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Over recent years, the Human Resource Information System (HRIS) has gained tremendous impetus in industry. Still, the literature states that most information system failures result from employee resistance and subsequent opposition behaviour. To address the gap in the literature, this study has targeted employees' technological symbolic adoption to analyze employee resistance behaviour. As employees' technological symbolic adoption occurs much before their actual technology adoption. Symbolic adoption means users' mental evaluation of the technology used for their work. This study has taken the perspective of HRIS symbolic adoption and identifies its antecedents and outcome factors, i.e., technology adoption factors and work-related outcomes. Thus, this study investigates the relationship between technology adoption factors (performance expectancy, effort expectancy, social influence, and information quality) and work-related outcomes (work-life balance, engagement, and creativity). Furthermore, this study examines the mediating effect of HRIS symbolic adoption between the above-stated factors. 415 HRIS end-users from the HR department of small-to-medium-sized organizations were recruited to collect data. This paper offers a theoretical and practical contribution, extending the line of research on the end user's symbolic adoption domain, and helping small and medium-size organizations to better understand end-users' technological adoption factors. In light of this study's findings, HR practitioners and management should focus on effective HRIS interventions in small and medium-sized organizations to stay ahead with engaged, creative, and balanced employees.

This prospective phase II trial was designed to assess disease control and late effects following proton radiotherapy in children and young adults with non-metastatic Ewing Family of Tumors (EFT) or other bone sarcomas and non-rhabdomyosarcoma soft tissue sarcomas (NRSTS). Sixty-nine pediatric and young adult patients (age < 30) with NRSTS or bone sarcomas were enrolled between September 2006 and July 2016. Chemotherapy and surgery were administered to patients in accordance with current standard practices or according to co-enrollment on cooperative group protocols. Median follow-up was 7.7 years (range 0.4-15.7). 39 patients had EWS sarcoma, 5 patients had osteosarcoma, and 25 patients had other histologies. Eight-year overall survival (OS), event-free survival (EFS), local regional control (LC), and distant control (DC) rates for the whole cohort were 77.5%, 67.2%, 82.1%, and 87.9%, respectively and 81.0%, 76.8%, 92.3%, and 89.7% for EWS and 73.2%, 56.5%, 69.7%, and 86.3% for other histologies. The median age at the time of radiation therapy was 12.3 years (range 1-22). The most common primary tumor locations were head and neck (42%); abdomen/pelvis (26%) and paraspinal (23%). Seventy percent of patients had gross residual disease at the time of radiotherapy. The median radiation dose was 55.8GyE (range 41.4-72). Patients with a GTR had no difference in EFS (8-year: 69.9% vs 65.8%, p = 0.9) or LC (8-year: 74.7% vs 85.3%, p = 0.4). The non-significant relationship between surgical extent and EFS/LC did not change across histology (among EWS, 8-year EFS was GTR: 85.7% vs STR 75.0%, p = 0.6 and 8-year LC was GTR: 85.7% vs STR 93.8%, p = 0.5; among all other histologies, 8-year EFS was GTR: 64.3% vs STR 49.2%, p = 0.6 and 8-year LC was GTR: 71.4% vs STR 68.8%, p = 0.8). Eight-year follow-up toxicity assessments showed 22 patients (31.9%) with at least one grade 2 toxicity and 13 patients (18.8%) with at least one grade 3 toxicity, both at least partially attributable to radiation therapy. There were no grade 4 toxicities reported. Eight-year OS, EFS, LC, and DC rates were similar to those observed in comparable studies of photon radiation. Proton radiation represents a safe and effective radiation modality for pediatric non-rhabdomyosarcoma bone and soft tissue sarcomas. [ABSTRACT FROM AUTHOR]

Byline: B. Bajaj, S. Shrestha The French physician Augustine Marie Morvan first used the term 'la choree fibrillare' to describe a syndrome characterized by peripheral nerve hyperexcitability, dysautonomia, insomnia and [...]

Introduction: Postural instability and gait difficulty are the major contributors to disability in patients with Parkinson's disease (PD) and are least responsive to dopaminergic therapies. Transcranial direct current stimulation (tDCS) of the brain is reported to improve locomotor function in patients with PD. Aims and Objectives: (1) To determine the effect of bilateral anodal tDCS on locomotor function by measuring the change in timed up and go (TUG) test scores in patients with PD immediately after tDCS. (2) To estimate the association of the effect of bilateral anodal tDCS on executive function and that on locomotor function by measuring the relation between the Stroop test scores and the TUG test scores. Study Design: Randomized triple-blind sham-controlled crossover study. Methods: A total of 30 patients with PD diagnosed using the Movement Disorder Society clinical diagnostic criteria for PD, belonging to H&Y stages 2--4, fulfilling the inclusion and exclusion terms were included in the study. Patients were randomized to receive the "real" or the "sham" tDCS stimulation in the first session and a week later the other type of stimulation, i.e., sham or real, was given. The gait of all the patients was assessed using the TUG test performed immediately before and after the "real" as well as the "sham" sessions. The Stroop test was also performed before and after each stimulation session. Results: The mean age [±standard deviation (SD)] of the study participants was 61.1 (±10.9) years, with two-thirds of them being males and one-third being females. Patients showed statistically significant improvement in the averaged TUG tests scores post the "real" stimulation compared to the "sham" stimulation session (p < 0.05). Statistically significant improvement in Stroop test scores (incongruent) was observed after the "real" stimulation. Conclusions: Locomotor function of patients with PD improves immediately following bilateral anodal tDCS, and the improvement in locomotor function has a positive correlation with improvement in executive function. Area of Research: Clinical aspects [ABSTRACT FROM AUTHOR]

Proffered Papers: Proffered papers 4: CNS OC-0094: Patterns of Failure in Pediatric Medulloblastoma and Implications for Hippocampal Sparing S. Baliga, B. Bajaj, L. Vanbenthuysen, J. Adams, S. Gallotto, E.A. Weyman, M.P. Lawell, N.J. Tarbell, S.M. MacDonald, T.I. Yock. [Extracted from the article]

Gabapentin is a new gamma aminobutyric acid (GABA) analogue that has anticonvulsant activity Preliminary results are promising with gabapentin for the treatment of refractory anxiety disorders. In a supplementary role in several behavioral disorders, especially in acute mania, it has produced significant beneficial results. In this study, the anxiolytic activity of gabapentin was examined in mice. There was a significant decrease in time spent in the central square, an increase in the crossings, and an increase in rearing in the open field with the low-dose gabapentin (10 and 30 mg/kg), implying anxiolysis. Furthermore, potentiation of diazepam with gabapentin was also reported. On screening the gabapentin for learning and memory with passive avoidance response, there was significant prolongation of step-down latency, decrease in step-down error, and decrease in the total time spent by the mice in the shock zone at 10 and 100 mg/kg of gabapentin. Gabapentin was not associated with any adverse effect on the memory of mice. The lack of effect of gabapentin on memory, exhibiting anxiolytic activity at a low dose, the lack of cognition deficits, lack of drug interaction, alleviating the requirement for plasma monitoring, and its freedom from dependence or abuse liability suggest the potential advantage of gabapentin over the exiting anxiolytics. [ABSTRACT FROM AUTHOR]

A 42 year old male patient presented with sudden onset painless drooping of right shoulder while lifting himself up with his right arm from squatting position. He was diagnosed to have fracture of spine of right scapula. Neurological examination of the patient revealed patient's inability to abduct the right arm and mild weakness of handgrip without associated wasting or fasciculations. Impairment of pain sensation in right half of face, right cervical and upper thoracic dermatomes (T1-T4), and absence of deep tendon reflexes in right upper limb with brisk deep tendon reflexes in lower limbs were discovered on examination. The patient's cervico-dorsal Magnetic Resonance Imaging confirmed a syrinx extending from cervico-medullary junction to the upper thoracic segments. The patient did not have any obvious features suggestive of charcot's arthropathy on clinical and radiological examination. The case highlights the importance of detailed neurological examination and unusual presentation of fracture of spine of scapula in a patient harbouring cervico-dorsal syrinx. [ABSTRACT FROM AUTHOR]

The postpericardiotomy syndrome may occur as a complication of temporary and permanent pacing. Physicians involved in procedures which may be complicated by this condition therefore need to be aware of its diagnosis and management. [ABSTRACT FROM AUTHOR]

An abstract of the article∣Cabergoline and the Risk of Cardiac Valve Regurgitation: A Serial Echocardiography Study,∣by V. Gontu, S. Burn, B. Bajaj and N. Bajaj is presented.

Patients with vitamin B12 deficiency are known to present with neuropsychiatric manifestations. Autoimmune origin of vitamin B12 deficiency due to pernicious anemia is relatively less common in Asians compared to certain western populations. Other autoimmune disorders including autoimmune thyroiditis may be associated with pernicious anemia. The coexistent hypovitaminosis B12 and hypothyroidism presenting with multiple level neuraxis involvement is relatively rare. Our patient, a 50 year old previously healthy male started becoming impulsive, irrational, and socially indiscreet around 4 months prior to presentation. He started talking to 'ghosts' and insisted that his house is haunted by 'spirits'. He was started on antipstchotics for his abnormal behaviour by psychiatrist only to worsen further. He was noted to have ataxic gait more prominent in the dark. He could hardly walk or feed himself without assistance. He had difficulty writing with his hand and had troublesome paraesthesias in extremities. When he presented to Neurology, he had MMSE score of 14/28. He had marked sensory ataxia, pseudoathetosis, normal motor power with exaggerated deep tendon reflexes and extensor plantars. Investigations revealed macrocytic hypochromic anemia with severely low vitamin B12 levels and hypothyroidism. Patient had positive antinuclear antibody, thyroid peroxidase and antiparietal cell antibodies. Elisa for HIV and routine blood tests including LFT, KFT were within normal limits. There was subclinical evidence of peripheral neuropathy. MRI Brain revealed cerebral atrophy and EEG showed background beta activity. Patient was started on 1000 microgam / d of parenteral vit B12 alongwith gradually escalating dose of I thyroxin. Patient showed significant signs of cognitive improvement within one week of treatment and reached MMSE score of 28/30 after 2 weeks. [ABSTRACT FROM AUTHOR]

Background: Herpes simplex virus (HSV) has rarely been reported as a cause of acute polyneuritis cranialis. Aim: To report the clinical features and outcome in a case of polyneuritis cranialis following reactivation of HSV 1 infection. Case: A 21 year old female, presented with acute onset difficulty in closing her left eye, deafness in left ear, electric shock like pain in her left face and left sided loss of taste sensation without hyperacusis, tinnitus, vertigo or ear discharge. Two weeks back, she had fever with vesicular eruptions in the oral cavity, which improved over one week. Patient had history of vesicular eruptions in her oral cavity two years back also. On examination, no vesicular rash was evident in oral cavity, external ear and tympanic membrane. Patient had left 7th infranuclear palsy and sensorineural deafness. There was no facial sensory loss. Left corneal reflex, with contralateral consensual response, was absent. Serum IgM and IgG for HSV1 antibodies were positive. CSF showed 16 lymphocytes/cmm, sugar 49 mg % (blood sugar: 99 mg %), protein 11 mg%, and positive PCR for HSV1 DNA. MRI brain showed enlargement of left cranial nerve V, VII and VIII complex with contrast enhancement. Audiometry and BAER were unrecordable from left ear. Left facial nerve conduction study showed decreased CMAP amplitude. Patient received intravenous acyclovir 30mg/kg/day for 10 days. Pain improved within 3 days and by 4 months, she made complete recovery with normal responses on repeat BAER and facial nerve conduction study. Conclusion: Reactivation of HSV 1 infection can present as polyneuritis cranialis. High index of suspicion and early treatment results in satisfactory outcome. [ABSTRACT FROM AUTHOR]

An abstract of the article "Correlation of decreased myocardial Doppler longitudinal velocities and intraventricular conduction abnormalities in patients with myotonic dystrophy" by D. Vinereanu, B. Bajaj, J. Fenton-May, M. Rogers, C. Madler, and A. G. Fraser is presented.

Purpose: To determine the dose-dependent effect of adjuvant radiotherapy on survival for pediatric intracranial ependymomas and explore patient and disease characteristics that experience survival benefit from higher doses., Methods: Data was accessed from the National Cancer Database. Inclusion criteria was comprised of a diagnosis of non-metastatic intracranial ependymoma, World Health Organization (WHO) grade 2 or 3, surgical resection, adjuvant radiotherapy between 4500-6300 cGy, and non-missing survivorship data. Crude and adjusted Cox proportional hazard ratios (HRs) were calculated to estimate the associations of patient, tumor, and treatment characteristics with overall survival (OS). Kaplan-Meier (KM) estimations were used to visualize survival curves for dosing for the general cohort and by subgroups (age, resection extent, and grade)., Results: Of the 1154 patients who met inclusion criteria, 405 received ≤ 5400 cGy and 749 received > 5400 cGy. We found no difference in OS crude (0.95, 95% CI 0.72-1.06) or adjusted (0.88, 95% CI 0.46-1.69) HR for those receiving ≤ 5400 cGy. KM curves showed no difference in OS for dosing for the general cohort based on age, surgical extent, and grade. However, there was better OS in those with WHO grade 2 tumors compared to grade 3 regardless of dose received., Conclusions: There was no difference in OS between patients who received ≤ 5400 cGy compared to > 5400 cGy. We found improved OS in those with grade 2 tumors compared to grade 3, however there was no difference in OS based on dose received by tumor grade, age, or resection extent. Limitations in data available prevent exploring other outcomes or toxicity., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: In resource-limited facilities, the greatest number of unfavorable maternal-fetal outcomes at referral hospitals is chronicled from emergency obstetric referrals of critically ill patients from lower health facilities. An efficient obstetric referral system is thus necessitated for improving maternal health. Referral practices have not been optimized effectively till date, owing to paucity of a detailed profile of referred women and indigenous barriers encountered during implementation process., Materials and Methods: This five-year retrospective audit was conducted in the Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi from September 2018 to 2023, in which records of all critically ill obstetric women referred were reviewed. The primary outcomes included were proportion and pattern of patients being referred, while secondary outcomes included demographic variables, referring hospital, reason and number of steps in referral, duration of hospital stay and fetomaternal outcome. The data were recorded on a predesigned case proforma and analyzed using the SPSSv23 version of software, after application of appropriate statistical tests., Results: The referral rate to obstetric intensive care unit (ICU) ranged from 39 to 47% in last 5 years; hypertensive disorder of pregnancy (31%) being the foremost cause of the referrals. Around 2/3rd women were transferred without escort (70%) or prior communication (90.6%) and referral slips were incomplete in half the admissions., Conclusion: Ensuring emergency obstetric care (EmOC) at various levels by up-gradation of health infrastructure would go a long way in improving fetomaternal health outcomes. There is need of standardized referral slips tailor-made to each state and contextualized protocols for early recognition of complications and effective communication between referral centers., How to Cite This Article: Marwah S, Suri J, Shikha T, Sharma P, Bharti R, Mann M, et al . Referral Audit of Critically Ill Obstetric Patients: A Five-year Review from a Tertiary Care Health Facility in India. Indian J Crit Care Med 2024;28(8):734-740., Competing Interests: Source of support: Nil Conflict of interest: NoneConflict of interest: None, (Copyright © 2024; The Author(s).)

Site-one protease (S1P) conducts the first of two cleavage events in the Golgi to activate Sterol regulatory element binding proteins (SREBPs) and upregulate lipogenic transcription. S1P is also required for a wide array of additional signaling pathways. A zymogen serine protease, S1P matures through autoproteolysis of two pro-domains, with one cleavage event in the endoplasmic reticulum (ER) and the other in the Golgi. We recently identified the SREBP regulating gene, (SPRING), which enhances S1P maturation and is necessary for SREBP signaling. Here, we report the cryo-EM structures of S1P and S1P-SPRING at sub-2.5 Å resolution. SPRING activates S1P by dislodging its inhibitory pro-domain and stabilizing intra-domain contacts. Functionally, SPRING licenses S1P to cleave its cognate substrate, SREBP2. Our findings reveal an activation mechanism for S1P and provide insights into how spatial control of S1P activity underpins cholesterol homeostasis., (© 2024. The Author(s).)

Objective:  Effect of the COVID-19 pandemic on knowledge, attitude, and practices toward antenatal care among antenatal women., Design:  Prospective observational study., Method: After taking written and informed consent, 3000 term/near-term SARS CoV2-negative antenatal women admitted to the hospital for emergency were enrolled; excluding those in advance labour or critically ill. An interview was conducted and a knowledge, attitude, and practices (KAP) questionnaire was filled out based on verbatim answers. All women were then given individualized antenatal and postnatal care as per hospital protocols and discharged accordingly. The data obtained during the study was recorded on predesigned case proforma and analysed at the end of the study using the SPSS v. 23 software, after the application of appropriate statistical tests., Main Result: All women knew about the pandemic and its signs and symptoms along with precautions to be taken. Most of the women 2652 (88.4%) thought that they were at increased risk of contracting an infection during pregnancy and 2208 (73.6%) thought that coronavirus can harm the baby and will increase the risk of pregnancy. Awareness of nearby health facilities providing antenatal care was in 71.2% and 94% were aware of functional outpatient department services but only 1.4% were aware of teleconsultation services. About 2094 women have had any ANC visits. All of them knew that taking iron, Ca and vitamin supplements and getting an ultrasound and investigations were necessary but only 1524 (50.8%) took these supplements regularly, 1752 (58.4%) got their ultrasound done and 41.6% got investigations done. Two thousand four hundred thirty-six (81.2%) women had this fear that they would contract COVID-19 infection during their visit to the hospital. All the respondents of our study wanted to have hospital delivery and knew that it was necessary to have ANC registration and none of them wanted to have home delivery., Conclusion: Mastering correct knowledge will foster a positive attitude among antenatal women and will not only prevent disease transmission but also improve pregnancy outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Marwah et al.)

Aim: The present study was carried out to compare the effectiveness of leukocyte platelet-rich fibrin (L-PRF) membrane and polylactic acid-polyglycolic acid (PLA-PGA) membrane along with hydroxyapatite crystal collagen fibers bone graft in the treatment of human infrabony defects using cone beam computed tomography., Materials and Methods: A total of 28 systemically healthy patients was chosen which were found appropriate after initial therapy. Each group comprises of 14 defects, according to randomized parallel design. The group A was managed by hydroxyapatite crystal collagen fibers bone graft in conjunction with L-PRF membrane, while group B was treated by hydroxyapatite crystal collagen fibers bone graft in conjunction with PLA-PGA membrane. Clinical and radiographic measurements were recorded at baseline and 6 months postoperatively., Results: Statically significant difference was seen in mean probing pocket depth (PPD), mean R-CAL, and DD from baseline to 6 months in group A and group B but there was no statically significant difference in mean PPD reduction (0.35 ± 1.90 mm), mean R-CAL gain (0.28 ± 1.85 mm) and DD reduction (0.12 ± 1.42 mm) seen at 6 months when compared between both the groups., Conclusion: At 6 months post-surgery both treatment modalities demonstrated statistically significant improvements with regards to CAL gains, PPD reduction, and reduction in radiographic defect depth., Clinical Significance: Platelet-rich fibrin (PRF) membrane and PLA-PGA membrane along with hydroxyapatite crystal collagen fibers bone graft are useful in the treatment of infrabony defect. Platelet-rich fibrin membrane with hydroxyapatite crystal collagen fibers bone graft have shown to be better in regeneration of bony defect as PRF membrane has growth factors which help in bone regeneration.

Aim: To evaluate and compare the effectiveness of nanocrystalline hydroxyapatite (NcHA) with advanced platelet-rich fibrin (A-PRF) and hydroxyapatite-reinforced beta tricalcium phosphate (HA + β-TCP) with A-PRF in the treatment of human infrabony defects clinically and radiographically using cone-beam computed tomography (CBCT)., Materials and Methods: There were a total of 28 defects, with 14 defects in the test and control groups, respectively. There were total 28 patients were involved in the study. The test group (group A) was treated with NHA and A-PRF, while the control group (group B) was treated with HA + β-TCP and A-PRF. Bone defect fill was the primary result of the investigation. Periodontal pocket depth (PPD), R-CAL, papillary bleeding index (PBI), and PI were the secondary outcome. Clinical and radiographic measurements were recorded at baseline and 6 months postoperatively., Results: No significant difference was observed between the two groups in terms of PPD reduction (4.64 ± 0.74 mm vs 4.07 ± 0.99 mm), clinical attachment loss (CAL) gain (4.64 ± 0.74 mm vs 3.92 ± 0.99 mm) and radiographic defect depth reduction (2.41 ± 0.32 mm vs 2.40 ± 0.27 mm) for test and control groups, respectively., Conclusion: At 6-month post-surgery, both treatment modalities demonstrated statistically significant improvements with regard to CAL gains, PPD reduction, and reduction in radiographic defect depth., Clinical Relevance: The NcHA and HA + β-TCP with A-PRF is a novel material used in the treatment of infrabony defect for periodontal regeneration. The NcHA and HA + β-TCP with A-PRF need to consider biomaterials for bone defect fill.

Background: Thin endometrium in infertile female patients has always been a clinical challenge for the treating reproductive physicians., Objective: This study aimed to evaluate the effect of intrauterine instillation of autologous platelet-rich plasma on endometrial thickness and vascularity in infertile female patients with thin endometrium undergoing ovarian stimulation with intrauterine insemination., Study Design: This prospective randomized control study included 120 women undergoing ovarian stimulation with intrauterine insemination, aged between 21 and 37 years, with persistent thin endometrium (<7 mm) on ≥1 cycle in previous ovarian stimulation cycles, even after conventional treatment with estradiol valerate. The women were randomly assigned to study group A and control group B. Baseline endometrial thickness and endometrial vascularity were noted. Intrauterine instillation of autologous platelet-rich plasma was done on the day of trigger in group A, whereas estradiol valerate was given in group B. Another evaluation of endometrial parameters was done on the day of intrauterine insemination. The cycle was repeated for 3 cycles or until the pregnancy was achieved, whichever occurred earlier. Parameters were noted for both groups. Primary outcomes were the change in endometrial thickness and endometrial vascularity. Secondary outcomes were positive pregnancy rate and clinical pregnancy rate., Results: In group A, mean pre-platelet-rich plasma endometrial thickness was 4.66±0.79 mm, which significantly increased to 7.47±0.85 mm after platelet-rich plasma instillation ( P <.05) after 3 cycles. This increase was significantly greater than that observed in group B. There was significant increase in endometrial vascularity in group A compared with group B ( P <.05). The positive pregnancy rate and clinical pregnancy rate in group A were 23.73% and 18.64%, respectively, and significantly higher than those in group B., Conclusion: Autologous platelet-rich plasma is a promising, easily procurable, and novel option for management of infertile females with thin endometrium not responding to conventional treatment. Using it in intrauterine insemination cycles can reduce costs and psychological burden of this subgroup of women by reducing the need for resorting to advanced options such as in vitro fertilization and surrogacy., (© 2023 The Authors.)