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Fever and rash in a returning traveller

Kumar N, Lewis DJ

BMJ, 2012;344:e2400.
PMID: 22496299 DOI: 10.1136/bmj.e2400
Fulltext Unusual branching pattern and termination of facial artery and its clinical implications for facial operations

Padur AA, Kumar N

J Vasc Bras, 2019 Jul 12;18:e20190021.
PMID: 31360158 DOI: 10.1590/1677-5449.190021

The facial artery is the main artery of the face and variations in its origin and its branching pattern have been documented. We report herein multiple facial artery branch variations in the face. A large posterior (premasseteric) branch originated from the left facial artery and coursed upwards behind the main trunk of the facial artery. This artery presented with a straight course and was closely related to the anterior border of the masseter. The branch then terminated by supplying the adjacent connective tissue below the parotid duct. It was also observed that the facial artery was very thick and tortuous and terminated as the superior labial artery. Knowledge of this variation is of great clinical significance in facial operations, especially for maxillofacial surgeons and plastic surgeons, because it forms the anatomical basis for the facial artery musculo-mucosal flap.
Fulltext Multiple Loops of External and Internal Carotid Arteries Vulnerable in Surgical and Radiological Procedures

Nayak S, Kumar N

Balkan Med J, 2018 05 29;35(3):285-286.
PMID: 29843502 DOI: 10.4274/balkanmedj.2017.1179
Fulltext Blast injuries of the ear

Singh AP, Prasad U, Kumar N

Singapore Med J, 1983 Dec;24(6):367-73.
PMID: 6681493

Clinical synopsis and investigations on fourteen patients with blast injuries of the ear successfully treated at the ENT Unit of the University Hospital, Kuala Lumpur, revealed few interesting observations in addition to usual findings. The most outstanding one was the absence of sensorineural deafness, although it has been claimed as one of the most constant features. Conservative management alone was found to be of significant value.
Fulltext An impact of content delivery, equity, support and self-efficacy on student's learning during the COVID-19

Kumar P, Kumar N, Ting H

Curr Psychol, 2023;42(3):2460-2470.
PMID: 34253947 DOI: 10.1007/s12144-021-02053-3

Due to the outbreak of Covid-19, the colleges and universities across the world have shifted to online classes in place of face-to-face classes. In the wake of this outbreak, the present study focuses on analyzing the impact of sudden shift to online classes, on the undergraduate and postgraduate student's overall learning. The PLS-SEM results concluded that the content delivery has been the most significant construct to impact both self-efficacy and overall learning. The self-efficacy partially mediates the support and equity relationship with the overall learning. The student with greater self-efficacy will have better overall learning from this e-synchronous teaching methodology. However, content delivery has a stronger role in impacting the overall learning even if there is absence of self-efficacy, thus concluding no mediation.
Impact of emotional intelligence and spiritual intelligence on the caring behavior of nurses: a dimension-level exploratory study among public hospitals in Malaysia

Kaur D, Sambasivan M, Kumar N

Appl Nurs Res, 2015 Nov;28(4):293-8.
PMID: 26608428 DOI: 10.1016/j.apnr.2015.01.006

PURPOSE: The purpose of this research is to study the impact of individual factors such as emotional intelligence (EI) and spiritual intelligence (SI) on the caring behavior of nurses.
METHODS: A cross-sectional survey using questionnaire was conducted by sampling 550 nurses working in seven major public hospitals in Malaysia. Data were analyzed using structural equation modeling (SEM).
RESULTS: The main findings are: (1) critical existential thinking and transcendental awareness dimensions of SI have significant impacts on assurance of human presence dimension of caring behavior; (2) personal meaning production and conscious state expansion dimensions of SI have significant impacts on perception of emotion and managing own emotions dimensions of EI; and (3) managing own emotions dimension of EI has significant impacts on respectful deference to other and assurance of human presence dimensions of caring behavior of nurses.
CONCLUSION: The results can be used to recruit and educate nurses.
KEYWORDS: Caring behavior; Emotional intelligence; Malaysia; Nurses; Spiritual intelligence
Fulltext Individual skills based volunteerism and life satisfaction among healthcare volunteers in Malaysia: role of employer encouragement, self-esteem and job performance, a cross-sectional study

Veerasamy C, Sambasivan M, Kumar N

PLoS One, 2013;8(10):e77698.
PMID: 24194894 DOI: 10.1371/journal.pone.0077698

The purpose of this paper is to analyze two important outcomes of individual skills-based volunteerism (ISB-V) among healthcare volunteers in Malaysia. The outcomes are: job performance and life satisfaction. This study has empirically tested the impact of individual dimensions of ISB-V along with their inter-relationships in explaining the life satisfaction and job performance. Besides, the effects of employer encouragement to the volunteers, demographic characteristics of volunteers, and self-esteem of volunteers on job performance and life satisfaction have been studied. The data were collected through a questionnaire distributed to 1000 volunteers of St. John Ambulance in Malaysia. Three hundred and sixty six volunteers responded by giving their feedback. The model was tested using Structural Equation Modeling (SEM). The main results of this study are: (1) Volunteer duration and nature of contact affects life satisfaction, (2) volunteer frequency has impact on volunteer duration, (3) self-esteem of volunteers has significant relationships with volunteer frequency, job performance and life satisfaction, (4) job performance of volunteers affect their life satisfaction and (5) current employment level has significant relationships with duration of volunteering, self esteem, employer encouragement and job performance of volunteers. The model in this study has been able to explain 39% of the variance in life satisfaction and 45% of the variance in job performance. The current study adds significantly to the body of knowledge on healthcare volunteerism.
Effect of spiritual intelligence, emotional intelligence, psychological ownership and burnout on caring behaviour of nurses: a cross-sectional study

Kaur D, Sambasivan M, Kumar N

J Clin Nurs, 2013 Nov;22(21-22):3192-202.
PMID: 24118522 DOI: 10.1111/jocn.12386

AIMS AND OBJECTIVES: To propose a model of prediction of caring behaviour among nurses that includes spiritual intelligence, emotional intelligence, psychological ownership and burnout.
BACKGROUND: Caring behaviour of nurses contributes to the patients' satisfaction, well-being and subsequently to the performance of the healthcare organisations. This behaviour is influenced by physiological, psychological, sociocultural, developmental and spiritual factors.
DESIGN: A cross-sectional survey was used, and data were analysed using descriptive statistics and structural equation modelling.
METHODS: Data were collected between July-August 2011. A sample of 550 nurses in practice from seven public hospitals in and around Kuala Lumpur (Malaysia) completed the questionnaire that captured five constructs. Besides nurses, 348 patients from seven hospitals participated in the study and recorded their overall satisfaction with the hospital and the services provided by the nurses. Data were analysed using structural equation modelling (SEM).
RESULTS: The key findings are: (1) spiritual intelligence influences emotional intelligence and psychological ownership, (2) emotional intelligence influences psychological ownership, burnout and caring behaviour of nurses, (3) psychological ownership influences burnout and caring behaviour of nurses, (4) burnout influences caring behaviour of nurses, (5) psychological ownership mediates the relationship between spiritual intelligence and caring behaviour and between emotional intelligence and caring behaviour of nurses and (6) burnout mediates the relationship between spiritual intelligence and caring behaviour and between psychological ownership and caring behaviour of nurses.
CONCLUSIONS: Identifying the factors that affect caring behaviour of nurses is critical to improving the quality of patient care. Spiritual intelligence, emotional intelligence, psychological ownership and burnout of nurses play a significant role in effecting caring behaviour of nurses.
RELEVANCE TO CLINICAL PRACTICE: Healthcare providers must consider the relationships between these factors in their continuing care and incorporation of these in the nursing curricula and training.
Fulltext Intention to adopt clinical decision support systems in a developing country: effect of physician's perceived professional autonomy, involvement and belief: a cross-sectional study

Sambasivan M, Esmaeilzadeh P, Kumar N, Nezakati H

BMC Med Inform Decis Mak, 2012;12:142.
PMID: 23216866 DOI: 10.1186/1472-6947-12-142

Computer-based clinical decision support systems (CDSS) are regarded as a key element to enhance decision-making in a healthcare environment to improve the quality of medical care delivery. The concern of having new CDSS unused is still one of the biggest issues in developing countries for the developers and implementers of clinical IT systems. The main objectives of this study are to determine whether (1) the physician's perceived professional autonomy, (2) involvement in the decision to implement CDSS and (3) the belief that CDSS will improve job performance increase the intention to adopt CDSS. Four hypotheses were formulated and tested.
Adoption of clinical decision support systems in a developing country: Antecedents and outcomes of physician's threat to perceived professional autonomy

Esmaeilzadeh P, Sambasivan M, Kumar N, Nezakati H

Int J Med Inform, 2015 Aug;84(8):548-60.
PMID: 25920928 DOI: 10.1016/j.ijmedinf.2015.03.007

The basic objective of this research is to study the antecedents and outcomes of professional autonomy which is a central construct that affects physicians' intention to adopt clinical decision support systems (CDSS). The antecedents are physicians' attitude toward knowledge sharing and interactivity perception (about CDSS) and the outcomes are performance expectancy and intention to adopt CDSS. Besides, we include (1) the antecedents of attitude toward knowledge sharing-subjective norms, social factors and OCB (helping behavior) and (2) roles of physicians' involvement in decision making, computer self-efficacy and effort expectancy in our framework.
Morphohistological analysis of the prevalence and distribution of atheroma in the abdominal aorta and its branches: a cadaveric study

Kumar N, Aithal AP, Verma S

J Vasc Bras, 2021;20:e20210014.
PMID: 34267790 DOI: 10.1590/1677-5449.210014

Background: Aneurysms and atheromatous processes are prominent pathological features that are commonly associated with significant morbidity and mortality.
Objectives: This cadaveric study was conducted to evaluate the morphometric and histological aspects of atheromatous plaque formation in abdominal aortas and their branches and their associated morphological variations, if present, characterized by loops, kinking, or tortuosity.
Methods: The study was performed using 30 human cadavers (approx. 65-75 years). Frequency of occurrence of calcified plaques in the abdominal aorta and its branches and their morphometric measurements were noted and histological features were observed with the aid of Hematoxylin & Eosin staining.
Results: Variations in the abdominal aorta and the common iliac artery were observed in 16.6% of specimens. Atheromatous plaque formation was seen in 2 specimens (1 specimen was associated with kinking) while in 3 other specimens only variation in normal structure (kinking/ tortuous artery) was observed. Histological analysis showed foamy macrophages and dense calcification, giving an atheromatous appearance.
Conclusions: Cadaveric reports of the location, nature, and degree of plaque formation in the abdominal aorta and its branches are extremely important in clinical settings and for choosing treatment options.
Vitamin D and COVID-19 Infection

Ainine A, Heward E, Kapasi R, Rocke J, Darby D, Kumar N, et al.

Med J Malaysia, 2021 11;76(6):881-883.
PMID: 34806677

INTRODUCTION: The COVID-19 pandemic has prompted the medical world to look at factors that may influence outcomes. There have been connections made between vitamin D and COVID-19, as vitamin D has previously been shown to play a role in the maintenance of immune homeostasis.
MATERIALS AND METHODS: We performed a prospective cohort study on 103 patients at Wigan Wrightington and Leigh NHS Foundation Trust looking at serum vitamin D levels of patients with positive COVID-19 swabs. Results were collated and correlations were made to compare vitamin D levels with age; severity of illness; hospital outcomes; and frailty. Comparisons were also made between frailty and outcome.
RESULTS: The results showed that there was a significant statistical difference between vitamin D levels and severity of infection: those who were treated in the intensive care units (ICU) (severe symptoms) had lower vitamin D levels than those treated on the ward (p=0.0446). There was also a correlation between vitamin D levels and frailty: those who were more frail had higher vitamin D levels than fitter patients (P=0.005). Vitamin D and frailty had no effect on hospital outcomes of COVID-19 infection.
CONCLUSION: Ultimately, we concluded that low vitamin D can increase susceptibility of contracting COVID-19, increase severity of infection but does not affect mortality.
Fulltext Lumbosacral Plexopathy in Pelvic Injury - A Cause of Hip Instability in Acetabular Fractures: A Report of Two Cases

Kumar N, Wayne-Yap MQ, Ebk K

Malays Orthop J, 2016 Jul;10(2):61-65.
PMID: 28435565 DOI: 10.5704/MOJ.1607.013

Lumbosacral plexopathy is a rare clinical entity that results in potentially severe neurological deficit. The clinical presentation of lumbosacral plexopathy includes motor and sensory deficits. However to the best of our knowledge, hip instability secondary to lumbosacral plexopathy has not been reported in current literature. We report two cases of pelvic injury in which recurrent hip subluxation occurred following fixation of acetabular fractures. We attribute this to inadequate hip muscle tension from the associated lumbosacral plexopathy. In patients with acetabular fractures, this may lead to debilitating hip joint instability. In an already traumatized hip joint, this instability has a poor prognosis and can lead to degenerative changes with the eventual need for hip replacement.
Helicobacter pylori in 2013: multiplying genomes, emerging insights

Ahmed N, Loke MF, Kumar N, Vadivelu J

Helicobacter, 2013 Sep;18 Suppl 1:1-4.
PMID: 24011237 DOI: 10.1111/hel.12069

We describe features of key additions to the existing pool of publicly accessible Helicobacter pylori genome sequences and sequences of Helicobacter pylori phages from April 2012 to March 2013. In addition, important studies involving H. pylori genomes, especially those pertaining to genomic diversity, disease outcome, H. pylori population structure and evolution are reviewed. High degree of homologous recombination contributes to increased diversity of H. pylori genomes. New methods of resolving H. pylori population structure to an ultrafine level led to the proposal of new subpopulations. As the magnitude of diversity in the H. pylori gene pool becomes more and more clear, geographic and demographic factors should be brought to analysis while identifying disease-specific biomarkers and defining new virulence mechanisms.
Fulltext Anti-snake venom and methanolic extract of Andrographis paniculata: a multipronged strategy to neutralize Naja naja venom acetylcholinesterase and hyaluronidase

Nayak AG, Kumar N, Shenoy S, Roche M

3 Biotech, 2020 Nov;10(11):476.
PMID: 33083200 DOI: 10.1007/s13205-020-02462-4

The study investigates the ability of methanolic extract of Andrographis paniculata (MAP) to supplement polyvalent anti-snake venom (ASV) in inhibiting neurotoxic enzyme acetylcholinesterase (AChE) and 'spreading factor' hyaluronidase from Naja naja (N.N) venom. AChE and hyaluronidase activity were measured in 100 or 200 µg of crude venom, respectively, and designated as 'control'. In Test Group I, enzyme assays were performed immediately after the addition of ASV/MAP/ASV + MAP to the venom. Inhibition of AChE by ASV (100-367 µg) was 12-17%, and of hyaluronidase (22-660 µg) was 33-41%. Under the same conditions, MAP (100-400 µg) inhibited AChE and hyaluronidase to the extent of 17-33% and 17-52%, respectively. When ASV (220 µg) and MAP (100-200 µg) were added together, AChE and hyaluronidase were inhibited to a greater extent from 39-63 to 36-44%, than when either of them was used alone. In Test Group 2, the venom was incubated with ASV/MAP/ASV + MAP for 10-30 min at 37 °C prior to the assay which enhanced AChE inhibition by 6%, 82% and 18% respectively, when compared to Test Group I. Though there was no change in inhibition of hyaluronidase in the presence of ASV, MAP could further increase the extent of inhibition by 27% and ASV + MAP upto 4%. In Test Group III, venom and substrate were incubated for 90 min and hyaluronidase activity was measured after the addition of inhibitors. Here, ASV + MAP caused increased inhibition by 69% compared to ASV alone. The study confirms the ability of phytochemicals in MAP to contribute to a multipronged strategy by supplementing, thereby augmenting the efficacy of ASV.
Fulltext Hepatoprotective effect of bone marrow-derived mesenchymal stromal cells in CCl4-induced liver cirrhosis

Aithal AP, Bairy LK, Seetharam RN, Kumar N

3 Biotech, 2021 Feb;11(2):107.
PMID: 33564610 DOI: 10.1007/s13205-021-02640-y

Bone marrow mesenchymal stromal cells (BM-MSCs) are multipotent stem cells which are ideal candidates for use in regenerative medicine. The objectives of this study were to evaluate the hepatoprotective effect of BM-MSC and its combination treatment with silymarin in carbon tetrachloride (CCl4)-induced liver cirrhosis animal model and to investigate whether tail vein or portal vein infusion was the ideal route for BM-MSC transplantation. 36 female Wistar rats were randomly divided into six groups (n = 6): Group 1 (normal control), Group 2 (received only CCl4, disease model), Group 3 (CCl4 + BM-MSCs through tail vein), Group 4 (CCl4 + BM-MSCs through portal vein), Group 5 (CCl4 + silymarin), Group 6 (CCl4 + BM-MSCs + silymarin). On the 21st day after treatment, blood samples were collected for biochemical estimations. After the experiment, the rats were sacrificed. Liver was dissected out and processed for histopathology and scanning electron microscopy studies. Liver enzyme and marker analysis, histopathological studies indicated that the combination of BM-MSCs and silymarin was effective in treating liver cirrhosis. Transplanted BM-MSCs in combination with silymarin ameliorated the liver tissue damage through their immunoregulatory activities. Among the two routes, the intravenous administration of cells through the tail vein was found to be more effective and safe.
Fulltext Evaluation of the merit of the methanolic extract of Andrographis paniculata to supplement anti-snake venom in reversing secondary hemostatic abnormalities induced by Naja naja venom

Nayak AG, Kumar N, Shenoy S, Roche M

3 Biotech, 2021 May;11(5):228.
PMID: 33959471 DOI: 10.1007/s13205-021-02766-z

Increasing evidence suggests a sizable involvement of hemotoxins in the morbidity associated with envenomation by the Indian spectacled cobra, Naja naja (N.N). This study investigates the ability of Indian polyvalent anti-snake venom (ASV), methanolic extract of Andrographis paniculata (MAP) and their combination in reversing the hemostatic abnormalities, viz. activated partial thromboplastin time(aPTT), prothrombin time(PT) and thrombin time(TT) in citrated plasma. These parameters were assessed in 2 groups of experiments. Group 1: Without the prior incubation of plasma with venom and Group 2: With prior incubation of plasma with venom for 90 min at 37°C. Venom caused significant (p
Application of DEA-Based Malmquist Productivity Index on Health Care System Efficiency of ASEAN Countries

Singh S, Bala MM, Kumar N, Janor H

Int J Health Plann Manage, 2021 Jul;36(4):1236-1250.
PMID: 33855765 DOI: 10.1002/hpm.3169

This study assesses and compares the productive efficiency of the national healthcare system of the ASEAN region which includes Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam amidst rising mortality rate from noncommunicable diseases (NCDs) in the Sustainable Development Goals (SDGs) era. Nonparametric data envelopment analysis technique based on the Malmquist Productivity Index is performed and its components, total factor productivity change, technical change and technological change are compared across the region. Two different models are considered in assessing and comparing the technical efficiency of the national healthcare system across the region with life expectancy at birth and mortality rate from NCDs as parallel health care output for both the models. The mean value of total factor productivity is 0.983 and 0.974 which suggests that national healthcare system productivity efficiency decays by 1.7% for Model I and 2.6% for Model II, respectively. This suggests that the health care system inefficiencies across the ASEAN region have not made life expectancy to improve as much as it should be and curtailed the mortality rate from growing chronic NCDs within a decade. The region is likely to lag behind in achieving SDGs 3 target 4 on reducing by one-third premature mortality from chronic NCDs unless the health care system's technical efficiency is improved across the region. The finding suggests a microlevel study on each country to identify major sources of healthcare system inefficiency in a bid to ameliorate it.
Concurrent Variations of Celiac and Superior Mesenteric Arteries

Satheesha Nayak B, Shetty SD, Sirasanagandla SR, Kumar N, Swamy Ravindra S, Abhinitha P

Kathmandu Univ Med J (KUMJ), 2019 11 16;16(64):345-347.
PMID: 31729351

Celiac trunk is the first ventral branch of the abdominal aorta. It usually terminates by giving three branches; the common hepatic artery, the left gastric artery and the splenic artery. We report a rare variation of the branching pattern of the celiac trunk. The Celiac trunk divided into two branches; left gastric artery and splenicogastroduodenal trunk. The splenico-gastroduodenal trunk divided into splenic and gastroduodenal arteries. The superior mesenteric artery and hepatic artery took origin from a common hepato-mesenteric trunk. The hepatic artery had a winding course around the portal vein and hepatic duct. The knowledge of these variations is important while doing radiological investigations and liver transplant and pancreatic surgeries.
Ratio Analysis Evaluation of Dermal Collagen and Elastic Fiber Contents: A Comparison of the Horizontal and Vertical Directions of Skin Tissues

Kumar N, Kumar P, Nayak B S, Aithal P A, Guru A

J Clin Aesthet Dermatol, 2019 Dec;12(12):21-24.
PMID: 32038760

Background: Stretching force on the skin leads to the widening of scars and/or hypertrophy. The uneven distribution profile of collagen and elastic fibers in the human dermis (evaluated based on their topographic areas) might determine the direction of incision for a more pleasing aesthetic result. Materials and methods: Full-thickness skin samples were collected in the horizontal and vertical directions from 15 areas of 32 human cadavers. The histological preparation of the skin samples was performed using special Verhoeff-van Gieson staining. Image analysis in the TissueQuant software was performed using photomicrographs. Quantitative fraction measures for collagen and elastic fibers were completed. From the data obtained, various ratios between collagen in the horizontal (CH) and vertical (CV) directions and elastic fibers in the horizontal (EH) and vertical (EV) directions were established and expressed as CH:CV and EH:EV. Results: In the areas where CV:CH was less than 1 (low ratio of significance), the collagen content was significantly higher in the horizontal direction than the vertical direction (CH>CV). However, this finding is reversed (CV>CH) in areas where CV:CH is greater than 1 (high ratio of significance). Similarly, in areas where EV:EH is less than 1 (low ratio of significance), the elastic fiber content was significantly higher in the horizontal direction than the vertical direction (EH>EV), whereas such is reversed (EV>EH) where EV:EH is greater than 1 (high ratio of significance). Conclusion: The evaluation of ratios of dermal collagen and elastic fibers in different directions together with the data of asymmetric distribution provide a useful guideline for aesthetic surgeons looking to place elective incisions in the direction that will ensure an improved aesthetically pleasing result.

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