Background and Objectives. SARS-CoV-2 virus has caused a global pandemic as declared by the World Health Organisation (WHO) in March 2020. In India, the first case was reported in Kerala on the 30th of January, and since then, many states are active but some are showing flattening. Following the seroprevalence testing in healthy blood donors, we can monitor the spread of the virus among healthy people, thus eventually leading to implementing strategies to reduce the spread. Thus, a need was felt to conduct a study to assess the IgG antibody status in healthcare workers differentiating those who were in COVID-19 and others in non-COVID-19 emergency duties during this pandemic. Materials and Methods. 2085 blood donors were allowed to donate blood only after fulfilling all the criteria laid down by the FDA of India with additional history of excluding COVID-19 suspects. IgG antibody testing was performed by chemiluminescence, and results were noted along with their reactive status. Their reactive status was analyzed with donor information to get an idea of the risk parameters for COVID-19. Medical healthcare workers in whom the study was carried out were 560, out of which 114 had worked in COVID-19 duties and 446 had worked in non-COVID-19 emergencies areas. COVID-19 area duties were further subdivided into triage, holding area, isolation, and COVID-19-related duties. The samples were run on architect i2000 and evaluated for their plasma immunoglobulin G. Results. Amongst the asymptomatic blood donors, 1.9&#x0025; was found to be COVID-19 IgG antibody positive. It was observed that maximum COVID-19 IgG positivity (57.1&#x0025;) was seen in the age group 18&#x2013;29 years followed by 26.2&#x0025; in the age group 30&#x2013;39 years. Donors in the age group 40&#x2013;49 years showed antibody positivity of 16.7&#x0025;, and no antibody-positive donors were found above 50 years of age. COVID-19 IgG positivity was maximum in replacement donors (61.9&#x0025;) followed by family donors (28.6&#x0025;) and least involuntary donors (0.6&#x0025;) Blood donors who showed high IgG positivity were mainly of labor class. Antibody IgG testing on medical healthcare workers showed 2.3&#x0025; positivity. The healthcare workers who were posted in COVID-19 duties showed 4.8&#x0025; positivity in the holding area (waiting area with the treatment of patients till their RT PCR report comes) and 5.7&#x0025; in other COVID-19 areas related to laboratory work. Healthcare workers doing duties in COVID-19 areas showed 2.7&#x0025; positivity, while those doing duties in non-COVID-19 emergency areas showed a positivity of 2.2&#x0025;. Conclusion. Our study shows that the prevalence of detectable antibodies was low in the general population in India and many patients were asymptomatic as seen in the blood donors, especially the labor class. Maximum exposure was present in young healthy males of labor class who remained asymptomatic. The healthcare workers were more exposed to COVID-19 as compared to the general population probably due to lack of precaution and awareness. Those doing non-COVID-19 duties were also exposed appreciably and needed to take all the precautions required for COVID-19 duties.

Tulika Chandra

Devisha Agarwal

D. Himanshu

Mallika Agarwal

Bipin Puri

SARS-CoV-2 IgG Surveillance in Asymptomatic Blood Donors and Health Workers

Constipation is a condition that is very prevalent and is reported in up to 40 percent of individuals with intellectual and developmental disabilities (IDD). Constipation in this patient population is most commonly secondary to neuromuscular abnormalities, immobility, suboptimal diet, and medication side effects. History taking is frequently limited in adults with IDD due to communication barriers, often leading to a missed diagnosis of constipation. Inadequately treated constipation may lead to adverse effects including behavioral disturbances, fecal impaction, intestinal obstruction, and even death from intestinal perforation and sepsis. As a result, a high index of suspicion must exist for this patient population. Treatment in these patients requires an individualized approach, to reduce the constipation and its associated health complications.

Reshmi Mathew

Barrett O. Attarha

Govind Kallumkal

Morgan Cribbin

Christopher Izzo

Linda Edwards

Rafik Jacob

A Primary Care Approach to Constipation in Adults with Intellectual and Developmental Disabilities

Background. Biopsy is an important tool for accurate diagnosis of disease in histopathology which can be examined at multiple levels during microscopic examination. The initial sections may not be representative of the entire biopsy, which leads to frequent request for deeper sections. This study assessed the frequency and diagnostic utility of deeper sections in noncutaneous small biopsy specimens at a tertiary hospital. Material and Methods. All the formalin fixed noncutaneous small biopsy specimens received were processed for grossing followed by tissue processing and embedding. The paraffin-embedded blocks were cut into 3&#x2013;5&#x2009;&#xb5;m sections, fixed in a glass slide, deparaffinised, and then stained with hematoxylin and eosin (H&#x26;E) stain as per the standard protocol. Deeper sections were instructed based on microscopic findings of initial slides. The overall frequency of deeper section, its levels of cutting, tissue survival, and outcome were assessed and interpreted for the final diagnosis. Results. A total of 125 cases (26.9&#x0025;) from 464 samples received were requested for deeper sections. The most frequent deeper sections were from cervix (72 cases) followed by stomach (18 cases) and endometrium (17 cases). The deeper sections were performed most frequently at 4 levels (17.8&#x0025;) followed by 5 levels (14.8&#x0025;) and 6 levels (13.3&#x0025;). Deeper sections revealed nondiagnostic additional features in 28.2&#x0025;, while 2.2&#x0025; showed additional diagnostic features. Likewise, 2.2&#x0025; had tissue segment loss. The overall mean level showing additional features was 6 levels. Tissue survival increased in 13&#x0025; cases and 1.5&#x0025; had decreased survival. The most common reason for requesting deeper section was to enhance sensitivity and diagnostic accuracy of disease. Conclusions. Deeper sections often contribute to final diagnosis. Therefore, deeper sections on biopsies that cannot readily be diagnosed on routine levels are recommended regardless of size of the lesion and there should be uniformity in the practice of deeper sections across the globe.

Gopal Lama

Paricha Upadhyaya

Smriti Karki

Anju Pradhan

Deeper Sections: Its Frequency and Diagnostic Utility in Histopathology of Noncutaneous Small Biopsy Specimen in a Tertiary Hospital in Nepal

Background. Refractive errors are the most common cause of visual impairment worldwide. Its proportion varied among societies and is considered as a public health challenge. Symptoms and signs associated with refractive errors are the most worrisome and common presentations in the general practice in eye clinics. Aim. The goal of this study was to determine the types and presentations of refractive error among the 0&#x2013;30-year-old Yemeni population to aid early identification, diagnosis, referral, and treatment. Methodology. A cross-sectional study including 1,500 out-patients aged from 0 to 30 years attending the ophthalmology clinic in Sanaa, Yemen (between 2012 and 2015). All patients underwent visual acuity examination, autorefractometer, and anterior and posterior segment examination and were grouped according to type, that is, myopia, hyperopia, and astigmatism. Results. Hyperopia was the most common single diagnosis (53.3&#x0025;) followed by myopia (33.3&#x0025;). Astigmatism was uncommon as a single diagnosis (13.4&#x0025;) but commonly associated with hyperopia or myopia. Myopia was more common in males (42.9&#x0025;) than in females (25&#x0025;). Hyperopia was more in females (62.5&#x0025;) than in males (42.9&#x0025;). Age groups most affected by refractive errors were 13&#x2013;18 years (27.7&#x0025;), 19&#x2013;24 years (24.8&#x0025;), and 25&#x2013;30 years (24.6&#x0025;), respectively. Decreased vision (53&#x0025;) was a common presentation in myopia and astigmatism (41.5&#x0025;) and less in hyperopia (39.6&#x0025;). Headache was common in astigmatism (56&#x0025;), hyperopia (28.8&#x0025;), and myopia (17.8&#x0025;). Muscle imbalance, namely, exotropia (27.2&#x0025;), is mainly found in myopia and esotropia (24.3&#x0025;) in hyperopia. Conclusions. In addition to decreased vision, our patients with refractive errors mostly complain of headaches with clear variations with age and type of refractive error. Early identification and proper categorization of refractive errors by age, gender, and other demographics by general physicians in primary care can better deduce and make useful referrals to eye specialists.

Tawfik Saleh Mohammed Dhaiban

Femina Purakaloth Ummer

Hanan Khudadad

Shajitha Thekke Veettil

Types and Presentation of Refractive Error among Individuals Aged 0&#x2013;30 Years: Hospital-Based Cross-Sectional Study, Yemen

Background. Back pain is often reported as a common complaint after surgery. Many studies showed that the prevalence of back pain after spinal anesthesia is high and its magnitude is considerable in developing countries. It is highly related to reduced quality of life, loss of work productivity, burden of health care costs, and satisfaction regarding health care service; therefore, measures should be taken to reduce or prevented postspinal back. The aim of this cross-sectional study was to assess the prevalence and factors associated with back pain among patients undergoing spinal anesthesia at the University of Gondar Comprehensive and Specialized Hospital, Northwest Ethiopia. Methodology. An institutional based cross-sectional study was conducted from March to May 2020. A total of 215 participants were enrolled in this study. A convenience sampling technique was used to get the study participants. Both univariable and multivariable logistic regression were used to identify factors associated with postspinal back pain. Variables with a <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42943pt" id="M1" height="10.2124pt" version="1.1" viewBox="-0.0498162 -6.78297 7.83752 10.2124" width="7.83752pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z"/></g></svg> value less than &lt;0.2 in the bivariable analysis were fitted into the multivariable analysis. In the multivariable analysis, a variable with a <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42943pt" id="M2" height="10.2124pt" version="1.1" viewBox="-0.0498162 -6.78297 7.83752 10.2124" width="7.83752pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-113"/></g></svg> value of &lt;0.05 was considered statistically significant. Results. The overall prevalence of postspinal back pain was 40.5% (95% CI: 34.0, 47.4). Being overweight (AOR = 3.8; 95% CI: 1.47, 9.96) and obese (AOR = 4.9; 95% CI: 1.19, 20.4), using big spinal needles (AOR = 5.9; 95% CI: 1.04, 33.4), two attempts of lumbar puncture (AOR = 5.5; 95% CI: 1.74, 17.59), more than three attempts of lumbar puncture (AOR = 4.9; 95% CI: 1.63, 15.2), and the number of bone contacts during spinal anesthesia procedure (AOR = 3.1; 95% CI: 1.14, 8.45) were positively associated with postspinal back pain. Conclusion and Recommendation. The overall incidence of back pain is high. Body mass index, size of spinal needle, number of attempts, and number of bone contacts are significantly associated with the incidence of back pain following spinal anesthesia. Thus, it is better to minimize the number of lumbar puncture attempts and bone contacts during spinal anesthesia to reduce postspinal back pain. In addition, using smaller size spinal needle is a good choice.

Tadael Gudayu Zeleke

Abraham Tarekegn Mersha

Nigussie Simeneh Endalew

Yonas Admasu Ferede

Prevalence and Factors Associated with Back Pain among Patients Undergoing Spinal Anesthesia at the University of Gondar Comprehensive and Specialized Hospital, North West Ethiopia: An Institutional Based Cross-Sectional Study

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Advances in Medicine publishes original research articles and&nbsp;review articles&nbsp;on recent advances in medicine and related disciplines. The journal focuses on diagnostic and imaging techniques, as well as drug design and development.

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Advances in Medicine - Table of contents 2021

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Advances in Medicine publishes original research articles and review articles on recent advances in medicine and related disciplines. The journal focuses on diagnostic and imaging techniques, as well as drug design and development.

Advances in Medicine