bluuebunny/crossref_metadata_2025 huggingface dataset:
Glaucoma burden and its profile in a tertiary care centre of North-East India: A retrospective hospital-based study
Authors: Nongrum Benjamin , Thangkhiew Lanalyn , Natung Tanie , Pandey Ishita , Shullai Wakaru , Wahlang Julie B. , Sundaram Shanthosh Priyan
Published: September 2024

ABSTRACT

Purpose:

To estimate the proportion and pattern distribution of glaucoma disease in a teaching hospital of North-East India.

Materials and Methods:

Retrospective hospital-based study of glaucoma cases from January 2014 to December 2022.

Results:

Out of a total of 89725 new patients, 449 patients had glaucoma with a prevalence of 0.50% (95% CI: 0.46%-0.55%) of which 361 (80.4%) were ≥40 years and 88 (19.6%) were <40 years. The commonest type was POAG (32.1%) followed by PACG (17.6%) while JOAG was 7.8%. Males (67.2%) were predominant with a male: female ratio of 2.0:1. The mean age of patients was 53.4 (17.1) years. PACG was found to be significantly higher among females (p=0.001) whereas POAG was higher among males (p=0.003). There was no association of either age or systemic conditions with the prevalence of POAG and PACG. Hypertension and diabetes were present among 139 (31.0%) and 103 (23.0%) respectively while 13 (2.9%) had chronic obstructive pulmonary disease (COPD), 5 had coronary artery disease (CAD) and 5 hypothyroidism.

Conclusion:

The prevalence of glaucoma though lower compared to other parts of the country, the number was significant, warranting screening activities owing to its silent nature. PACG was significantly higher among females while POAG was higher among males. Systemic factors like COPD, CAD and hypothyroidism require further studies for better understanding of the temporal association with glaucoma.
Virtual care is a double-edged sword: Adjusting preventive care service delivery in community health clinics during COVID-19
Authors: Papajorgji-Taylor Dea , Sheppler Christina R. , McMullen Carmit , O’Connor Patrick J. , Gold Rachel
Published: September 2024

ABSTRACT

Purpose:

Qualitatively examine how community health clinics delivered cardiovascular disease (CVD) preventive care during COVID-19 using virtual care and related adaptations.

Methods:

Semi-structured interviews were conducted in 2021–2022 with nine clinician leaders from four clinics across the country that share an electronic health record. Interviews covered: (1) the pandemic’s impact on preventive care delivery, (2) the adaptation and role of virtual care, and (3) management of CVD risk in this context. Collected data were analyzed using a thematic analysis approach.

Results:

Staff reported substantial pros and cons to virtual care for CVD risk management. It was seen as useful for general check-ins with patients. However, without current laboratory results and vital measurements, providers found it challenging to assess patient CVD risk and direct care accordingly.

Conclusion:

Findings add to the evolving evidence base that the necessary pivot to virtual care during the pandemic spurred innovations but also created limitations and delays in delivering appropriate preventive care.
Exploring the link between leptin levels and metabolic syndrome in elderly Indian patients: Implications for family medicine and primary care practices
Authors: Singhal Arjun Kumar , Singh Gaurav , Singh Shravan Kumar , Karunanand Busi , Gunjan Gagan , Agrawal Sonu K.
Published: September 2024

ABSTRACT

Background:

The metabolic syndrome (MetS), according to the Adult Treatment Panel III of the National Cholesterol Education Programme, is a collection of metabolic abnormalities that includes one, two, or all three of the following traits: obesity in the abdomen, dyslipidemia, hypertension, fasting blood sugar, or insulin resistance. This study’s aim was to assess the relationship between fasting serum leptin and MetS in elderly adults with T2DM in the Northern Indian population.

Material and Methods:

The following information was collected from all the participants: (1) anthropometric data, (2) biochemical data, and (3) a lifestyle questionnaire on sociodemographic data, dietary practices, smoking, and alcohol intake to identify their risk factors for diabetes mellitus, CVD, and hypertension.

Results:

A total of 36 older participants (56.30%) had a history of hypertension, while 29 elderly participants (44.61%) had diabetes mellitus. A total of 32 elderly participants (49.2%) had MetS, and this group had higher serum leptin (P 0.003), body weight (P = 0.019), BMI (P 0.001), waist circumference (P 0.001), CRP (P = 0.021), insulin (P = 0.001), and HOMA-IR (P = 0.003) values as well as higher percentages of females (P = 0.001), and those with type 2 diabetes mellitus (P = 0.002) and hypertension (P = 0.039) than those in the non-MetS group.

Conclusion:

In older persons with T2DM, our study discovered a favorable correlation between serum leptin and MetS. It can act as a standalone indicator of MetS, offering a way to spot populations at risk for associated consequences and enabling early intervention.
From data to decisions: Exploring family planning services utilization in Karnataka and India through the prism of NFHS-4 and NFHS-5
Authors: Kulkarni Namratha , Kumar Saurabh , Havaldar Pavan P.
Published: September 2024

ABSTRACT

Background:

Family planning (FP) services are pivotal in assessing a country’s healthcare efficacy. Despite India’s strides in FP promotion, disparities persist in its utilization rates. This study analyzes Karnataka’s FP trends by using National Family Health Survey (NFHS) rounds 4 and 5, comparing its indicators with national averages.

Methods:

A retrospective record review-based descriptive study design was employed. Data from NFHS-4 (2015–16) and NFHS-5 (2019–21) were analyzed using MS Excel 365. Key variables included age at marriage, total fertility rate (TFR), and various contraceptive methods.

Results:

Karnataka exhibited a stable rate of early marriages for women and a decline among men aged 25–29 years. TFR in Karnataka slightly decreased, with increased contraceptive usage and significant growth in modern contraceptive methods. However, male sterilization rates remained low. There was an improvement in health workers’ engagement with female non-users and in providing information on contraceptive side effects.

Conclusion:

While Karnataka has progressed in FP, challenges such as early marriages persist. Enhancing integration, leveraging technology, and empowering women are essential for comprehensive FP services in India.
Coverage evaluation of Iron folic acid and vitamin A supplementation among children in rural Puducherry—A Mixed method study
Authors: Mohan Reenaa , Vaishnavi B Sowbarnika , Premanandh Kandasamy
Published: September 2024

ABSTRACT

Background:

Despite many measures taken by the government, still the problem of Vitamin A deficiency and anaemia exists among children. This study focuses on coverage of iron and folic acid and Vitamin A supplementation among children aged between 9 months and 5 years and to find out the barriers in administrating these supplements to children.

Methods:

An explanatory sequential mixed methodology was conducted in the field practice area of Thirubuvanai primary health centre. In the quantitative survey, a cross-sectional cluster sampling survey was conducted to find the coverage of IFA and Vitamin A supplementation among children (n = 215), followed by a qualitative interview (n = 14) to find out the barriers in administrating these supplements to children was conducted among the mothers.

Results:

Our study found that Vitamin A supplementation coverage was taken only by 42% of the children in the last 6 months preceding the survey. IFA supplementation was taken by 31.2% of the children in the last 7 days preceding the survey. Lack of awareness, myths and misbeliefs, fear of adverse effects and lack of family support were found as barriers in administering the supplement to the children.

Conclusion:

The study findings have highlighted the need for community health education to improve the coverage of supplement administration.
Risk and protective factors of miscarriage: Evidence from a nationally representative sample of women in India
Authors: Sonu H S , Das Sumit Kumar , Tony Roshni , Binu V S
Published: September 2024

ABSTRACT

Context:

Miscarriage is the most distressing complication in early pregnancy, with one in every five pregnant women ending in a miscarriage, and its causes are multifactorial.

Aim:

This study aimed to find the risk and protective factors of miscarriage among women aged 15–49 years in India by using the National Family Health Survey (NFHS-5) data.

Methods and Material:

The data were taken from NFHS-5; 53,560 women aged 15–49 years who had reported either a miscarriage (n = 5104) or livebirth (n = 48,456) during the last 12 months preceding the survey were included in the study.

Statistical Analysis Used:

Various sociodemographic, lifestyle, comorbid, and fertility-related factors were considered in the Poisson regression analysis, and adjusted prevalence ratios were obtained.

Results:

Significant sociodemographic risk factors were age less than 20 years or more than 34 years, urban residence, primary and higher education levels, wealth index middle and above, and occupation as employed. Muslim religion, Scheduled Tribe, and Other Backward Class castes were statistically significant protective factors. Obesity, severe anemia, hypertension, and thyroid disorder were the significant comorbid risk factors, whereas tobacco chewing was the only significant lifestyle risk factor. A higher number of ever-born children was the fertility-related risk factor, whereas the use of intrauterine devices was a significant protective factor for miscarriage.

Conclusions:

To reduce the incidence of miscarriage in developing countries like India, the respective governments and healthcare providers should develop intervention programs targeting women in well-educated and high-income families.
Constrains for attending District Early Intervention Centre (DEIC) of Purba Bardhaman district, West Bengal: Perspectives of both service providers and caregivers of the beneficiaries, a Mixed-Method Study
Authors: Bhattacharya Haimanti , Mandal Sutapa , Taraphdar Pranita , Das Sulagna
Published: September 2024

ABSTRACT

Rashtriya Bal Swasthya Karyakram (RBSK) is an ongoing screening program that deals with early detection and management of the 4Ds prevalent in children (defects at birth, diseases, deficiencies, and developmental delays). It runs a District Early Intervention Centre (DEIC), which is an interdisciplinary approach of a multidisciplinary team placed under one roof. It provides referral support to children detected with health conditions during health screening. Aims: This study was conducted to assess the clinicosocial profile characteristics of the beneficiaries attending DEIC and to explore the challenges faced by both the caregivers and service providers. Settings and Design: A facility-based, mixed-method study with phenomenological approach was conducted in Burdwan Medical College of Purba Bardhaman district, West Bengal, from January 2023 to April 2023. Methods and Materials: For quantitative part, record analysis was conducted involving all children enrolled at DEIC from January 2022 to December 2022, and for qualitative part, caregivers and service providers were selected purposively and interviewed using the in-depth-interview (IDI) guide. Inductive thematic analysis was conducted simultaneously till data saturation was achieved. Statistical Analysis Used: The principles of descriptive statistics were applied to organize and present the quantitative data in tables and diagrams. Qualitative data were transcribed into verbatim and analyzed thematically with inductive approach. Results: Out of 3332 children enrolled, 58.4% were males, and 44.2% were aged between 0 and 1 month. 59.3% of them had developmental delays, 7.9% had defects, 42.9% had diseases, and 21.3% had some deficiencies. Major hindering factors in service provision among service providers were resource deficiency, inadequate capacity building, administrative bottlenecks, limited supportive supervision, inadequate advocacy, and awareness deficit. No major constraints were found from caregivers’ perspective in accessing healthcare. Conclusions: DEIC is running with shortage of proper infrastructure and adequate supervision. Periodic training, appropriate awareness building, and continuous flow of logistics are needed to ensure a better quality of life among beneficiaries.
Current trend of sexual maturity, teeth eruption, and bone fusion in the present female population, relative to documented age and development of prediction model for age of females
Authors: Nath Anamika , Thakuria Pradip K. , Gogoi Nitu K. , Debnath Ambalika
Published: September 2024

ABSTRACT

Background:

Understanding sexual maturity and bone fusion is crucial in forensic investigations and legal contexts. This study investigates the contemporary trend of sexual maturity and bone fusion in females, comparing the observed age-related characteristics with documented ages. Such analyses contribute to the accuracy of age estimation methods used in medico-legal scenarios.

Methods:

A comprehensive study was conducted involving a diverse sample of females, and their sexual maturity and bone fusion were assessed relative to documented ages. The research utilized a cross-sectional design, collecting data through interviews, medical examinations, and radiographic imaging. Ethical approval was obtained, and participants provided informed consent. Variables included documented age, age of menarche, stages of sexual maturity, dentition, and bone fusion. Validation of model performance was conducted.

Results:

Among 70 cases studied, the mean age of menarche was 10.48 years (range: 7–12 years). Maternal reports indicated menarche onset between 12–17 years. Tanner’s Staging 5 for pubic hair and fully developed breasts occurred at 14 years. Permanent teeth increased with age, with 28 or more teeth present at age 14 or above. Fusion of the distal end of the Radius and Ulna with the parent bone was positive from 15 years onwards. The regression model predicted age accurately (97.99% fit).

Conclusion:

The results highlight the early onset of sexual maturation, consistent teeth eruption, and bone fusion patterns in females. The observed correlations offer valuable insights for medicolegal practitioners and forensic experts.
Awareness of rhinoplasty surgery among the population in the Jazan Region, Saudi Arabia
Authors: Khawaji Nehad K. , Mokarbesh Hadi M. , Kariri Khalil I. , Dallak Fatimah H. , Othathi Faisal A. , Hakami Ayman M. , Wafi Abdulaziz Y.
Published: September 2024

ABSTRACT

Background:

Cosmetic and plastic surgery is becoming increasingly prevalent all over the world among both men and women. Saudi Arabia ranks 22nd among the top 25 countries with the world’s highest rates of cosmetic surgeries. This study aimed to assess the awareness of the population in the Jazan region regarding rhinoplasty surgery and to identify their main determinants.

Material and Methods:

A cross-sectional study of 425 participants was conducted at four randomly selected malls in Gizan City. A self-administered questionnaire was first developed to collect the data necessary to fulfill the research objectives, data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22. The quantitative data were reported as a mean and standard deviation, and the qualitative data were reported as frequency and percentage. Regarding tests for significance, the Chi-square test used a P value less than 0.05 as an indicator of significance. Logistic regression was used to detect the predictors of poor knowledge of rhinoplasty surgery.

Results:

The mean age of the participants was 39.46 ± 10.08. Of the participants, 53.6% have poor knowledge while 36.0% have good knowledge regarding rhinoplasty surgery. Moreover, 60.2% have an unfavorable attitude while 23.6% have a favorable attitude toward rhinoplasty surgery. The most important predictors of poor knowledge of rhinoplasty surgery are as follows: (a) old age (OR = 4.89), (b) illiteracy (OR = 4.12), (c) intermediate education (OR = 3.65), and (d) male sex (OR = 1.18).

Conclusion:

There was a low level of knowledge regarding rhinoplasty surgery among the study participants, most of the participants had negative (unfavorable) attitudes toward rhinoplasty surgery. Mass media plays an important role as a source of information. We recommend further studies to find out other personal factors affecting knowledge and attitude toward rhinoplasty surgery.
Development of Protocol for the Indian Council of Medical Research (ICMR) task force study to strengthen the implementation of National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) in tribal population
Authors: Raina Sunil Kumar , Babu Bontha V. , Basappa Yogish C. , Hazarika Chaya R. , Jebasingh Felix K. , Masoodi Shariq R. , Thomas Nihal , Kerketta Anna S. , Menon Nand Kumar
Published: September 2024

ABSTRACT

Understanding the health culture of tribal community is important as health problems among tribal communities and their care is influenced by sociocultural factors, which will help in the implementation of health services. The conventional way of improving the access for the general populations may not suit the tribal populations owing to their distinct culture and owing to health systems factors as well. A stepwise process was followed for the development of a protocol to study to strengthen the implementation of National Programme for Prevention and Control of Non-Communicable Diseases. The study was planned to be carried out across six tribal districts of India. A detailed protocol was built around Implementation Research Logic Model, primarily as a method for planning, executing, reporting, and synthesizing the implementation.
Burden of care in caregivers of patients with schizophrenia in Greater Noida, U.P., India
Authors: Maan Nikita , Kumar Abhinit , Nayar Nikhil , Kumar Kunal , Sheoran Chaitanya
Published: September 2024

ABSTRACT

Background:

Schizophrenia is a serious mental illness that causes major functional impairments, raises the risk of disability, and reduces life expectancy. It affects around 7 in 1000 people b/w the age of 15 and 35 years. Schizophrenia poses a great challenge not only for the patient but also for the people and the society around the patient. Family members who serve as informal primary carers may suffer personal expenses as a result of providing care for those who have major mental illnesses. One outcome that is regularly studied is the caregiver burden or the challenges encountered in providing care.

Aims:

Burden of care in caregivers of patients with schizophrenia in Greater Noida, U.P, India.

Methods:

This cross-sectional study was carried out at the School of medical sciences and Research, Sharda University. We enrolled 100 caregivers and it is assessed through the burden assessment scale.

Results:

Caregivers ranged in age from 20 to 85, with a mean age of 47 (SD=14.1). The male-to-female ratio was 1.7, with 63 men and 37 women present. The majority of the caregivers were parents (n=54), siblings (n=9), spouses (n=10), or their children (n=5). On the burden assessment scale, the severity of the burden was found on the basis of mild, moderate, severe, and very severe.

Conclusion:

It is important to understand the mental health of caregivers in order to develop an appropriate intervention to deal with their mental health problems. Therefore, this study highlighted the need for psychological interventions not only for the patients but also for caregivers.
Evaluation of Successful and Failed Filtering Blebs after Trabeculectomy Using Anterior Segment Optical Coherence Tomography
Authors: Tekin Serek , Seven Erbil , Batur Muhammed , Özer Muhammet D , Yasar Tekin
Published: September 2024

Purpose:

To evaluate filtering bleb characteristics using anterior segment optical coherence tomography (AS-OCT) and analyze correlations between these parameters and intraocular pressure (IOP).

Methods:

The study included 54 eyes of 43 patients who underwent trabeculectomy with mitomycin-C. The patients were divided into two groups based on mean postoperative IOP. The criterion for surgical success was mean unmedicated postoperative IOP ≤18 mmHg. Patients with IOP values >18 mmHg were prescribed anti-glaucoma drops and classified as a surgical failure. All patients underwent AS-OCT, and maximum bleb height, maximum bleb wall thickness, and maximum fluid-filled cavity height were measured. AS-OCT bleb parameters were compared between the successful and failed groups.

Results:

Of the 54 eyes, 37 (68.5%) were in the successful group, and 17 (31.5%) were in the failed group. Mean preoperative IOP values in the successful and failed groups were 26.9 ± 6.5 mmHg and 22.9 ± 4.9 mmHg, preoperatively, versus postoperative values of 13.3 ± 2.1 mmHg and 22.8 ± 2.8 mmHg, respectively. Mean postoperative follow-up time was 17.4 ± 9.5 months in the successful group and 19.1 ± 10.1 months in the failed group (P = 0.22). In the successful and failed groups, mean bleb height was 1473.7 ± 150.6 μm and 1165.4 ± 217 μm (P < 0.001), bleb wall thickness was 670.5 ± 119.9 μm and 538.8 ± 144.3 μm (P = 0.001), and fluid-filled cavity height was 736.5 ± 196.8 μm versus 532.5 ± 226.2 μm (P = 0.001), respectively.

Conclusions:

The results of this study showed that higher AS-OCT values for bleb height, wall thickness, and fluid-filled cavity height were associated with greater functional success. These parameters may be helpful in determining bleb functionality.
Scleral Compromise in Hereditary Porphyria Cutanea Tarda
Authors: Paez Soria Eugenia Andrea , Cremona Federico Andres , Lucero Saá Francisco , Chiaradía Pablo
Published: September 2024

Purpose:

To report a case of bilateral scleral compromise in a male patient with hereditary porphyria cutanea tarda (PCT).

Methods:

Case report.

Results:

A 57-year-old male was referred to the Cornea Service at Hospital de Clinicas in Buenos Aires for bilateral scleral thinning. He claimed ocular discomfort and photophobia. Slit-lamp biomicroscopy revealed an oval area of deep scleral thinning without uveal prolapse, adjacent to a conjunctival hyperemic zone in the interpalpebral area, 2 mm temporal to the limbus in the right eye. The left eye presented with a conjunctivalized scleral thinning in the interpalpebral area, 2 mm temporal to the limbus. Physical examination revealed facial hyperpigmentation and hypertrichosis and multiple hypopigmented scars in hands and nails. His family history was positive for PCT. The diagnosis was made by urine porphyrin test and genetic molecular testing. In an attempt to reduce ocular and systemic levels of porphyrins, the patient was treated with oral hydroxychloroquine and repeated phlebotomies, altogether with specially designed glasses to avoid local exposure to sunlight.

Conclusions:

Scleral involvement is a rare manifestation of PCT. An adequate treatment, including interdisciplinary management may ameliorate ocular signs and symptoms.
Results of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy in Inflammatory Choroidal Neovascularization
Authors: Zina Sourour , Khochtali Sana , Invernizzi Alessandro , Ksiaa Imen , Hager Ben Amor , Viola Francesco , Abroug Nesrine , Khairallah Moncef
Published: September 2024

Purpose:

To report the visual outcomes of intravitreal (IVT) anti-vascular endothelial growth factor (anti-VEGF) in inflammatory choroidal neovascularization (iCNV).

Methods:

A retrospective study of 43 eyes of 38 patients with active choroidal neovascularization (CNV) related to ocular inflammatory disease, treated with IVT injections of anti-VEGF (bevacizumab, ranibizumab, or aflibercept), with or without associated systemic anti-inflammatory therapy, at Fattouma Bourguiba University Hospital, Monastir, Tunisia (24 eyes of 23 patients) and at Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (19 eyes of 15 patients) from January 1, 2013, to December 31, 2018.

Results:

The mean age was 35.5 ± 16.4 years. The sex ratio male:female was 0.27. Seventeen eyes (39.5%) of 17 patients (44.7%) had only anti-VEGF injections, and 26 eyes (60.5%) of 21 patients (45.3%) had anti-VEGF injections and associated systemic anti-inflammatory therapy. Bevacizumab was injected in 36 eyes (83.7%), ranibizumab in six eyes (14%), and aflibercept in one eye (2.3%). Mean follow-up was 20.3 ± 19.2 months (range, 6–106 months). Mean visual acuity improved from 0.8 ± 0.37 logMAR (approximate Snellen equivalent 20/125) to 0.51 ± 0.42 logMAR (approximate Snellen equivalent 20/63) (P < 0.001). Mean central macular thickness on optical coherence tomography decreased from 403.7 ± 121.9 to 293.7 ± 82.8 μm (P < 0.001). Mean gain of vision was 2.9 ± 3.1 lines. The mean number of injections was 2.5. Twenty eyes (46.5%) received a single injection. There were no side effects related to the IVT injections of anti-VEGF.

Conclusions:

CNV is a sight-threatening complication of uveitis. IVT anti-VEGF seems to be an effective and safe treatment for iCNV when inflammation is controlled.
Adverse Events of Femtosecond-Assisted Laser-Assisted In situ Keratomileusis: A Manufacturer and User Facility Device Experience Database Study
Authors: Hong Sungmin , Yu Austin , Wong Amanda , Adamovich-Zeitlin Richard , Shah Paras , Minaya Josue , Wang Carol , Peng Travis , Saleem Matthew , Lau Nathan , Gupta Rohun , Gorski Matthew , Winokur Jules , Zhu Daniel
Published: September 2024

Purpose:

To analyze the United States Food and Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE) database, which contains reports of adverse events involving medical devices, and characterize the most common adverse events of femtosecond (FS) laser-assisted in situ keratomileusis (LASIK).

Methods:

The MAUDE database was queried on May 19, 2022, for adverse events involving the ophthalmic FS laser reported from January 2012 to April 2022. Reports unrelated to LASIK procedures were excluded. Data extraction was performed on these reports, including the type of adverse event and whether surgery was successfully completed. Frequency analysis was performed using the Statistical Package for the Social Sciences.

Results:

From the 3491 reported adverse events involving the FS laser system, 1136 met the inclusion criteria. Of the 672 cases where outcomes were reported, 476 were successfully completed and 196 were aborted. The most common intraoperative complications were incomplete cut (42.8%), thinner than intended flap (17.6%), and difficulty lifting the flap (12.0%). FS-related complications included opaque bubble layer (2.3%), air bubbles in the anterior chamber (2.4%), and vertical gas breakthrough (4.1%). Other device-related intraoperative complications included suction loss (10.2%), difficulty docking (2.4%), and laser malfunction (2.0%). The most common postoperative complications were diffuse lamellar keratitis (DLK) (7.8%) and rainbow glare (4.6%).

Conclusion:

The most common intraoperative FS-assisted LASIK complication in the MAUDE database was an incomplete flap. The most common postoperative complication was DLK. This study is the first to investigate FS-assisted LASIK adverse events in the MAUDE database. It can raise awareness of real-world surgical complications and help ophthalmologists better counsel and treat patients.
Development of Progressive Chiari I Malformation in a Child with Unilateral Sporadic Retinoblastoma
Authors: Karimi Saeed , Arabi Amir , Shahraki Toktam , Ansari Iman , Safi Sare
Published: September 2024

Purpose:

To report a case of progressive Chiari malformation type I (CIM) in a patient with unilateral sporadic retinoblastoma (RB) treated with intra-arterial chemotherapy (IAC) and enucleation.

Methods:

A 5-year-old male patient with a history of RB in his left eye treated with IAC and enucleation presented to our clinic for routine RB surveillance. Radiotherapy had not been used for the treatment of his RB.

Results:

A progressive herniation of cerebellar tonsils through the foramen magnum was detected on follow-up magnetic resonance imaging (MRI). Brain and cervical MRI revealed no central nervous system mass, hydrocephalus, or syringomyelia. There was no history of head trauma.

Conclusion:

Progressive CIM may occur in unilateral sporadic RB.
Clinicopathological Features and Management of Orbital Cholesterol Granuloma
Authors: Zhao Yun , Li Jiagen , Ji Zhongkun , Yu Shasha , Lin Jinyong , Zhao Hong
Published: September 2024

Purpose:

To investigate the clinical features, radiographic features, treatment strategies, pathological features, and prognosis of orbital cholesterol granuloma (CG).

Methods:

Twelve patients with orbital CG who were referred to Tianjin Eye Hospital between January 2002 and December 2020 were included in this retrospective case series study. Data collected including patient ophthalmic manifestations, imaging findings, treatment strategies, pathological features, and prognosis were retrospectively reviewed.

Results:

The patients comprised 10 males and 2 females. The mean age was 34.5 years (standard deviation [SD] = 8.9, median: 36 and range: 16–45 years). Four patients had a history of orbital trauma. The clinical manifestations at the first visit were proptosis (7/12, 58.3%), periorbital or eyelid swelling (6/12, 50%), limitation of eye movement (4/12, 33.3%), ptosis (2/12, 16.7%), and decreased visual acuity (1/12, 8.3%). Computed tomography (CT) showed a nonenhancing, well-circumscribed lesion in the orbit with extensive erosion of the adjacent frontal bone and temporal bone. Magnetic resonance imaging (MRI) showed a nonenhancing mass with intermediate-to-high signal intensity on T1- and T2-weighted images. Ten patients underwent lateral orbitotomy, and two patients underwent supraorbital orbitotomy. All patients had aggressive bone erosion. Histopathologic evaluation of the cyst contents and wall revealed cholesterol clefts, multinucleated giant cells, histiocytes, foamy macrophages, and altered blood pigments. The mean follow-up time of 79.6 months (SD = 49.8, range: 19–193 months). Three patients were lost to follow-up. No postoperative diminution of vision was noted, and no recurrence was observed.

Conclusions:

CGs can present as superotemporal or temporal orbital lesions. The diagnosis can be established based on CT and MRI. Most of the patients can have no history of orbital trauma.
The Effect of Acute Rises in Intraocular Pressure after Intravitreal Bevacizumab Injection on the Peripapillary Retinal Nerve Fiber Layer Thickness and the Role of Anterior Chamber Paracentesis
Authors: Khodabande Alireza , Zarei Mohammad , Khojasteh Hasan , Mohammadi Massood , Asadi Khameneh Esmaeil , Torkashvand Ali , Davoodabadi Mahmood
Published: September 2024

Purpose:

To evaluate acute changes in intraocular pressure (IOP) and their short-term effects on the peripapillary retinal nerve fiber layer (RNFL) thickness after intravitreal bevacizumab (IVB) injection.

Methods:

Fifty-eight eyes of 37 patients with treatment-naïve diabetic macular edema or exudative age-related macular degeneration were included in the study. Patients were divided into two groups, and the participants of each group received 3 monthly injections of IVB. IOP was measured right before the injection, immediately after the injection, and 5 min and 20 min after each injection. Peripapillary, RNFL thickness was measured before the injection and 1 month after the third injection. In the second group, anterior chamber (AC) paracentesis was performed before IVB injection.

Results:

IOP values after injection in all sessions were significantly higher in the first group (P < 0.001). The peripapillary RNFL thickness changes 1 month after the third injection was not statistically significantly different in each group (P = 0.816 and 0.773 for the first and second groups, respectively).

Conclusion:

AC paracentesis is an effective modality to reduce the acute rise in IOP. The effect of acute IOP elevation on the peripapillary RNFL thickness was not statistically significant.
Spontaneous Resolution of Posttraumatic Retinal Pigment Epithelium Tear and Associated Exudative Retinal Detachment
Authors: Panigrahi Pradeep Kumar , Minj Anita , Thareja Japesh , Navyasree Chinthala , Veerla Laukya Jyothsna Devi
Published: September 2024

Purpose:

To report a case of posttraumatic retinal pigment epithelium (RPE) tear complicated with exudative retinal detachment that underwent spontaneous resolution.

Methods:

Case report.

Results:

A 61-year-old healthy female presented with sudden-onset loss of vision in the left eye for 5 days following blunt trauma. She had undergone left upper eyelid and eyebrow laceration repair elsewhere. A comprehensive ophthalmic examination revealed a subfoveal RPE tear with exudative retinal detachment in the left eye. There was spontaneous healing of RPE tear and complete resolution of exudative retinal detachment 2 weeks following the initial presentation.

Conclusions:

RPE tear is an extremely rare complication following blunt trauma. The size of the RPE tear can play an important role in determining the final visual prognosis in such cases.
Q Fever Endocarditis with Bilateral Multifocal Retinitis: A Case Report
Authors: Maamouri Rym , Beizig Olfa , Mzoughi Khadija , Cheour Monia
Published: September 2024

Purpose:

To describe a case of bilateral retinitis in a patient with endocarditis and a serologically confirmed Q fever.

Methods:

A single case report documented with multimodal imaging.

Results:

A 55-year-old patient with culture-negative endocarditis was referred to our department for an ocular examination. His visual acuity was 20/20 in both eyes. Fundus examination showed white retinal infiltrates with few superficial retinal hemorrhages scattered in the posterior pole. There was no staining on fluorescein angiography. Swept-source optical coherence tomography (SS-OCT) revealed increased inner retinal reflectivity with a focal area of retinal thickening. Laboratory tests showed a high titer of antibodies against Coxiella burnetii. The patient was treated with doxycycline. Two weeks later, fundus examination showed partial resolution of retinitis with inner retinal thinning in SS-OCT.

Conclusions:

Multifocal retinitis is an uncommon presentation of Q fever. The diagnosis should be considered, especially when associated with culture-negative infective endocarditis, highlighting the importance of routine ocular examination.
Pseudohyperkalemia Revisited: An Updated Review of a Foremost Preanalytical Error of Serum or Plasma Potassium Measurement in the Clinical Laboratory
Authors: Okpara Henry Chima , Izuchukwu Emeka Callistus Onyeka , Ilechukwu E. C.
Published: September 2024

Background:

Potassium is one of the most abundant cations in the human body. Increased plasma potassium concentration (hyperkalemia) is one of the most common electrolyte abnormalities in contemporary clinical practice. Moderate and severe hyperkalemia are potentially life-threatening conditions and constitute medical emergencies. Measured hyperkalemia may be true hyperkalemia or false hyperkalemia (pseudohyperkalemia). Pseudohyperkalemia is due to false elevation of measured potassium concentration in vitro and it is a fairly common source of preanalytical error of potassium determination in the clinical laboratory.

Objective:

To review the general and recent concepts/mechanisms that underlie the phenomenon of pseudohyperkalemia in contemporary clinical practice.

Methods:

An up-to-date review of available literature and selected references on the phenomenon of pseudohyperkalemia, its causes, variants, mechanisms, clinical implications, identification, management, and prevention.

Conclusion:

Pseudohyperkalemia is a fairly common preanalytical error of potassium measurement in the clinical laboratory and a potential cause of misdiagnosis and unnecessary treatment of hyperkalemia. Exclusion of pseudohyperkalemia before the diagnosis of hyperkalemia (true hyperkalemia) is highly recommended.
Incidence and Risk Factors of Post-Transurethral Resection of the Prostate Urethral Strictures in a Black African Population
Authors: Calistus Amu Okwudili , Azubuike Affusim Emmanuel , Solomon Anyimba Kenchukwu , Chukwunonso Iwenofu Anthony , Chinonso Odo
Published: September 2024

Background:

One of the late complications of transurethral resection of the prostate (TURP) is urethral stricture. This is a disturbing problem more so in a resource-poor Black African community. We sought to prospectively study some of the implicated risk factors in literature.

Patients and Methods:

This was a prospective, observational study carried out at 82 Division Military Hospital, Enugu, Nigeria from 2015 to 2022.

Results:

One hundred and ninety-four patients that had TURP for BPH were studied. The mean age of the participants was 66.28 years (standard deviation = 8.19). Ten patients (5.15%) had urethral stricture after the surgery. None of the factors studied which include age, previous prostate surgery, preoperative urethral catheter duration, resection time, resected prostate size, the presence of diabetes mellitus, and postoperative urinary tract infection was found to have a significant risk for the development of urethral stricture post-TURP.

Conclusion:

More studies are required to unravel significant risk factors for urethral stricture following a TURP. It is probably due to the interplay of many factors.
Beyond wrecking a wall: revisiting the concept of blood–brain barrier breakdown in ischemic stroke
Authors: Castillo-González Julia , González-Rey Elena
Published: September 2024

The blood–brain barrier constitutes a dynamic and interactive boundary separating the central nervous system and the peripheral circulation. It tightly modulates the ion transport and nutrient influx, while restricting the entry of harmful factors, and selectively limiting the migration of immune cells, thereby maintaining brain homeostasis. Despite the well-established association between blood–brain barrier disruption and most neurodegenerative/neuroinflammatory diseases, much remains unknown about the factors influencing its physiology and the mechanisms underlying its breakdown. Moreover, the role of blood–brain barrier breakdown in the translational failure underlying therapies for brain disorders is just starting to be understood. This review aims to revisit this concept of “blood–brain barrier breakdown,” delving into the most controversial aspects, prevalent challenges, and knowledge gaps concerning the lack of blood–brain barrier integrity. By moving beyond the oversimplistic dichotomy of an “open”/“bad” or a “closed”/“good” barrier, our objective is to provide a more comprehensive insight into blood–brain barrier dynamics, to identify novel targets and/or therapeutic approaches aimed at mitigating blood–brain barrier dysfunction. Furthermore, in this review, we advocate for considering the diverse time- and location-dependent alterations in the blood–brain barrier, which go beyond tight-junction disruption or brain endothelial cell breakdown, illustrated through the dynamics of ischemic stroke as a case study. Through this exploration, we seek to underscore the complexity of blood–brain barrier dysfunction and its implications for the pathogenesis and therapy of brain diseases.
Smashed skin grafting in stable vitiligo: Efficacy and safety
Authors: Kaur Manjit , Malhotra Suresh Kumar
Published: September 2024

Background: Vitiligo is a common skin disorder that entails cosmetic disfigurement due to depigmentation and carries a social stigma. Smash grafting is an easy-to-master surgical treatment modality for stable vitiligo that has failed to respond to other treatments. The technique involves procuring a thin skin graft from a donor site, smashing it into the thinnest possible pieces, and grafting the smash onto the dermabraded vitiligo site. Objective: To analyze the efficacy and safety of smash grafting in patients with stable vitiligo. Materials and Methods: Thirty patients underwent smash grafting in stable recalcitrant vitiligo lesions. The patients were randomly placed in groups A and B. Group A received PUVASOL therapy postprocedure, while group B received only sunlight exposure after smash grafting. The patients were followed up every month for 3 months to assess repigmentation of the grafted site compared to the patient’s normal skin color. Results: Repigmentation was noticed at the grafted site starting as early as 3 weeks postprocedure in all the patients, and an increase in pigmentation intensity was observed until the end of the study follow-up. At the end of the 3-month follow-up, 76.66% of the patients had regained 50% or more pigmentation of the involved lesion. Conclusion: Smash grafting provided excellent repigmentation in >75% of patients without any significant complications. It is a simple and effective surgical technique that is underutilized. Furthermore, this procedure is less resource-intensive and easier to master than other surgical techniques for vitiligo.
Dr ALM’s Medicolegal Series – Part 2 – Expert Opinion
Authors: Sundaram Alagappan Meenakshi
Published: September 2024

A patient was admitted in a hospital for fever with chills and was treated for Typhoid fever but the patient deteriorated and referred to another hospital in moribund state. In the second hospital she was diagnosed to be suffering from Malaria but the patient died. The husband of the patient moved District Consumer Forum which held the doctors and hospital negligent because of wrong treatment. Aggrieved by the order of the District Forum, the hospital preferred an appeal to the State Consumer Disputes Redressal Commission (FA No. 89 of 2005) and the insurance company, preferred another appeal (FA no. 1066 of 2005). The State Forum vide its order dated 31.10.2008 allowed the appeals and turned down the order of District Consumer Forum. The patient side moved National Commission. In the order of the State Commission there is a casual reference to the effect that “there is also no expert opinion to state that the line of treatment adopted by the appellant/opposite party No.1 Hospital is wrong or is negligent”. The National Commission turned down the order of State Commission and restored the order of District Forum.In the opinion of The National Commission, before forming an opinion that expert evidence is necessary, the Fora under the Act must come to a conclusion that the case is complicated enough to require the opinion of an expert or that the facts of the case are such that it cannot be resolved by the members of the Fora without the assistance of expert opinion. This Court makes it clear that in these matters no mechanical approach can be followed by these Fora. Each case has to be judged on its own facts. The following points are stressed by The National Commision. Wrong diagnosis is negligence. Recordings in the case sheet is very important and Over writing in the case sheet leads to suspicion.The evidence act sections 61, 64,74 and 75 need not be applied in the consumer council. Expert opinion is required only in complicated cases of Medical Negligence and NOT in simple, straight forward cases and in complicated cases, before issuing a notice to the doctor, The Consumer Forum has to satisfy itself that there is prima facie medical negligence by referring the case to the medical board with concerned specialists. Where expert opinion is needed the consumer fora can refer the case to civil court. There should not be “straight jacket approach” in getting expert opinion in all cases of medical negligence and the power of seeking opinion is vested with the consumer council.
Lactobacilli - Probiotic as well as an Uncommon Pathogen – Current Status Regarding the “Two Sides of the Same Coin:” An Overview
Authors: Antony Beena
Published: September 2024

Lactobacilli are nonsporing, lactic acid producing, anaerobic bacilli, classified under the phylum Firmicutes that form part of the normal flora in specific areas of the human body inclusive of the oral cavity, gastrointestinal tract, and the urogenital system. This genus, for instance contains Lactobacillus acidophilus, Lactiplantibacillus plantarum, Lacticaseibacillus rhamnosus, and others, when they are involved in the breakdown of glucose, they release lactic acid. It plays a major role in the production of fermented foods and in addition, it can serve as a probiotic which can be good to the host in that it can help in digestion, synthesis of vitamins, and can prevent colonization by pathogens. Lactobacilli are in association, although, in a commensal manner in large numbers during puberty and pregnancy and are also acidity maintainers, thereby preventing the pathogens to occupy the vaginal tract. They have also been declared to influence antiviral functions together with the suppression of virulence factors of pathogens based on recent studies. However, some categories of strains have been associated with life-threatening conditions such as endocarditis, meningitis, liver abscess, and bacteremia, particularly in immunocompromised clients. Regarding Lactobacilli, speciation has grown with methods such as MALDI-TOF, as it is faster and accurate than biochemical assays. Because their fermentative metabolism differs, they are grouped into the obligate homofermentative, facultative heterofermentative, and the obligate heterofermentative lactobacilli that assists in their identification and functionality. Lactobacilli being the probiotics are known to be safe and effective as endorsed by such bodies as the US Food and Drug Administration and European Food Safety Authority. Prebiotics are most effective in preterm infants and neonates where they help in strengthening the Gut barrier and Immunity. Thus, two probiotic strains like L. rhamnosus, and L. acidophilus have shown some positive impacts against different infections such as Helicobacter pylori, Clostridium difficile-associated diarrhea, and periodontitis. Nevertheless, one cannot disregard the possible pathogenicity of Lactobacilli as a number of strains are known to produce enzymes and organic acids which are hazardous to the human body. These examples of invasive infections stemming from strict regard for the use of probiotics only serve to enforce the prospect of heedful application of probiotics, especially to the vulnerable groups of people. Furthermore, diseases such as vaginal lactobacillosis are created to focus on the need for moderation in the consumption of probiotics. In summary, it can be seen that both, the roles and effects of Lactobacilli are twofold, as positive components with great potential for benefiting health as well as negative aspects that need further assessment.
SJLA_2024_A3: Oncological Outcomes of Elective versus Emergency Surgery for Colon Cancer: A Tertiary Academic Center Experience
Authors: Bin Traiki Thamer A. , Alshammari Sulaiman A. , Alrabah Razan N. , Alzahrani Amirah M. , Alshenaifi Saud T. , Alhassan Noura S. , Abdulla Maha-Hamadien , Zubaidi Ahmad M. , Al-Obeed Omar A. , Alkhayal Khayal A.
Published: September 2024

Background:

In this study, we aimed to identify the oncological outcomes in colon cancer patients who underwent elective versus emergency curative resection.

Methods:

All patients who underwent curative resection for colon cancer between July 2015 and December 2019 were retrospectively reviewed and analyzed. Patients were divided into two groups based on the presentation into elective and emergency groups.

Results:

A total of 215 patients with colon cancer were admitted and underwent curative surgical resection. Of those, 145 patients (67.4%) were elective cases, and 70 (32.5%) were emergency cases. Family history of malignancy was positive in 44 patients (20.5%) and significantly more common in the emergency group (P = 0.016). The emergency group had higher T and TNM stages (P = 0.001). The 3-year survival rate was 60.9% and significantly less in the emergency group (P = 0.026). The mean duration from surgery to recurrence, 3-year disease-free survival, and overall survival were 1.19, 2.81, and 3.11, respectively.

Conclusion:

The elective group was associated with better 3-year survival, longer overall, and 3-year disease-free survival compared to the emergency group. The disease recurrence rate was comparable in both groups, mainly in the first 2 years after curative resection.