Explore the vast range of titles available.

Background Transgender people are more likely to experience heightened risks of physical and psychological distress and tend to report a poorer quality of life compared to the general population. This study aimed to determine the quality of life and self-esteem, health-seeking behaviour, and to explore the lived experiences among transgender women. Methods Using the snowball sampling technique, 73 transgender women were included in this mixed-methods study. Quantitative data were collected through the Short-Form-12 (SF-12) and the Rosenberg Self-esteem Scale (RSES). Maximum variation sampling was employed to select 10 participants for the qualitative component, aiming to gain in-depth insights into their personal experiences and health-seeking behaviours. Appropriate descriptive and inferential statistics were applied for analysis. A thematic analysis approach was used to represent qualitative findings. Results The mean age of the participants was 30.93 (SD = 4.70) years. Findings revealed that participants had poor mental (Mean µ = 38.80) and physical (Mean µ = 38.08) health. The cohort demonstrated a notably high level of self-esteem (Mean µ = 30.93 ± 4.70). A substantial proportion (76.7%) of participants experienced discrimination or mistreatment while seeking healthcare services, stating unfavorable experiences (19.2%) and strongly unsatisfied (5.5%), whereas more than half (56.2%) avoided giving any opinions. From the qualitative analysis, three major themes emerge: discovering my true identity as transgender person , survival in a world of discrimination , violence , and trauma , and struggle with economic , professional , and legal challenges. Conclusions In our study, participants reported lower mental and physical health, experienced discrimination, and had negative perceptions while accessing health services. The study carries important implications for the development of inclusive and high-quality healthcare services to ensure transgender people’s access to and utilization of healthcare.

ObjectivesTo evaluate whether the performance of the modified Clinical Pulmonary Infection Score (CPIS) for diagnosis of ventilator-associated pneumonia (VAP) could be improved by incorporating procalcitonin (PCT), lactate and a standardised lung ultrasound score (LUS).DesignProspective observational study.SettingInternal medicine and respiratory intensive care units (ICUs) of a tertiary care centre in India over 18 months.Participants97 adult patients receiving invasive mechanical ventilation for 48 hours or more with suspected VAP.Primary and secondary outcome measuresThe primary outcome was the diagnostic accuracy (area under the receiver operating characteristic curve (AUC)) of the integrated score compared with a reference standard of quantitative bronchoalveolar lavage culture (>104 CFU/mL). Secondary outcomes included ICU length of stay and 14-day mortality.ResultsOf the 97 patients, 70 (72.2%) were culture positive. The modified CPIS alone demonstrated limited diagnostic utility (AUC 0.686). In contrast, the novel 4-point Lactate-Lung Ultrasound-Procalcitonin-Clinical Pulmonary Infection Score (LPCPIS) score (integrating CPIS >5, lactate >2.15 mmol/L, PCT >1.3 ng/mL and LUS >14) achieved excellent discriminatory ability (AUC 0.919, 95% CI 0.844 to 0.976). At a cut-off of ≥2, the score yielded 95.7% sensitivity and 77.8% specificity. Crucially, a 4-point LPCPIS bedside score of ≤1 was associated with a highly diminished probability of VAP, yielding a negative predictive value of 100% in this cohort. In comparison, a score ≥3 strongly indicated a high likelihood of VAP, with a positive predictive value of 96.5% and specificity of 92.6%, pending definitive microbiological confirmation.ConclusionsThe novel 4-point LPCPIS bedside score demonstrates significant diagnostic superiority over the traditional modified CPIS (AUC 0.919 vs 0.686). By integrating bedside lung ultrasound with biomarkers, this simplified pragmatic tool provides impressive discriminatory power, allowing clinicians in resource-limited settings to reliably assess probability of VAP and guide early antimicrobial decision-making while awaiting definitive microbiological cultures.

Literature reported the effectiveness of internet-based interventions over face-to-face interaction on tobacco quitting; however, limited sample size reinforces to integrate and analyze these studies' findings to reach a single conclusion. Therefore, we evaluated the effectiveness of the internet as an intervention approach versus face-to-face interaction on reducing tobacco use among adults. A systematic search was performed through various electronic databases such as Medline, PsychInfo, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ResearchGate, Google Scholar, and Academia. Reference lists of the eligible articles were also screened. Full-text articles were included as per eligibility criteria (PICO framework). No ethnicity restriction was applied. A total of 13 studies were selected for meta-analysis, with 3852 and 3908 participants in intervention and control groups, respectively. Forest plot favours the intervention group at one month follow up for tobacco quitting (OR: 2.37, CI: 1.86-3.02,  =0.00001, I2=0%), at three months (OR: 1.88, CI: 1.48-2.40,  =0.00001, I2=42%) at six months (OR: 2.02, CI: 1.64-2.50,  =0.00001, I2=38%) and at one year of follow-up (OR: 1.43, CI: 1.18-1.74,  =0.00001, I2=36%) comparing to control group. Conclusively, internet and web-based interventions are highly useful in tobacco quitting at one month, three months, six months, and one year of follow-up compared to face-to-face interaction or no intervention, although the level of evidence was moderate. Additionally, limited trials in developing countries, arising need for research on internet use for tobacco control in developing countries.

INTRODUCTION: Gastrointestinal neuropathies are frequently found in diabetic patients. AIM: The aim of this study was to find out the safety, adverse reactions, and long-term effectiveness of Pistacia lentiscus plant extract (mastic gum) in diabetic gastroparesis (DG) with respect to sustainable improvement in gastroparesis symptoms (Gastrointestinal Cardinal Symptom Index [GCSI] score) by observational follow-up study of a single-centric double-blind noninferiority randomized control trial. MATERIALS AND METHODS: Thirty-eight individuals were recruited and equally randomized in two study groups based on GCSI score and TC99 radionuclide gastric emptying scintigraphy (GES), i.e. the mastic gum group and the levosulpiride group. After 24 weeks, the GCSI score was recalculated in both the groups, and patients were evaluated for the safety, adverse reactions, and long-term effectiveness of mastic gum and the standard drug levosulpiride. RESULTS: In the extended study, mean GCSI score changes at 24 weeks were statistically significant (P < 0.001) (t-test) between the two groups. In the mastic gum arm, the change in mean GCSI score at 24 weeks was statistically nonsignificant mean ± (standard deviation [SD]) 16.7± (3.81) compared to the GCSI score at 2-month postintervention mean (SD) 16.35± (2.27) (intragroup P = 0.89) (repeated measures ANOVA). It strongly indicates that mastic gum provided a sustainable improvement in DG symptoms in comparison to levosulpiride, with excellent subjective well-being postintervention, without any obvious significant adverse effects. CONCLUSION: Six-month (24-week) interim analysis of patients suggests that mastic gum gives a sustainable improvement in DG symptoms without any obvious adverse effects as compared to levosulpiride.

BACKGROUND: Coronavirus disease rapidly spreads across the entire world in < 2 months and gravely jeopardizes the regular human routine. The medical fraternity recommends a vaccine as one of the best solutions to save the universe. However, to be effective, the population should reflect an encouraging attitude to accept it. The study aimed to measure vaccine acceptability and reason for hesitancy among the public. MATERIALS AND METHODS: Eight hundred and forty one adults visiting a tertiary care hospital responded to a pretested validated questionnaire on vaccine acceptability and hesitancy. The Chi-square test and independent t-test, followed by multinomial logistic regression, were used to analyze the findings. RESULTS: Overall, 53.4% (n = 445) of participants interested to take vaccine, 27.2% (n = 229) were not sure, and the remaining 19.4% (n = 163) did not intent to vaccinate. Gender (P = 0.013), information on the vaccine (P = 0.022), chances to get coronavirus disease in the next 6 months (P < 0.001), awareness on India COVID-19 vaccine (P < 0.001), Indian manufacturing company of vaccine (P < 0.001), family history of the laboratory-confirmed case (P < 0.001), and health status (P = 0.011) found a significant association with intention to vaccination (a response \"yes\" vs. \"no\" and \"not sure\"). Reasons for vaccine hesitancy included specific antivaccine attitudes and beliefs, a concern of fear and phobia, lack of information, and safety issues on the vaccine. CONCLUSIONS: This institute-specific survey revealed that approximately every 4 in 8 people were not sure to take the vaccine, and one in five people refused to be vaccinated. The study recommends using target-based health education to understand and address vaccine-specific concerns to enhance vaccine coverage, and boost confidence among the population.

Background: Sepsis is one of the leading contributors to global mortality and morbidity, causing multi-organ failure, mainly involving cardiovascular failure, both systolic and diastolic dysfunction, leading to adverse clinical outcomes. There is little clinical data on the correlation with the mortality of patients with type 2 diabetes mellitus (T2DM) with sepsis and septic shock and left ventricular diastolic dysfunction. Our study sought to assess whether the severity of diastolic dysfunction could predict 28-day mortality.Methodology: The study included T2DM patients admitted to the intensive care unit (ICU) with sepsis and septic shock defined according to the Third International Consensus Definitions for Sepsis and Septic Shock at a tertiary care center in northern India. A total of 132 patients (age = 61.01 ± 13.12 years; 62% male; mean APACHE II (Acute Physiology and Chronic Health Evaluation II) score = 25.74 ± 4.79; Sequential Organ Failure Assessment (SOFA) score = 12.34 ± 3.36) underwent transthoracic echocardiography within two hours of ICU admission till 28 days of admission or till mortality occurred. Clinical variables (APACHE II and SOFA score) and cardiac biomarkers, such as N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), troponin I, and creatine phosphokinase-MB, were measured at the time of admission and after 72 hours to compare with mortality. Diastolic dysfunction was defined according to the American Society of Echocardiography (ASE) 2009 guidelines, classifying subjects into grade 0 (normal), if early diastolic velocity (e') ≥ 8 cm/s; grade 1 (impaired relaxation), if e' < 8 cm/s and early (E) to late (A) ventricular filling velocities (E/A) ratio < 0.8; grade 2 (pseudo normal), if e' < 8 cm/s, E/A = 0.8-1.5, and peak E-wave velocity by the peak e' velocity (E/e') ratio = 9-12; and grade 3 (restrictive), if e' < 8 cm/s, E/A > 2, deceleration time (DT) < 160 ms, and E/e' ≥ 13.Results: Thirty-seven (40.65%) out of 132 patients had diastolic dysfunction on initial echocardiography, while 54 (59.34%) had diastolic dysfunction on at least subsequent echocardiography. Total mortality was 68.93% with the highest mortality (100%) observed among those with grade 3 diastolic dysfunction. The 28-day mortality with diastolic dysfunction in sepsis and septic shock patients showed significant results (p < 0.001), indicating that with a higher E/A ratio or higher grade of diastolic dysfunction with the increase in SOFA score, the early ICU mortality is the highest and have the shortest duration of ICU stay with mean ± SD = 6.2 ± 2.48, as compared to other grades with 100% mortality. Also, the cardiac biomarker NT-pro-BNP was markedly elevated with a mean ± SD value of 503 ± 269.3 pg/ml, indicating early predicted mortality. No correlation was detected between mortality and the mean levels of fasting blood sugar, postprandial blood sugar, and glycosylated hemoglobin.Conclusion: Our study concluded that diastolic dysfunction is an important and strongest independent mortality predictor in patients with T2DM with severe sepsis and septic shock, and the higher the grade of diastolic dysfunction, the higher the mortality with the lowest mean ICU stay.

Enoxaparin-mediated bullous hemorrhagic dermatosis (BHD) is one of the rare side effects during prophylaxis of enoxaparin for various thromboembolic events. We report a case of a 74-year-old female with multiple comorbidities who developed BHD at a distant site from subcutaneous delivery of enoxaparin. Histopathological analysis confirmed the diagnosis of BHD. Discontinuation of enoxaparin resulted in the gradual resolution of the bullae formation, and the patient was started on novel oral anticoagulation with apixaban. The usual cutaneous adverse effects of enoxaparin include maculopapular rash, pruritus, skin necrosis, eczematous dermatitis, and rarely bullous hemorrhagic dermatosis. This hemorrhagic bullae dermatosis at a distant site from the administration is a relatively rare and benign side effect of enoxaparin which is an under-recognized complication of low-molecular-weight heparin.

Late presentation to HIV care and delay of people living with HIV (PLHIV) linkage to ART continue to be a challenge in many countries of the world, including India. It has an adverse impact on the health of the patient and the outcome of antiretroviral therapy (ART) programs. In this study, we assessed the proportion of late presenters (LPs), factors associated with late presentation among PLHIV, and barriers to early presentation for HIV care among LPs in a tertiary center in India. A sequential mixed-method study in which the quantitative part was conducted among 156 PLHIV receiving treatment at the ART center of All India Institute of Medical Sciences, Rishikesh, India. It was followed by a qualitative study with in-depth interviews of LPs. Continuous variables such as age and CD4 count were presented as median and interquartile range (IQR) and analyzed using the Mann-Whitney U test. Categorical variables such as gender, marital status, and probable mode of transmission, represented as frequency tables and proportions, were analyzed with Pearson's chi-square test or Fisher's exact test. A framework analysis with the help of social cognitive theory was conducted to analyze the barriers to presenting for HIV care. The prevalence of late presentation to HIV care was 77.6%. The most probable mode of transmission was sexual contact among early and LPs. Age, marital status, and type of sexual contact were found to be associated with late presentation. The barriers to timely presentation for HIV care were identified as personal, behavioral, and environmental factors, which were interrelated. Regular testing of HIV in asymptomatic high-risk groups, extensive social and behavioral change communication to improve awareness, and new initiatives to sensitize healthcare professionals to enable them to provide better HIV care are necessary for the timely identification of PLHIV.

Background: Sepsis is a common clinical syndrome in critical patients in the medical intensive care unit. Many scoring systems and biomarkers are introduced to detect unfavorable outcomes in sepsis patients. This study aims to identify pentraxin 3 (PTX3) as a predictor of sepsis in patients who are critically ill and admitted to intensive care units.Materials and methods: This prospective observational survey purposively included 100 patients with sepsis identified by the Surviving Sepsis Campaign guidelines in the medical intensive care unit at one of the apex care centers in North India. Socio-demographic and clinical profiles were collected using a structured and validated checklist. Simple and multi-linear regression analyses were used to determine PTX3 as a predictor of sepsis.Results: A total of 100 patients were prospectively observed. Among them, 61% were males, and 39% were females, with a mean age of 50.78 (±13.53) years. From nine potential predictors, lactate (95% CI: 1.048-1.890, B: 1.469, p < 0.001), procalcitonin (95% CI: 0.136-0.270, B: 0.203, p < 0.001), and SOFA (Sequential Organ Failure Assessment) scores (95% CI: 0.112-0.450, B: 0.281, p = 0.001) significantly predict the changes in PTX3 level (R-square: 0.842, adjusted R-square: 0.826) in patients.Conclusions: PTX3 was found to correlate with the severity of sepsis as SOFA score and other markers like lactate, procalcitonin, and APACHE-II (Acute Physiology and Chronic Health Evaluation II) score.