症状严重程度通过ADHD测试进行评估，SP则通过简短感官档案（SSP）进行评估：结果：多动症儿童的 SSP 平均分与对照组的平均分相比有显著差异，多动症儿童组与对照组相比，SP 有明确差异的儿童比例有显著差异。相关研究发现，SP 缺陷的严重程度也与多动症症状的严重程度相关：结论：与对照组相比，多动症儿童的感统失调有明显差异，感统失调的严重程度与多动症症状的严重程度成正比。
{"title":"Sensory processing patterns in children with attention-deficit hyperactivity disorder: A case–control study","authors":"Aritra Bandyopadhyay, Saswati Nath, U. Mandal, Sreeprova Ghoshal, Abhishek Dandapath, S. Mallick","doi":"10.3126/ajms.v15i6.63425","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.63425","url":null,"abstract":"Background: Sensory processing (SP) indicates the ability of the nervous system to receive, analyze, process, and respond to external sensory input and coordinates motor movements accordingly. Children with various neurodevelopmental disorders, like autism spectrum disorder, have SP issues. However, studies regarding SP issues in attention-deficit/hyperactivity disorder (ADHD) compared to typically developing children are relatively less.\u0000Aims and Objectives: To study the SP pattern of children with ADHD, to compare with the control group, and to study the correlation of symptom severity with SP deficit in children with ADHD.\u0000 Materials and Methods: All children attending the child guidance clinic at R. G. Kar Medical College and Hospital were screened, and children with ADHD without any other comorbid disorder as diagnosed by Diagnostic and Statistical Manual 5 were selected. Their ADHD symptom severity was assessed using the ADHD test, and SP was assessed using the Short Sensory Profile (SSP).\u0000Results: The SSP mean score of the children with ADHD was significantly different than the mean score of the control group, and the percentage of children having a definite difference in SP was significantly different in the ADHD children group compared to the control group. The severity of the SP deficit also correlates with the severity of ADHD symptoms, as found by the correlation study.\u0000Conclusion: Children with ADHD have shown a definite difference in SP compared to controls, and the severity of the sensory problem is proportionate to the severity of the symptoms of ADHD.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"20 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141277693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Spinal anesthesia often causes more post-operative nausea and vomiting (PONV). Cesarean-section patients have a significantly more PONV rate. Therefore, evidence-based knowledge about PONV prevention and care for high-risk individuals is urgently needed to reduce the consequences. Aims and Objectives: The aim of the study was to compare the efficacy and safety of granisetron with that of ondansetron in the prevention of PONV in patients undergoing cesarean section under spinal anesthesia. Materials and Methods: A total of 86 pregnant women with American Society of Anesthesiologists grade I–II scheduled for cesarean delivery under spinal anesthesia were enrolled. Patients were divided into two equal groups (n=43): Ten minutes before spinal anesthesia, patients in group B (granisetron) received 2 mg granisetron intravenously diluted to 10 mL with normal saline, whereas patients in group A (ondansetron) received 4 mg ondansetron. Results: There was no significant difference between Groups A and B in terms of the number of vomiting episodes between 0 and 6 h. Group A had significantly more episodes of nausea after 2 h than Group B after 0–2 h. After 2–6 h, however, the nausea was similar in all groups. Of the patients in Group A, 4 (9.3%) required antiemetic medication, in Group B, it was 2 (4.7%). In Group A, 8 patients (18.6%) and 6 patients (14%) complained of headache and dizziness, respectively; in Group B, 3 patients (7.0%) and (0%), respectively. Dizziness was significantly more pronounced in Group A than in Group B. Conclusion: The results of the study show that granisetron (2 mg) was more effective than ondansetron (4 mg) in minimizing PONV episodes in women undergoing spinal anesthesia for cesarean section. There were no significant side effects and both drugs were comparatively safe.
背景：脊髓麻醉通常会引起更多的术后恶心和呕吐（PONV）。剖腹产患者的 PONV 发生率明显更高。因此，迫切需要以证据为基础的 PONV 预防知识和对高危人群的护理，以减少后果：该研究旨在比较格拉司琼和昂丹司琼对脊柱麻醉下剖宫产患者预防 PONV 的有效性和安全性：共招募了86名美国麻醉医师协会I-II级孕妇，计划在脊柱麻醉下进行剖宫产。患者被平均分为两组（43 人）：在脊髓麻醉前十分钟，B组（格拉司琼）患者静脉注射用生理盐水稀释至10毫升的2毫克格拉司琼，而A组（昂丹司琼）患者则注射4毫克昂丹司琼：结果：A 组和 B 组在 0 至 6 小时内的呕吐次数没有明显差异，但 A 组在 2 小时后的恶心次数明显多于 B 组。在 A 组患者中，有 4 人（9.3%）需要服用止吐药，B 组为 2 人（4.7%）。在 A 组中，分别有 8 名患者（18.6%）和 6 名患者（14%）抱怨头痛和头晕；在 B 组中，分别有 3 名患者（7.0%）和 0 名患者（0%）抱怨头痛和头晕。A 组头晕症状明显比 B 组明显：研究结果表明，格拉司琼（2 毫克）比昂丹司琼（4 毫克）更能有效减少剖宫产椎管麻醉妇女的 PONV 发作。两种药物都没有明显的副作用，相对安全。
{"title":"The efficacy and safety of granisetron with ondansetron for the prevention of post-operative nausea and vomiting in patients undergoing cesarean section under spinal anesthesia","authors":"Supriya Singh, Sanni Deyol Gautam, Narendra Singh Bafila, Rajesh Kumar","doi":"10.3126/ajms.v15i6.63091","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.63091","url":null,"abstract":"Background: Spinal anesthesia often causes more post-operative nausea and vomiting (PONV). Cesarean-section patients have a significantly more PONV rate. Therefore, evidence-based knowledge about PONV prevention and care for high-risk individuals is urgently needed to reduce the consequences.\u0000Aims and Objectives: The aim of the study was to compare the efficacy and safety of granisetron with that of ondansetron in the prevention of PONV in patients undergoing cesarean section under spinal anesthesia.\u0000Materials and Methods: A total of 86 pregnant women with American Society of Anesthesiologists grade I–II scheduled for cesarean delivery under spinal anesthesia were enrolled. Patients were divided into two equal groups (n=43): Ten minutes before spinal anesthesia, patients in group B (granisetron) received 2 mg granisetron intravenously diluted to 10 mL with normal saline, whereas patients in group A (ondansetron) received 4 mg ondansetron.\u0000Results: There was no significant difference between Groups A and B in terms of the number of vomiting episodes between 0 and 6 h. Group A had significantly more episodes of nausea after 2 h than Group B after 0–2 h. After 2–6 h, however, the nausea was similar in all groups. Of the patients in Group A, 4 (9.3%) required antiemetic medication, in Group B, it was 2 (4.7%). In Group A, 8 patients (18.6%) and 6 patients (14%) complained of headache and dizziness, respectively; in Group B, 3 patients (7.0%) and (0%), respectively. Dizziness was significantly more pronounced in Group A than in Group B.\u0000Conclusion: The results of the study show that granisetron (2 mg) was more effective than ondansetron (4 mg) in minimizing PONV episodes in women undergoing spinal anesthesia for cesarean section. There were no significant side effects and both drugs were comparatively safe.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"52 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141275670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Estimation of the risk of future atherosclerotic cardiovascular (CV) events is an important step in the primary prevention of CV events. However, the relative accuracy of the various currently available CV risk scores is not validated in Indians. Aims and Objectives: The study was done to compare the accuracy of three clinically relevant CV risk assessment algorithms in the South Indian population and to validate the risk scores by correlating with the measures of subclinical atherosclerosis. Materials and Methods: This cross-sectional study was conducted among patients attending a chest pain clinic at a Tertiary care center in South India. The study included subjects ≥30 years of age, with no previous coronary artery disease (CAD) and major cardiac illness. Totally 110 subjects were included in the study. Detailed clinical evaluation and routine investigations were done. The 10-year CV risk for each subject was calculated using the three risk scores – Framingham, American College of Cardiology/American Heart Association (ACC/AHA), and Q risk score. The risk scores of all patients were then correlated with their corresponding carotid intima-media thickness (CIMT) measured using carotid Doppler and coronary angiography results. Results: The mean age of the study population was 51.45±9.01 years and the majority of them were females (57.2%). CAD patients demonstrated significantly increased CIMT. There was a significant positive correlation (P<0.001) between all three risk scores and carotid intimal medial thickness. As the carotid intimal medial thickness increases, the risk scores also increased (as shown by Pearsons’s correlation coefficient). Similarly, all three risk scores also showed a significant positive correlation (P<0.001) with the severity of CAD as assessed by CAG (as shown by one-way analysis of variance). The ACC/AHA score was the best score with a slightly higher accuracy of 69.9% than that of Q risk score (69.5%). The accuracy of Framingham’s score was found to be 68.3%. Conclusion: ACC/AHA and Q risk score may be the most appropriate CV risk assessment algorithm for use in Indian populations at present. However, large-scale prospective studies are needed to confirm these findings.
{"title":"Cardiovascular risk score predictive accuracy and subclinical atherosclerosis correlation in the Indian population: A cross-sectional study","authors":"Elanchezhian Selvaprakash, Kannan Kumaresan, Narendran Mani, Viswanathan Narasimhan","doi":"10.3126/ajms.v15i6.63983","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.63983","url":null,"abstract":"Background: Estimation of the risk of future atherosclerotic cardiovascular (CV) events is an important step in the primary prevention of CV events. However, the relative accuracy of the various currently available CV risk scores is not validated in Indians.\u0000Aims and Objectives: The study was done to compare the accuracy of three clinically relevant CV risk assessment algorithms in the South Indian population and to validate the risk scores by correlating with the measures of subclinical atherosclerosis.\u0000Materials and Methods: This cross-sectional study was conducted among patients attending a chest pain clinic at a Tertiary care center in South India. The study included subjects ≥30 years of age, with no previous coronary artery disease (CAD) and major cardiac illness. Totally 110 subjects were included in the study. Detailed clinical evaluation and routine investigations were done. The 10-year CV risk for each subject was calculated using the three risk scores – Framingham, American College of Cardiology/American Heart Association (ACC/AHA), and Q risk score. The risk scores of all patients were then correlated with their corresponding carotid intima-media thickness (CIMT) measured using carotid Doppler and coronary angiography results.\u0000Results: The mean age of the study population was 51.45±9.01 years and the majority of them were females (57.2%). CAD patients demonstrated significantly increased CIMT. There was a significant positive correlation (P<0.001) between all three risk scores and carotid intimal medial thickness. As the carotid intimal medial thickness increases, the risk scores also increased (as shown by Pearsons’s correlation coefficient). Similarly, all three risk scores also showed a significant positive correlation (P<0.001) with the severity of CAD as assessed by CAG (as shown by one-way analysis of variance). The ACC/AHA score was the best score with a slightly higher accuracy of 69.9% than that of Q risk score (69.5%). The accuracy of Framingham’s score was found to be 68.3%.\u0000Conclusion: ACC/AHA and Q risk score may be the most appropriate CV risk assessment algorithm for use in Indian populations at present. However, large-scale prospective studies are needed to confirm these findings.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"28 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141278976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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