Aspect of sleep quality amid undergraduate medical students in correlation with BMI.

Purpose: This study aimed to assess the quality of sleep among medical undergraduates from different phases of the medical program using the Pittsburgh Sleep Quality Index (PSQI) and to study the association of body mass index (BMI) with the quality of sleep among them. Material and Methods: Sleep quality was assessed among 482 medical undergraduates using the PSQI. Students undergoing treatment for psychiatric illness, diabetes or hypertension, history of alcohol consumption, and smoking were excluded from the study. Obesity was ascertained by calculating the BMI and categorized into 2 groups of23.0 according to the World Health Organization (WHO) guidelines for the Asian population. The chi-square test was utilized to compare seven components of PSQI and sleep quality for different phases and BMI groups and SPSS 24 was used to compare the components and the global score. Results: Only 0.8% of the total sample classified their sleep as very bad whereas 69.5% classified themselves as fairly good sleepers. The study participants had an average sleep time of 7.06±1.26 hours. The sleep duration (p23 had daytime dysfunction every day. Conclusions: It is necessary to create awareness among medical undergraduates about the importance of good sleep hygiene which will help them to improve their academic performance

Knowledge, attitude, and perception of the general public towards the impact of hemoglobinopathies on pregnancy outcomes: a questionnaire-based study

Background: Knowledge about hemoglobinopathies in the general public is unsatisfactory. Many couples are unaware of their carrier status and a child can be born with unexpected, serious hemoglobinopathies. Willingness to participate in screening programs can substantially help in bringing down the birth of children affected with hemoglobinopathies. To understand the knowledge, attitude, and perception of the general public on various hemoglobinopathies and their pregnancy outcomes we performed a questionnaire-based descriptive survey. Methods: After obtaining approval from the institutional ethics committee and validation by an expert panel we circulated a Google form consisting of 21 questions via WhatsApp which was made available for 3 months. Efforts were made to collect as many responses as possible. The responses were extracted onto a Microsoft Excel sheet and analyzed. Results: It was observed that though the majority of the population from various sectors of India agreed on the importance of early detection, only about 75.5% would consider signing up for screening themselves. Around 33.6% percent of the participants had not even heard about hemoglobinopathies and about 92.7% of the participants felt the need for the availability of more easily accessible information on the topic. Conclusion: The study concludes that there is a need for more awareness programs among the general public as well as better access to information on hemoglobinopathies so that the implications of being affected are clearly understood, and strategies for prevention by timely screening can be strengthened

3-Dimensional model making as an innovative tool for enhanced learning through student engagement among early professional medical graduates

Background: Various innovative teaching-learning methods have been introduced in the medical curriculum for a better understanding of the difficult topics. We introduced the 3-dimensional (3D) model-making as an innovative tool for enhanced learning through student engagement among early professional medical graduates. Methods: The study was conducted in the Department of Biochemistry of a Private Medical College. The phase I medical undergraduate students were divided into 20 groups with 10 students in each group. The topics taught by didactic lectures were allotted to each group by lottery method and were informed that the best model will be suitably rewarded after evaluation. Feedback was collected from the students on a five-point Likert scale after the submission and evaluation of the models. Results: About 92% of the students expressed that 3D model-making was an innovative method of learning in the medical profession, and 96.3% agreed that the topics allotted were relevant to the syllabus and helped in better understanding of the subject when compared to didactic lectures. The students also agreed that the 3D model-making activity enhanced their creativity and application of knowledge to learn biochemistry, developed a positive attitude, helped to coordinate with their peers, and improved communication skills. They suggested that this activity should be continued with the inclusion of more topics. Discussion: The 3D model-making activity helped the students to enjoy learning, think differently, understand better, expand their knowledge and recall information more comprehensively

DNA Methylation Pattern Of Cpg Site In The Promoter Region Of CALCA-Alpha Gene As A Putative Epigenetic Biomarker In Neonatal Sepsis- A Prospective Observational Study In South India

Background: Recently, several studies have been reported on epigenetic modifications of DNA as a predisposing factor for several diseases among neonates and adults. Here we aimed to study the changes in the DNA methylation pattern in the promoter region of the CALCA gene among the neonates suspected to have sepsis in a tertiary care hospital. Methodology: All the neonates suspected to have sepsis based on the inclusion criteria during the study period were included in the study as cases. Normal healthy neonates were included in the study as controls. Positive cases were isolated from suspected cases based on positive blood culture and sensitivity reports. DNA extraction was done by the non-enzymatic salting-out method and was subjected to bisulfite conversion by manual method. Methylation-specific PCR was performed on a Thermal cycler gradient using a standard protocol. Positive samples were further analyzed for their melting behavior using the EpiTetHRM kit. Results: A total of 115 neonates were included in the study out of which 63 were normal healthy controls and 52 were diagnosed to have sepsis by the neonatologist based on the clinical presentation. Out of the 52 neonates suspected to have sepsis only 7 had positive blood culture. DNA methylation of the CALCA gene was detected in one healthy control and 5 neonates in the sepsis group. Conclusion: DNA methylation status in the promoter region of the CALCA gene were more from the methylation status in the normal healthy controls. Hence, this may serve as a useful biomarker for sepsis in the future

Redefining the polypill: pros and cons in cardiovascular precision medicine

Polypill is a multi-drug formulation in a single pill intended to simplify the drug regimen and reduce medication-induced adverse effects. The most common multidrug combinations in a polypill are used to treat cardiovascular diseases and are targeted against key modifiable risk factors such as hypertension and hyperlipidemia. These contain blood-pressure lowering agents, statins, and anti-platelet agents usually in a fixed dose. Polypills can be an affordable therapeutic intervention for treating high-risk patients, as these are proven to increase patients’ adherence to medication and improve clinical outcomes. Over the previous years, randomized clinical trials of several polypills have yielded contradictory findings, raising skepticism regarding their widespread use in primary disease prevention. Here, we have reviewed the concept of polypills, the evidence-based strengths, the limitations of this polypharmacy intervention strategy, and discussed future directions for their use in the primary and secondary preventive management of cardiovascular diseases and associated risk factors

Sigma-Metric Analysis to Evaluate Quality Management of Analytical Processes Using RCA and QGI in a Clinical Biochemistry Laboratory, South India

Introduction: This study aimed to identify laboratory errors at the earliest through Sigma-metric analysis and to evaluate quality management of analytical processes. Methods: Sigma-metrics and Quality Goal Indices (QGI) were calculated by harvesting the IQC and EQC data of an accredited laboratory for 31 biochemical parameters run on Roche Cobas6000 and e411. Those with Sigma 2 were further analysed by applying the various Westgard rules, as suggested. Results: Nearly 13 chemistry analytes showed world-class performance with Sigma \u3e 6 and most of the immunoassay parameters showed marginal performance with sigma \u3e 2 6. Sodium, Chloride, Total T4, Beta-HCG and TSH were found to have Sigma \u3c 2 indicating unacceptable performance. A significant improvement was observed in the Sigma-metrics analysis after performing the root cause analysis. Conclusion: Sigma-metric analyses the quality management of various analytical processes in biochemistry. The poor assay performance will be picked up by the Root cause analysis and Quality Goal Indices calculation. With the help of RCA and QGI, we plan to increase the resource management by decreasing the frequency of QC runs

Biochemical & Hematological parameters to predict severity and mortality in COVID 19 patients – a retrospective study

Introduction: Coronavirus diseases (COVID-19), the global pandemic has posed a serious threat to the health of individuals across the world and is associated with increased morbidity and mortality. Several biochemical and hematological parameters are found to be altered in these patients and there is a need to identify a suitable biomarker that can help in better risk stratification of these patients. Hence in this study, we intend to evaluate the clinical utility of these parameters to predict severity and mortality in COVID-19 patients. Material & Methods: A retrospective, observational study was conducted in a tertiary care hospital involving Reverse Transcription Polymerase Chain Reaction (RT-PCR) positive COVID-19 patients (n-322). Data about patient\u27s age, gender, co-morbidities, duration of hospital and intensive care unit (ICU) stay, need for mechanical ventilation and laboratory investigations were obtained from the Hospital Information System (HIS). Results: The average duration of hospital stay was 10 days, and the ICU stay of these patients was 6.5 days.[M1] [DSS2] There was a statistically significant increase in C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), neutrophils, and neutrophil/lymphocyte ratio (NLR), and lower mean lymphocytic count (p=0.05), in patients who required ICU admission when compared to those who didn’t and[M3] [DSS4] also among non-survivors compared to survivors. Conclusion: Among the various biochemical & hematological markers, CRP, ferritin, LDH AST, and NLR were found to be better predictors of severity and mortality in COVID 19 patients. Timely monitoring of these markers would therefore help in better management and improved outcome for these patients

Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Funding: F Carvalho and E Fernandes acknowledge support from Fundação para a Ciência e a Tecnologia, I.P. (FCT), in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy i4HB; FCT/MCTES through the project UIDB/50006/2020. J Conde acknowledges the European Research Council Starting Grant (ERC-StG-2019-848325). V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006.proofepub_ahead_of_prin

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe