Critical Care Papers & Publications

India is a country of immense diversity. It is home to people of many different racial, languages, ethnic, religious, and national backgrounds. Groups of people in India differ from each other not only in physical or demographic characteristics but also in distinctive patterns of behavior and these patterns are determined by social and cultural factors like language, region, religion, and caste. Apart from behaviour, economic development, level of education and political culture of the people in various social segments differ from region to region. More you can say that economy and cultures have been enriched by the contributions of migrants from round the globe. In an increasingly globalised world, migratory movements is continuously shaping the countries all over the world. Some countries like India and Ireland, which set the example of economic development and social integration, have the positive impact of the migration by globalisation and some countries like USA, which recently witness racism, xenophobia and discrimination have the negative impact on the migrants. It does not mean India do not face fragmentation and USA do not have cohesion. USA have many stories which show successful integration process, that facilitated the lives of immigrant communities, but being a developed country it still suffers from cultural alienation. In these countries, borders are built within borders to create cultural divides that do not allow people to integrate. Recently, this problem has become more prominent due to the rise of terrorism, clash of cultures in the world, leading to the glorification of stereotypes. People are becoming less accepting towards anyone who does not belong to their region. Migration does not stop after people move from one place to another place. The main question start after that ‘now what’ they will do. That is why this topic needs to be discussed thoroughly in order to find better solutions. This paper will begin with an analysis of different approaches to Migration, discuss the target groups for integration policies, provide indicators of the current situation of migrants and proceed to an analysis of integration tools: legislation, social policies and participatory processes. It will focus not only on the impact of migration but also on social integration, mix culture like indo-western culture in a comparative basis.

Ekta Meena

India is a country of immense diversity. It is home to people of many different racial, languages, ethnic, religious, and national backgrounds. Groups of people in India differ from each other not only in physical or demographic characteristics but also in distinctive patterns of behavior and these patterns are determined by social and cultural factors like language, region, religion, and caste. Apart from behaviour, economic development, level of education and political culture of the people in various social segments differ from region to region. More you can say that economy and cultures have been enriched by the contributions of migrants from round the globe. In an increasingly globalised world, migratory movements is continuously shaping the countries all over the world. Some countries like India and Ireland, which set the example of economic development and social integration, have the positive impact of the migration by globalisation and some countries like USA, which recently witness racism, xenophobia and discrimination have the negative impact on the migrants. It does not mean India do not face fragmentation and USA do not have cohesion. USA have many stories which show successful integration process, that facilitated the lives of immigrant communities, but being a developed country it still suffers from cultural alienation. In these countries, borders are built within borders to create cultural divides that do not allow people to integrate. Recently, this problem has become more prominent due to the rise of terrorism, clash of cultures in the world, leading to the glorification of stereotypes. People are becoming less accepting towards anyone who does not belong to their region. Migration does not stop after people move from one place to another place. The main question start after that ‘now what’ they will do. That is why this topic needs to be discussed thoroughly in order to find better solutions. This paper will begin with an analysis of different approaches to Migration, discuss the target groups for integration policies, provide indicators of the current situation of migrants and proceed to an analysis of integration tools: legislation, social policies and participatory processes. It will focus not only on the impact of migration but also on social integration, mix culture like indo-western culture in a comparative basis.

Ekta Meena

In this paper, investigations are made to analyze the human body temperature during wound healing process due to surgery. Wound is considered after the skin graft. Skin graft is a technique used in plastic surgery. Skin is the first line of defense between the human and environment, it is very susceptible to damage. Internal body or core temperature (Tb) is one of the clinical vital signs along with pulse and respiratory rates. Any disturbance in body temperature will drive complexities in wound healing process. These studies are important in the mechanism of establishing the limits of thermal regulation of human body during the healing process in different situations and conditions. The Finite element method is used to analyze tissues temperature for normal tissues (donor site) and abnormal tissues (tissues after surgery). Appropriate boundary conditions have been framed. Numerical results are obtained using Crank Nicolson Method.

Manisha Jain

Physically unclonable function (PUF) is a hardware security module preferred for hardware feature based random number and secret key generation. Security of a cryptographic system relies on the quality of the challenge-response pair, it is necessary that the key generation mechanism must unpredictable and its response should constant under different operating condition. Metastable state in CMOS latch is undesirable since it response becomes unpredictable, this feature used in this work to generate a unique response. A feedback mechanism is developed which forces the latch into the metastable region; after metastable state, latch settle to high or state depends on circuit internal condition and noise which cannot be predicted. Obtained inter hamming variation for 8 PUF is 51% and average intra hamming distance is 99.76% with supply voltage variation and 96.22% with temperature variation.

Abhishek Kumar

One of the unique features of Indian society is prevalence of caste system which was originated thousands of years back to demarcate the people engaged in different occupation or jobs. Initially it was not much rigid but gradually people belonging to upper castes for their own selfish means to maintain their monopoly made this arrangement hereditary and started treating people of lower castes disgracefully. For preservation of this system, people started controlling their women to prevent inter-caste marriages and the concept of endogamy came up. This robbed away many types of freedom from women. For women belonging to lower castes, this situation is worse as they are doubly subjugated on the basis on caste as well as gender. Men belonging to their own caste treat them as secondary beings. This paper throws light on this intersection. How intersection of these two kinds of inequalities place them at the lowest position in Indian society. Dr. B.R. Ambedkar rises as their leader who all his life worked for empowerment of downtrodden section of society. He argues that education is the primary tool for evading these differences among people. He further emphasizes to adopt the concept of exogamy to break the backbone of Indian caste system and to immediately leave a religion or culture which legitimizes such system of inequality among people of the same land.

Swati sharma

One of the unique features of Indian society is prevalence of caste system which was originated thousands of years back to demarcate the people engaged in different occupation or jobs. Initially it was not much rigid but gradually people belonging to upper castes for their own selfish means to maintain their monopoly made this arrangement hereditary and started treating people of lower castes disgracefully. For preservation of this system, people started controlling their women to prevent inter-caste marriages and the concept of endogamy came up. This robbed away many types of freedom from women. For women belonging to lower castes, this situation is worse as they are doubly subjugated on the basis on caste as well as gender. Men belonging to their own caste treat them as secondary beings. This paper throws light on this intersection. How intersection of these two kinds of inequalities place them at the lowest position in Indian society. Dr. B.R. Ambedkar rises as their leader who all his life worked for empowerment of downtrodden section of society. He argues that education is the primary tool for evading these differences among people. He further emphasizes to adopt the concept of exogamy to break the backbone of Indian caste system and to immediately leave a religion or culture which legitimizes such system of inequality among people of the same land.

Swati sharma

Background: This study investigated the utilization of consumer health informatics in health promotion among the staff of tertiary institutions in Rivers state. Subjects & Methods: A cross-sectional descriptive research design was used. Two research questions guided this paper. The population of this paper comprised all the 13,046 staff of tertiary institutions in Rivers state. A sample of 1226 staff was drawn using multi-stage sampling techniques. An instrument titled, “Utilization of Consumer Health Informatics in Health Promotion Questionnaire” (UCHIHPQ) was adopted for data collection. The instrument was validated and reliability yielded an index of 0.80. Mean and Standard Deviation statistics were used to answer the research questions. The statistical analysis was performed with the use of SPSS v23. Results: The result revealed among others that to a very large extent, the respondents accepted that consumer health informatics was used to improve their nutritional and physical health status. Conclusion: It was therefore concluded and recommended among others that staff of tertiary institutions in Rivers state should regularly use intelligent informatics applications to attain a healthy balance between self-reliance and seeking professional help concerning nutritional and physical health matter

FXintegrity Publishing

Background: Acute and chronic heart or kidney failure affect each other in cardiorenal syndromes (CRS). In CRS, hemodynamic and non-hemodynamic changes occur, causing acute or progressive renal and cardiac failures. CRS is classified into five types based on the first organ failure and causes failure of the other organ. We believe that the current CRS classification is not the correct one that effectively describes the underlying cause of CRS. Hence, we consider it better to be classified into three categories (cardiorenal, renocardiac, and cardio-reno-cardiac syndrome) and then subdivided into acute and chronic types or types 1 and 2 (respectively, according to the onset of the underlying type of failure (i.e., acute or chronic). Other subtypes that occur inthe heart and dysfunction occur simultaneously are acute cardio-reno-cardiac syndrome (type 5) and Chronic cardio-reno-cardiac syndrome (type 6). Aim: In Part 1 of the review series, the pathophysiological mechanisms and clinical and therapeutic applications of all types of CRS will be narratively discussed and updated. Furthermore, we provide a comprehensive review of diagnostic biomarkers and their clinical significance in the identification, outcome prediction, and treatment of all CRS types. Method: An extensive search of PubMed, Google, EMBASE, Scopus, and Google Scholar was conducted for review articles, original articles, and commentaries published between Jan 2010 and Aug 2024 using different phrases, texts, and keywords, such as CRS, renocardiac syndrome, and CRS. The topics included secondary CRS, CRS pathogenesis, CRS therapy, SLGT inhibitor use in CRS, novel therapy in CRS types, and prevention of CRSs. Conclusion: Renal and cardiac failure in patients with CRS seem to have different pathophysiological mechanisms. Early detection and treatment can improve the outcomes of CRS. Clinical manifestations and therapy protocols vary according to pathophysiology. Hence, new guidelines and research on universal diagnostic and treatment techniques are urgently required. Moreover, the current nomenclature for CRS is confusing; therefore, we believe that a new nomenclature system should be introduced, reducing confusion and making differentiation between CRS types easier and less confusing.

Karishma

Background: COVID-19-positive patients are at increased risk of adverse clinical outcomes, with type 2 diabetes cohorts at substantially higher risk compared to the general population. The additional role of diabetic and non-diabetic polypharmacy in these patients' clinical course has remained unexamined. In this study we have comprehensively examined the role of polypharmacy in the determination of mortality outcomes in patients with COVID-19 clinical syndrome. Methods: We retrospectively examined case notes and electronic records of N = 497 patients with type 2 diabetes and COVID-19 infection. We ascertained the number of medications each patient was taking and used this to categorize the study cohort into diabetic [n = 246] (5 or more diabetic medications), and non-diabetic polypharmacy [n = 251] (5 or more non-diabetic medications). The primary outcome was the need for intensive care admission between the two groups. Results: In patients with “non-diabetic polypharmacy” (>5 medications), advancing age, and higher HBA1c levels, were associated with increased risk of Intensive care admission (OR 1.06 [CI 1.03-1.07], P = <0001), (OR 1.01 [CI 1.01- 1.20], P 0.017), respectively. Patients taking 5 or more non-diabetic medications had an increased likelihood of admission into the intensive care unit compared to those on lower medication thresholds (OR = 1.7; CI = 1.1 to 1.3; p-value = <0.0006). Conclusion: In an inpatient cohort of type 2 diabetic patients with COVID-19, non-diabetic polypharmacy was associated with a multiplicative risk of intensive care admissions. This will necessitate the need for periodic medication reviews in these cohorts of patients to mitigate these potential risks and improve clinical outcomes.

Karishma

A 33-year-old young male patient with a history of uncontrolled hypertension was referred to my clinic due to a 2-week fever, generalized body aches, shortness of breath, and easy fatigue. Clinical examination showed a toxic dyspneic patient, but conscious and well-oriented. His blood pressure was 170/100 mm Hg, pulse 90 beat/min, respiratory rate 15/min, and the temperature was 38.6°C. Cardiac examination showed a harsh systolic murmur at the mitral area radiating to the axilla. Abdomen examination revealed moderate splenomegaly and mild hepatomegaly. The rest of the examination was unremarkable.

Karishma

Background: Ward rounds are a cornerstone of inpatient care, critical to patient management, interdisciplinary communication, and bedside teaching. However, despite their importance, ward rounds are often unstructured and inconsistent, limiting both clinical efficiency and educational impact. Objective: This narrative review examines common deficiencies in current ward round practices and proposes a structured, evidence-informed framework to enhance their effectiveness. Methods: A narrative review was conducted to identify deficiencies in ward round practices and develop a practical, evidence-informed framework for improvement. Given the focus on conceptual and experiential insights, a formal quality appraisal of the included studies was not performed. Results: The review identified recurrent challenges, including poor planning, unclear leadership, inadequate time management, and a lack of integrated teaching. Drawing on best practices, a three-phase model—preparation, execution, and education—is proposed to enhance team communication, patient involvement, and trainee learning. Conclusions: Structured, goal-oriented ward rounds can significantly improve care coordination, safety, and clinical education. Institutions should prioritize standardized ward round models supported by training in leadership, teaching, and interdisciplinary collaboration.

Karishma

Background: Malaria in pregnancy (MiP) remains a critical public health concern in Nigeria, with significant implications for maternal and fetal health. Despite national policy guidelines advocating the use of Intermittent Preventive Treatment in pregnancy using Sulphadoxine- Pyrimethamine (IPTp-SP), its uptake remains suboptimal in many rural communities. This study aimed to assess the factors influencing IPTp-SP utilization among pregnant women attending antenatal clinics (ANCs) in rural areas of Abia State. Methods: A descriptive cross-sectional study design was adopted, involving 422 pregnant women selected through a multistage sampling technique across three predominantly rural Local Government Areas (LGAs): Ugwunagbo, Isiala Ngwa South, and Ukwa East. Data were collected using a structured, interviewer-administered questionnaire and analyzed using SPSS version 25. Descriptive statistics, chi-square tests, and Pearson correlation analyses were employed to examine associations between socio-demographic variables, accessibility, beliefs, health system factors, and IPTp uptake. Statistical significance was set at p < 0.05. Results: The majority of respondents were married (82.0%), aged between 25 and 34 years (46.9%), and had attained at least secondary education (71.1%). Key barriers to IPTp uptake included drug unavailability (30.6%), long waiting times (28.9%), fear of side effects (19.4%), and cultural beliefs (23.0%). Notably, only 24.6% reported consistent IPTp-SP availability during ANC visits, and 46.4% had to purchase the drugs outside the clinic. Correlation analysis revealed significant associations between IPTp uptake and distance to clinic (r = -0.412, p = 0.001), health education (r = 0.562, p < 0.001), drug availability (r = 0.489, p = 0.002), and cultural beliefs (r = -0.297, p = 0.012). Chi-square analysis confirmed significant relationships between IPTp uptake and education level (χ² = 19.438, p = 0.001), awareness (χ² = 24.511, p < 0.001), and satisfaction with ANC services (χ² = 14.257, p = 0.003). Conclusion: The study highlights multifaceted determinants affecting IPTp-SP uptake among pregnant women in rural Abia State. These include socio-demographic factors, health system challenges, cultural beliefs, and availability of services. Interventions aimed at increasing awareness, ensuring consistent drug availability, and improving ANC service delivery are critical to enhancing IPTp coverage in rural Nigeria.

Karishma