bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulation Training for Emergency Sternotomy in the Cardiovascular Intensive Care Unit
Authors: Tsiouris Athanasios , Protos Adam N. , Keys Victoria D. , Chambers Deanna , Jeyakumar Ashok Kumar Coimbatore , Shake Jay G.
Published: June 2024

Background

Emergency resternotomy in the intensive care unit for a patient who has undergone cardiac surgery can be daunting for surgeons and critical care staff. Clinicians involved are often unfamiliar with the surgical instruments and techniques needed.

Local Problem

After an emergency intensive care unit resternotomy resulted in suboptimal performance and outcome, protocols for emergency resternotomy were established and improved.

Methods

Education and simulation training were used to improve staff comfort and familiarity with the needed techniques and supplies. The training intervention included simulations to provide hands-on experience, improve staff familiarity with resternotomy trays, and streamline emergency sternotomy protocols. Preintervention and postintervention surveys were used to assess participants’ familiarity with the implemented plans and algorithms.

Results

All 44 participants (100%) completed the preintervention survey, and 41 of 44 participants (93%) returned the postintervention survey. After the intervention, 95% of respondents agreed that they were prepared to be members of the team for an emergency intensive care unit sternotomy, compared with 52% of respondents before the intervention. After the intervention, 95% of respondents strongly agreed or agreed that they could identify patients who might need emergency sternotomy, compared with 50% before the intervention. The results also showed improvement in staff members’ understanding of team roles, activation and use of the emergency sternotomy protocol, and differences between guidelines for resuscitating patients who experience cardiac arrest after cardiac surgery and the post–cardiac arrest Advanced Cardiovascular Life Support protocol.

Conclusion

Results of this quality improvement project suggest that simulation training improves staff comfort with and understanding of emergency resternotomy.
Rapid Nurse Training to Meet Surge Capacity: An Integrative Review
Authors: Chilson Sarah , Charais Chantel , Jones Joshua , Goforth Carl
Published: June 2024

Background

The COVID-19 pandemic resulted in unprecedented health care challenges and transformation of nursing practice. A significant challenge faced by health care systems was the rapid identification and training of nurses in various specialties, including critical care, to care for a large influx of critically ill patients.

Objective

To identify common themes and modalities that support best practices for the rapid training of registered nurses in team-based critical care nursing.

Methods

With the Whittemore and Knafl integrative review methodology as a framework, a literature review was conducted using a priori search terms.

Results

The integrative review included 11 articles and revealed 3 common themes: communication challenges, team dynamics, and the methodological approach to implementing training.

Discussion

This integrative review highlighted 3 main implications for future practice and policy in the event of another pandemic. Clear and frequent communication, multidisciplinary huddles, and open communication are paramount for mitigating role confusion and enhancing team dynamics. A multimodal approach to training appears to be feasible and effective for rapidly training support registered nurses to care for critically ill patients. However, the optimal training duration remains unidentified.

Conclusions

Rapidly training registered nurses to care for critically ill patients in a team-based dynamic is a safe and effective course of action to mitigate staff shortages if another pandemic occurs.
A Review of Chlorhexidine Oral Care in Patients Receiving Mechanical Ventilation
Authors: Simmons Jennifer S. Carroll , Bourgault Annette M. , Sole Mary Lou , Peach Brian C.
Published: June 2024

Background

Chlorhexidine gluconate has been considered the criterion standard of oral care for patients receiving mechanical ventilation because of its ability to reduce the incidence of ventilator-associated events. Optimal concentrations and frequencies remain unclear, as do adverse events related to mortality in various intensive care unit populations.

Objective

To examine the current evidence for the efficacy of chlorhexidine gluconate in reducing the incidence of ventilator-associated events, mortality, intensive care unit length of stay, and duration of mechanical ventilation in patients receiving ventilator support.

Methods

In this integrative review, CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE, and Health Source: Nursing/Academic Edition were searched using terms related to mechanical ventilation and chlorhexidine gluconate oral care with dates ranging from 2012 to 2023.

Results

Seventeen articles were included in this review: 8 systematic reviews, 8 randomized clinical trials (3 of which were not included in any systematic review), and 1 quasi-experimental study. Chlorhexidine gluconate oral care was associated with a reduced incidence of ventilator-associated events, but efficacy depended on concentration and frequency of administration. With stratification by intensive care unit population type, a nonsignificant trend toward increased mortality was found among non–cardiac surgical patients who received this care.

Conclusion

The evidence regarding the efficacy of chlorhexidine gluconate oral care in reducing ventilator-associated events in specific intensive care unit populations is contradictory. Recently published guidelines recommend de-implementation of chlorhexidine gluconate oral care in all patients receiving mechanical ventilation. Such care may be beneficial only in the cardiac surgical population.
Evaluation of the effects of no-tillage openers on maize: a field study
Authors: Benetti Marco , Gasparini Franco , Peruzzi Andrea , Sartori Luigi
Published: June 2024

The openers are the planter components that interact with soil and several researchers studied openers characteristics and behaviour in different conditions, but few explored the effects on crop emergence, growth and yield. The aim of this study is to evaluate and quantify any effects of openers on crop de-velopment and yield. The performance of three planters equipped with five different openers were compared on maize in a field test: double disc (DD), punch planter (PP), horizontal furrow with winged opener (HW), vertical furrow with winged opener (VW), vertical furrow with shank opener (SO). Seed spacing, depth, penetration resistance and plant emergences, root dry mass and yield were measured respectively on seeding slots and during crop development to evaluate openers effects. The results showed low variability in seed depth and spacing when DD and PP openers were used despite higher level of compaction on DD slot. High variability was found on maize plants when VW and HW openers were used. SO obtained relevantly lower yield in absolute value -35% (1.7 Mg ha-1) compared to other openers. However, the high variability observed in the different replicates and plant adaptability to stress conditions could explain the absence of significant differences in crop yield.
Comparative study between fundus fluorescein angiography and optical coherence tomography angiography in evaluation of diabetic maculopathy
Authors: Zaky Marwa A. , Hamed Walaa R. , Marey Hatem M. , El Ghoubashy Esraa S.
Published: June 2024

Background

Diabetic maculopathy is a serious consequence of diabetic retinopathy (DR) that greatly affects the visual acuity. Diabetic macular edema (DME) and diabetic macular ischemia (DMI) are major causes of vision affection in diabetic patients.

Purpose

The aim of this study was to compare fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) in evaluation of diabetic maculopathy.

Patients and methods

This comparative cross-sectional study was performed on 87 eyes of 54 patients with type I or type II diabetes, older than 18 years old with any diabetic retinal changes, and 108 eyes of 54 control subjects. An ocular examination was performed as well as color fundus photography, FA, and OCTA. Investigations were done on the same day. FA and OCTA findings were summarized and compared.

Results

The mean age of the patients was 59.4±8.5 years. OCTA was statistically significantly superior to FA in diagnosing DMI. The foveal avascular zone (FAZ) was ischemic (enlarged) in 74 (85.06%) eyes by OCTA compared with only 46 (52.87%) eyes by FA, with a statistically significant difference (P = 0.001). In addition, OCTA detected microaneurysms significantly more than FA (P = 0.001). The mean FAZ area of the control eyes by OCTA was significantly less than in the ischemic eyes (U = 56.602, P < 0.001), while the superficial capillary plexus (SCP) vascular density (VD) and the deep capillary plexus (DCP) VD in the control eyes was statistically significantly higher than in the ischemic eyes (U = 36.984, P < 0.001, and U = 35.955, P < 0.001, respectively). FA showed diffuse leakage (edema) at the macula as the most common pattern of DME that was detected in 37.9% of the eyes followed by focal macular leakage in 18.4% of the eyes and cystoid leakage in 8% of the eyes while 35.5% of the eyes showed no macular edema.

Conclusion

OCTA is a cornerstone in DMI diagnosis both qualitatively and quantitatively. In addition, it is essential in evaluating the deep retinal vasculature, while FA is essential in diabetic retinopathy grading and in the diagnosis of DME in a qualitative manner. Both investigations are complementary to each other in diabetic maculopathy evaluation.
Prevalence of refractive errors and visual impairment due to refractive errors among school children in Cairo, Egypt
Authors: Mahmoud Doaa A. , Mansour Mona N.
Published: June 2024

Aim

The aim of this research was to study the distribution and patterns of refractive errors (REs) among school children and the incidence of amblyopia in each type.

Patients and methods

This is an observational nonrandomized population-based cross-sectional study that included children aged 6-18 years attending the Outpatient Clinic of Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt. All children were subjected to comprehensive eye examination including best corrected visual acuity (BCVA), expressed in LogMAR, cycloplegic REs that was documented using a NIDEK auto-refractometer-keratometer, cover-uncover testing, and fundus examination. The prevalence of REs, amblyopia, and anisometropia was estimated.

Results

The study included 960 children (1920 eyes), with a mean age of 13.08±3.41 years. Emmetropia was found in 834 (43.4%) eyes, while myopia was reported in 587 (30.6%) eyes, hypermetropia in 114 (5.9%) eyes, and myopic astigmatism in 385 (20%) eyes. Anisometropia was reported in 65 (6.77%) children, while amblyopia was found in 49 (5.1%) eyes. The amblyopia prevalence was statistically significantly higher among the hypermetropic group (3.9%) than the myopic astigmatism group (1.2%), (P = 0.031).

Conclusion

The overall prevalence of REs among the examined children was 56.6% mainly myopia followed by myopic astigmatism and lastly hypermetropia. This draws the attention to the increased incidence of myopia which needs further social studies.
Possible association of primary open-angle glaucoma with thyroid dysfunction and oxidative stress
Authors: Abdel Hamid Mona A. , Fahmy Iman A. , Ghaffar Amany Abdel , Mahmoud Soheir A. , ElHossary Ghada G. , Kenawy Mahmoud M. , Moemen Leqaa A.
Published: June 2024

Background

Primary open-angle glaucoma (POAG) is a leading cause of blindness worldwide. Thyroid dysfunction and oxidative stress can be associated with POAG.

Purpose

The aim of this study was to determine whether thyroid dysfunction (hypothyroidism or hyperthyroidism) is associated with glaucoma in Egyptian patients and to evaluate the level of oxidative stress (OS) markers in the serum of POAG patients. It also aimed to investigate the relationship between the OS markers and thyroid hormones in those patients.

Patients and methods

The study included 60 patients with POAG who were compared with 20 normal controls. Serum samples from the POAG patients and controls were examined for thyroid hormones [triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH)] using the ELISA technique. The OS markers [hydrogen peroxide (H2O2), nitric oxide (NO), malondialdehyde (MDA), and reduced glutathione (GSH)] were also determined using colorimetric methods.

Results

There were no significant differences in the levels of T4 and TSH in the patients (3.14±2.25 ng/dl and 2.43±1.37 u/l, respectively) compared with the controls (3.35±1.88 ng/dl and 1.76±0.99 u/l, respectively) (P=0.245 and 0.064, respectively). However, there was a significant decrease in the T3 level in the POAG patients (2.88±0.54 pg/ml) compared with the controls (3.35±0.6 pg/ml) (P=0.029). In addition, there was a significant increase in the levels of H2O2 (2.83±1.66 mM/l), NO (54.64±29.21 umol/l), and MDA (164.12±96.5 nmol/ml) in the patients compared with the controls (0.83±0.55 mMol/l, 22.49±6.37 umol/l, and 44.36±12.59 nmol/ml, respectively) (P<0.001). There was also a significant decrease in the level of GSH in patients (54.32±32.1 mg/dl) compared with controls (103.99±45.52 mg/dl), (P<0.001). A significant negative correlation was detected between TSH and T4 (r=−0.41, P= 0.001), TSH and MDA (r=−0.27, P=0.04), T3 and H2O2 (r=−0.05, P=0.05), and T4 and NO (r=−0.35, P=0.01).

Conclusion

There was no association between POAG and thyroid dysfunction. However, the POAG patients are susceptible to OS and damage, as they had elevated serum levels of H2O2, NO, and MDA and reduced levels of GSH. Since the thyroid hormone level was associated with the OS markers, antioxidant therapy may be beneficial and may help to regulate the intraocular pressure and protect the trabecular meshwork cells from OS in those patients.
Ayush grid: Digital health platform
Authors: Ram Thrigulla Saketh
Published: June 2024

Innovative use of Information Communication Technology in the Ayush sector enables achieving Universal Health Coverage (UHC), health emergency protection, and healthier populations in the integrative health-care acumen. Ayush Grid (AG) is an Ayush-centric Digital Health Platform (DHP) created by the Ministry of Ayush, Government of India in the year 2018. It works in sync with the Ayushman Bharat Digital Mission (ABDM)-India's national digital health infostructure platform. The components of the AG cover all the verticals of the Ayush Sector, namely Health Services, Education, Ayush Research, Central Sector and Centrally Sponsored Schemes, Training Programmes, Citizen Centric Services, Drug Licencing Portal, and Media Outreach through four distinct layers namely The core layer, National Layer, State Layer, and Citizen access. The significant contributions of AG so far are the implementation and maintenance of the National Ayush Morbidity and Standardized Electronic (NAMASTE) portal, Ayush Research Portal, development and implementation of Ayushman Bharat Health Account (ABHA) enabled Ayush Hospital Information Management System (AHMIS), Ayush Sanjivani app (during COVID-19 pandemic), assisting the World Health Organization (WHO) in the development of mYoga app, Ayurveda Siddha and Unani International terminologies and morbidity codes (as Module-2, Chapter-26, ICD-11), development of benchmarks for the use of Artificial Intelligence (AI) in the field of traditional medicine under the “Artificial Intelligence for Health (AI4Health)” initiative by the International Telecommunication Union (ITU) and WHO, etc. The paper discusses the role of AG as an enabler to integrate Ayush systems in the national and international health-care setting.
Pentraxin-3 is Associated with Adverse Diastolic Remodeling in Patients with ST-Elevation Myocardial Infarction after Successful Reperfusion by Primary Percutaneous Intervention
Authors: Somuncu Mustafa Umut , Tatar Fatih Pasa , Serbest Nail Guven , Uygur Begum , Demir Ali Riza
Published: June 2024

Background:

Determinants of adverse diastolic remodeling in ST-elevated myocardial infarction (STEMI) after successful revascularization are not well established. Besides, the relationship between Pentraxin-3 (PTX-3) and diastolic function deterioration is unknown. This study hypothesizes that PTX-3 level would be associated with diastolic remodeling.

Materials and Methods:

Ninety-eight STEMI patients were included in our study. Echocardiography was performed before and 12–18 weeks after discharge. Two groups were generated according to the PTX-3 value, and the follow-up/baseline echocardiographic parameters were compared. Diastolic adverse remodeling was accepted as a persistent restrictive filling pattern or an increase in at least one grade of diastolic dysfunction. The independent predictors of diastolic adverse remodeling were investigated.

Results:

Adverse diastolic remodeling was detected in 19.3% of patients. High left ventricular mass index (odds ratio [OR]: 1.096, confidence interval [CI] 95%: 1.023–1.174, P = 0.009), high PTX-3 (OR: 1.005, CI 95%: 1.001–1.009, P = 0.024), and failing to achieve thrombolysis in myocardial infarction flow 3 after percutaneous coronary intervention (OR: 6.196, CI 95%: 1.370–28.023, P = 0.005) were determined as independent predictors of adverse diastolic remodeling. The ratio of follow-up/baseline left atrial volume index was higher in the high PTX-3 group (1.15 vs. 1.05, P = 0.029). Moreover, being in the high PTX-3 group predicted adverse diastolic remodeling at 7.4 times.

Conclusion:

Higher PTX-3 level is associated with adverse diastolic remodeling in STEMI patients.
Acute Myocarditis Associated with Legionella Infection
Authors: Spighi Lorenzo , Coiro Stefano , Morroni Sara , Benedetti Martina , Savino Ketty , Ambrosio Giuseppe , Cavallini Claudio
Published: June 2024

Pneumonia is the most commonly described manifestation of Legionella pneumophila infection (legionellosis), and extrapulmonary manifestations are uncommon. There are a few descriptions of acute myocarditis associated with legionellosis. We present a case of acute myocarditis in a patient admitted for legionellosis with multisystemic involvement (lung, heart, and kidney). Left ventricular (LV) dysfunction was documented by cardiac magnetic resonance (CMR) and two-dimensional speckle-tracking echocardiography; layer-specific strain analyses were performed, which allowed to differentiate subendocardial or subepicardial contractile impairment. Layer-specific strain analyses by echocardiography demonstrated impairment of subepicardial deformation in the inferolateral wall, which mirrored CMR findings, showing late gadolinium enhancement in the subepicardium of the same LV segments. After initiation of appropriate antibiotic therapy with levofloxacin, LV systolic function rapidly improved as assessed by both CMR and strain analyses, with concomitant normalization of both clinical and biochemical abnormalities. The basic mechanisms of myocardial involvement during legionellosis are unclear; we discussed our findings according to the limited available evidence.
Transcatheter Mitral Valve Repair with the PASCAL System after Early Edge-to-Edge Surgical Failure
Authors: Granata Giuseppina , Rubbio Antonio Popolo , De Marco Federico , Barletta Marta , Salvatore Tanya , Bedogni Francesco , Maurizio Tusa
Published: June 2024

We report the challenging case of percutaneous treatment of early recurrent mitral regurgitation after Alfieri edge-to-edge surgical procedure.
A Giant Left Circumflex Artery Aneurysm with Thrombosis Formation Presenting as a Left Atrioventricular Groove Mass
Authors: Badalabadi Reza Mohseni , Hosseinsabet Ali , Omran Abbas Salehi , Shirani Shapoor
Published: June 2024

A coronary artery aneurysm is defined as the dilation of a coronary artery segment that is 1.5-fold the diameter of the neighboring normal segments. A patient with a history of aortic valve replacement and coronary artery bypass graft surgery, transthoracic echocardiography revealed a large mass with an echolucent center in the left atrioventricular groove. Transesophageal echocardiography showed that the left atrial appendage was free of thrombosis, and there was a mass with an echolucent center beneath the left atrial appendage, suggestive of aneurysmal dilation in the left circumflex artery with thrombosis formation Coronary artery computed tomography angiography confirmed this finding. In patients with or without a history of coronary aneurysms, the presence of a mass in the atrioventricular groove on echocardiography should alert clinicians about the presence of a coronary artery aneurysm with thrombosis formation as a probable etiology.
Treatment of an Ill-Fitting Complete Dental Prosthesis with Digital Sensor Device
Authors: Gupta Shilpi , Srinivasan Ramya , Tharakan Sanjana Rebecca , Viswanathan Anitha Kuttae , Chander Gopi Naveen
Published: June 2024

Complete edentulism is one of the most common problems encountered by geriatric individuals. With advanced aging, despite attempts made to retain natural dentition, loss of entire teeth is yet observed. For precise denture fabrication, a digital sensor device was used during the making procedure. The use of sensor device aided in better appreciation and more retentiveness of denture.
Automated Camera Lucida Method with Colored Images through Integration of Hardware and Software in Microscopic Zooming
Authors: Vahabi Fateme , Kermani Saeed , Vahabi Zahra , Pestechian Nader
Published: June 2024

Automating the camera Lucida method which is a standard way for focusing microscopic images is a very challenging study for many scientists. Hence, actually combining hardware and software to automate microscopic imaging systems is one of the most important issues in the field of medicine as well. This idea reduces scanning time and increases the accuracy of user's results in this field. Closed-loop control system has been designed and implemented in the hardware part to move the stage in predefined limits of 15°. This system produces 50 consecutive images from parasites at the mentioned spatial distances in two directions of the z-axis. Then, by introducing our proposed relational software with combining images, a high-contrast image can be presented. This colored image is focused on many subparts of the sample even with different ruggedness. After implementing the closed-loop controller, stages movement was repeated eight times with an average step displacement of 20 μm which were measured in two directions of the z-axis by a digital micrometer. On average, the movement's error was 1 μm. In software, the edge intensity energy index has been calculated for image quality evaluation. The standard camera Lucida method has been simulated with acceptable results based on experts' opinions and also mean squared error parameters. Mechanical movement in stage has an accuracy of about 95% which will meet the expectations of laboratory user. Although output-focused colored images from our combining software can be replaced by the traditional fully accepted Camera Lucida method.
A Highly Robust Medical Image Watermarking Method for Medical Real-time Applications
Authors: Mehrabi Mahdi , Zarei Vahdi , Ghanbari Mohammad
Published: June 2024

Background:

Watermarking such as other security concepts is an ongoing challenging research issue, especially for medical images, to protect patient privacy. Medical images need to be shared and transferred between hospitals and specialists as quickly as possible for better diagnosis. Fast and simple watermarking is needed as well as the robust transferring of channel noise, such as salt and pepper noise and robust cropping that may occur from specialists and signature encryption for patient privacy.

Methods:

In this article, a highly robust and simple watermarking method is introduced. The proposed method has very low computational complexity and at the same time, it is very robust to interference and uses simple computations such as (XORs) Exclusive ORs and rotations that can be done in real-time. The proposed method uses a combination of hidden neighboring signature information, Sudoku permutation, and noise pre-processing to achieve high robustness against salt and pepper noise and cropping. Simple signature encryption is also used.

Results:

The proposed method is examined in different medical image datasets. The experimental results indicate the proposed watermarking system is robust to salt and pepper noise density of up to 90% and about 70% cropping. The number of computations including encryption is five XOR per pixel and a rotation per block of signature size.

Conclusion:

A novel method for medical image watermarking is presented. The proposed method is in the spatial domain, has encryption, and uses only XOR computation. The proposed method is highly robust to noise and cropping which is necessary for medical uses. The proposed method can be used efficiently for real-time watermarking for medical and nonmedical image datasets.
Aptamer-Based Magnetic Nanoprobe for Quantitative Measurement of Chloramphenicol in Milk through Portable Reader
Authors: Marofi Hossein , Rafati Adele , Gill Pooria
Published: June 2024

Background:

We described here an aptamer-based magnetic nanoprobe for measuring the amount of chloramphenicol (CAP) in milk.

Methods:

The nanoprobe presented in this method consists of a magnetic nanoparticle conjugated to a specific CAP aptamer. If the target is detected in the sample, the nanoprobe binds to it, and the aptamer forms a G-quadruplex structure. This structure mimics the peroxidase activity in the presence of the hemin cofactor. If tetramethylbenzidine is added to the sample containing the nanoprobe, a blue color light is observed. After adding a stop reagent solution, the color produced is measured by a microplate reader and a portable meter.

Results:

This study proves a 99% positive linear relationship between the microplate reader's results and the portable meter results.

Conclusion:

Conjugation of the aptamer to magnetic nanoparticles and applying magnetic separation operations change the nanoprobe performance by 11% for both mentioned devices.
Assessing Muscle Fatigue in Multiple Sclerosis using the Sample Entropy of Electromyographic Signals
Authors: Gomez-Hernández Marina , Olaya-Mira Natali , Viloria-Barragán Carolina , Henao-Pérez Julieta , Rojas-Mora Jessica María , Díaz-Londoño Gloria
Published: June 2024

Background:

Multiple sclerosis (MS) is a progressive and neurodegenerative disease of the central nervous system. Its symptoms vary greatly, which makes its diagnosis complex, expensive, and time-consuming. One of its most prevalent symptoms is muscle fatigue. It occurs in about 92% of patients with MS (PwMS) and is defined as a decrease in maximal strength or energy production in response to contractile activity. This article aims to compare the behavior of a healthy control (HC) with that of a patient with MS before and after muscle fatigue.

Methods:

For this purpose, a static baropodometric test and a dynamic electromyographic analysis are performed to calculate the area of the stabilometric ellipse, the remitting MS (RMS) value, and the sample entropy (SampEn) of the signals, as a proof of concept to explore the feasibility of this test in the muscle fatigue quantitative analysis; in addition, the statistical analysis was realized to verify the results.

Results:

According to the results, the ellipse area increased in the presence of muscle fatigue, indicating a decrease in postural stability. Likewise, the RMS value increased in the MS patient and decreased in the HC subject and the opposite behavior in the SampEn was observed in the presence of muscle fatigue.

Conclusion:

Thus, this study demonstrates that SampEn is a viable parameter to estimate muscle fatigue in PwMS and other neuromuscular diseases.
Design and Implementation of a Smart Wireless Controlled Visual Acuity Measurement System
Authors: Vafaie Mohammad Hossein , Ahmadi Beni Ebrahim
Published: June 2024

In this article, a smart visual acuity measurement (VAM) system is designed and implemented. Hardware of the proposed VAM system consists of two parts: a wireless remote controller, and a high-resolution LCD controlled through a Raspberry-Pi mini-computer. In the remote controller, a 3.5” graphical LCD with a touch screen is used as a human-machine interface. When a point is pressed on the touch screen, the unique identifier (ID) code of that point as well as its page number is transmitted to the Raspberry-Pi. In the Raspberry-Pi, data are received and processed by a smart application coded in visual studio software. Then, the commanded tasks are executed by the Raspberry-Pi’s operating system. Numerous charts, characters, and pictures are stored in the proposed VAM system to provide various VAM options while the size of the optotypes is adjusted automatically based on the distance of the patient from the LCD. The performance of the proposed VAM system is examined practically under the supervision of an expert optometrist where the results indicate that visual acuity, astigmatism, and color blindness of patients can be examined precisely through the proposed VAM system in an easier and more comfortable manner.
RR Interval-based Atrial Fibrillation Detection using Traditional and Ensemble Machine Learning Algorithms
Authors: Shrikanth Rao S. K. , Martis Roshan Joy
Published: June 2024

Atrial fibrillation (AF) is a life threatening disease and can cause stroke, heart failure, and sometimes death. To reduce the rate of mortality and morbidity due to increased prevalence of AF, early detection of the same becomes a prior concern. Traditional machine learning (TML) algorithms and ensemble machine learning (EML) algorithms are proposed to detect AF in this article. The performances of both these methods are compared in this study. Methodology involves computation of RR interval features extracted from electrocardiogram and its classification into: normal, AF, and other rhythms. TML techniques such as Classification and Regression Tree, K Nearest Neighbor, C4.5, Iterative Dichotomiser 3, Support Vector Machine and EML classifier such as Random Forest (RF), and Rotation Forest are used for classification. The proposed method is evaluated using PhysioNet challenge 2017. During the tenfold cross validation, it is observed that RF classifier provided good classification accuracy of 99.10% with area under the curve of 0.998. Apart from contributing a new methodology, the proposed study also experimentally proves higher performance with ensemble learning method, RF. The methodology has many applications in health care management systems including defibrillators, cardiac pacemakers, etc.
Evaluating the Gray Level Co-Occurrence Matrix-Based Texture Features of Magnetic Resonance Images for Glioblastoma Multiform Patients’ Treatment Response Assessment
Authors: Alibabaei Sanaz , Rahmani Masoumeh , Tahmasbi Marziyeh , Tahmasebi Birgani Mohammad Javad , Razmjoo Sasan
Published: June 2024

Background:

Medical images of cancer patients are usually evaluated qualitatively by clinical specialists which makes the accuracy of the diagnosis subjective and related to the skills of clinicians. Quantitative methods based on the textural feature analysis may be useful to facilitate such evaluations. This study aimed to analyze the gray level co-occurrence matrix (GLCM)-based texture features extracted from T1-axial magnetic resonance (MR) images of glioblastoma multiform (GBM) patients to determine the distinctive features specific to treatment response or disease progression.

Methods:

20 GLCM-based texture features, in addition to mean, standard deviation, entropy, RMS, kurtosis, and skewness were extracted from step I MR images (obtained 72 h after surgery) and step II MR images (obtained three months later). Responded and not responded patients to treatment were classified manually based on the radiological evaluation of step II images. Extracted texture features from Step I and Step II images were analyzed to determine the distinctive features for each group of responsive or progressive diseases. MATLAB 2020 was applied to feature extraction. SPSS version 26 was used for the statistical analysis. P value < 0.05 was considered statistically significant.

Results:

Despite no statistically significant differences between Step I texture features for two considered groups, almost all step II extracted GLCM-based texture features in addition to entropy M and skewness were significantly different between responsive and progressive disease groups.

Conclusions:

GLCM-based texture features extracted from MR images of GBM patients can be used with automatic algorithms for the expeditious prediction or interpretation of response to the treatment quantitatively besides qualitative evaluations.
An Emotion Recognition Embedded System using a Lightweight Deep Learning Model
Authors: Bazargani Mehdi , Tahmasebi Amir , Yazdchi Mohammadreza , Baharlouei Zahra
Published: June 2024

Background:

Diagnosing emotional states would improve human-computer interaction (HCI) systems to be more effective in practice. Correlations between Electroencephalography (EEG) signals and emotions have been shown in various research; therefore, EEG signal-based methods are the most accurate and informative.

Methods:

In this study, three Convolutional Neural Network (CNN) models, EEGNet, ShallowConvNet and DeepConvNet, which are appropriate for processing EEG signals, are applied to diagnose emotions. We use baseline removal preprocessing to improve classification accuracy. Each network is assessed in two setting ways: subject-dependent and subject-independent. We improve the selected CNN model to be lightweight and implementable on a Raspberry Pi processor. The emotional states are recognized for every three-second epoch of received signals on the embedded system, which can be applied in real-time usage in practice.

Results:

Average classification accuracies of 99.10% in the valence and 99.20% in the arousal for subject-dependent and 90.76% in the valence and 90.94% in the arousal for subject independent were achieved on the well-known DEAP dataset.

Conclusion:

Comparison of the results with the related works shows that a highly accurate and implementable model has been achieved for practice.
Risk Factors for Uncorrected Refractive Error
Authors: Soleimani Mohammadreza , Saberzadeh-Ardestani Bahar , Hakimi Hamid , Fotouhi Akbar , Alipour Fateme , Jafari Fatemeh , Lashay Alireza , Hashemi Hassan
Published: June 2024

Purpose:

To determine the prevalence of visually significant uncorrected refractive error (URE) in Rafsanjan and investigate the related factors. URE is the leading cause of visual impairment (VI) which causes the second-highest number of years lived with disability. The URE is a preventable health problem.

Methods:

In this cross-sectional study participants from Rafsanjan who were 35–70 years were enrolled between 2014 and 2020. Demographic and clinical characteristics data were gathered, and eye examination was performed. Visually significant URE was defined as present if habitual visual acuity was (HVA; visual acuity with present optical correction) >0.3 logMAR in the best eye and the visual acuity of that eye showed >0.2 logMAR improvement after the best correction. Logistic regression was used to determine the association between predicting variables (age, sex, wealth, education, employment, diabetes, cataract, and refractive error characteristics) and outcome (URE).

Results:

Among the 6991 participants of Rafsanjan subcohort of the Persian Eye Cohort, 311 (4.4%) had a visually significant URE. Diabetes was significantly more prevalent in the participants with visually significant URE, at 18.7% versus 13.1% in patients without significant URE (P = 0.004). In the final model, each year of increase in age was associated with 3% higher URE (95% confidence interval [CI]: 1.01–1.05). In comparison to low hyperopia, participants with low myopia had 5.17 times more odds of visually significant URE (95% CI: 3.38–7.93). However, antimetropia decreased the risk of visually significant URE (95% CI: 0.02–0.37).

Conclusion:

Policymakers should pay special attention to elderly patients with myopia to effectively reduce the prevalence of visually significant URE.
Pulsatile Ocular Blood Flow Registered with Optical Coherence Tomography Angiography in Patients with High Intraocular Pressure
Authors: Maltsev Dmitrii S. , Kulikov Alexei N. , Burnasheva Maria A.
Published: June 2024

Purpose:

To present a series of cases demonstrating pulsatile ocular blood flow registered with optical coherence tomography angiography (OCTA) and to describe the clinical characteristics of this phenomenon.

Methods:

Seven primary open-angle glaucoma patients (eight eyes) were included, with a median age of 67.0 years (range, 39–73 years), who demonstrated alternating hypointense bands of OCTA flow signal on the macular scan at increased intraocular pressure (IOP). All patients received comprehensive ophthalmic examination, OCTA examination with RTVue-XR, and infrared video scanning laser ophthalmoscopy. Changes in retinal microcirculation were assessed on the raw OCTA scans as well as the resultant vessel density maps before and after IOP reduction.

Results:

Median IOP in study eyes was 39.0 mmHg (range, 36–58 mmHg). Hypointense bands of OCTA flow signal were associated with arterial pulsation on video scanning laser ophthalmoscopy in all eyes and agreed with the heart rate and resulted in a spotted grid pattern of hypoperfusion on vessel density maps in seven eyes. Median vessel density in superficial capillary plexus and deep capillary plexus was 32.4% and 47.2%, respectively, at high IOP, and increased statistically significantly to 36.5% (P = 0.016) and 50.9% (P = 0.016), respectively, after IOP reduction.

Conclusions:

Alternating hypointense flow signal bands on OCTA scans are possibly caused by the pulsatile character of retinal blood flow during the cardiac cycle in eyes with high IOP and may reflect the imbalance between IOP and perfusion pressure. This phenomenon is responsible for the reversible decrease of vessel density at high IOP.
Efficacy and Safety of Cataract Surgery-Assisted Selective Laser Trabeculoplasty: A Pilot Study
Authors: Maltsev Dmitrii S. , Kulikov Alexei N. , Kazak Alina A. , Burnasheva Maria A. , Vasiliev Alexander A.
Published: June 2024

Purpose:

To evaluate the intraocular pressure (IOP)-lowering effect and safety of selective laser trabeculoplasty (SLT) with same-day cataract surgery which we named cataract surgery-assisted selective laser trabeculoplasty (CAST) compared to conventional SLT and cataract surgery as standalone procedures.

Methods:

Patients with primary open-angle glaucoma and cataract were included in this prospective interventional study. All patients received either a CAST procedure, standard SLT, or standard cataract surgery. IOP was assessed at baseline and at months 1, 2, 3, and 6. Topical IOP-lowering medication was canceled during the follow-up if necessary.

Results:

Twenty-nine, twenty-seven, and thirty eyes received the CAST procedure, SLT, and standard cataract surgery, respectively. There was no statistically significant difference in age, male-to-female ratio, or baseline IOP between groups (P > 0.05). The mean IOP reduction at 6 months after the CAST procedure, SLT, and standard cataract surgery was −7.3 ± 3.8 mmHg, −3.8 ± 3.7 mmHg, and −0.7 ± 3.7 mmHg, respectively (P < 0.001). Eleven out of 29 (37.9%) and 5 out of 27 (18.5%) eyes achieved 30% reduction of IOP after the CAST procedure and SLT, respectively. No eyes achieved 30% reduction of IOP at the end of the follow-up in cataract surgery group. The median number of IOP-lowering medications cancelled after the CAST procedure was 1.0 (range, 0–3). No antiglaucoma medication was cancelled after SLT or cataract surgery. No adverse events were registered in patients who received the CAST procedure.

Conclusion:

At 6-month follow-up, the CAST procedure had a significantly greater IOP-lowering effect and reduction of topical antiglaucoma medication than SLT or cataract surgery alone.
Globe Rupture Secondary to a Spontaneous Suprachoroidal Hemorrhage in a Blind Glaucomatous Eye: A Case Report
Authors: Patil Nikhil S. , Hanna Najib-Georges , Khan Yasser
Published: June 2024

Purpose:

To report a rare case of globe rupture following a spontaneous expulsive suprachoroidal hemorrhage without a predisposing event.

Methods:

Case report.

Results:

A 40-year-old man presented with a 3-week history of episodic eye pain, likely associated with uncontrolled glaucoma, and a spontaneous clot exuding from his right eye without a predisposing event. Notably, the patient had a remote past ocular history of posttraumatic glaucoma and untreated retinal detachment from childhood. He underwent uncomplicated evisceration of the right eye with polymethyl methacrylate implantation.

Conclusions:

Spontaneous expulsive suprachoroidal hemorrhage without a predisposing event is an exceedingly rare phenomenon, with only six previously reported cases. It is possible that eyes with a history of trauma, possibly diseased eyewalls, and eyes with high intraocular pressure may be the most susceptible to spontaneous suprachoroidal hemorrhage and consequent globe rupture.
Medial Rectus Plication in the Management of Dissociated Horizontal Deviation
Authors: Kiarudi Mohammad Yaser , Tafaghodi Bahar , Sabermoghadm Aliakbar , Es’haghi Acieh , Ghavami Shahri Seyed Hosein
Published: June 2024

Purpose:

To report a case of medial rectus plication for the management of dissociated horizontal deviation (DHD).

Methods:

We introduce medial rectus plication for improving the control of exoshift of DHD.

Results:

A 20-year-old woman with a chief complaint of left eye outward deviation since childhood was referred to the strabismus clinic. The diagnosis of DHD was made according to the detection of asymmetric slow abduction of the left eye (50 prism diopter) during visual inattention or cover testing. The left lateral rectus (LR) was recessed 8 mm with a posterior fixation suture (PFS). In the early postoperative period, the control of DHD improved; however, after 6 months, the patient and her parents complained of frequent observation of the exoshift of the left eye (30 prism diopter). For better control of DHD, medial rectus plication (5 mm) of the left eye was considered the second operation. After 12 months of follow-up, the control of deviation improved, and there was no manifest deviation.

Conclusions:

The literature's recommended procedure for unilateral DHD without a duction deficit is to perform a unilateral LR muscle recession. Some authors have proposed adding PFS to augment the effect of LR recessions. Although recurrence may occur, medial rectus plication can be considered one of the reversible options and can be used in recurrences of DHD after the first surgical procedure.
Long COVID-19 “A Metabolic Sequela,” the New-Onset Diabetes among Cohorts Admitted at Tertiary Care Hospital, Hyderabad
Authors: Bala Sudha , Darivemula Surendra B , Muralidharan Shrikanth , Bandaru Rajiv K , Katkuri Sushma N , Singireddy Anesha
Published: June 2024

Introduction:

Long COVID is now being encountered by many individuals during this pandemic. It is best diagnosed by a history consistent with acute COVID-19 followed by a prolonged recovery.

Aim:

This study was undertaken to detect new-onset diabetes mellitus among COVID cohorts and their associated factors.

Materials and Methods:

A total of 152 COVID-19 patients admitted at ESIC medical college and hospital without a known history of diabetes mellitus were included in the study. Data were collected about sociodemographic variables, their symptoms at presentation, lifestyle determinants, and measurement of blood sugar by HbA1C for a period of 6 months follow-up with three readings (baseline, third month, and sixth month) using a predesigned and pre-tested questionnaire schedule.

Results:

Mean HbA1c was found to be 7.28 ± 2.09 at the third reading with new-onset diabetes mellitus development among 38 (25%). There was a positive correlation between age and mean HbA1c measurement on follow-up. Significant risk factors were the presence of comorbidities OR = 15.23 (4.42–22.46), sedentary lifestyle 6.14 (1.39–9.11), tobacco usage 6.80 (2.63–14.55), symptomatic COVID-19 presentation 2.43 (1.11–5.41), alcohol usage 2.11 (0.99–4.49) and extra physical activity 1.72 (0.66–2.32).

Conclusions:

There was a quarter of patients with new-onset diabetes mellitus in the present study. This will help us to identify the risk factors of this sequela at the earliest for initiating preventive strategies at the primary care level.
Diabetes Treatment with Dapagliflozin and Its Combinations: Insights from Clinical Practice
Authors: Bafna Akshay , Mehta Ajit , Garg Rajeev , Balagopalan Jayagopal Pathiyil , Rajput Rajesh , Zalte Nitin , Naik Preethi , Sugumaran Amarnath , Mohanasundaram Senthilnathan
Published: June 2024

Objective:

To evaluate the perception of clinicians about the association of heart failure (HF) and type 2 diabetes mellitus (T2DM) and the utilization of dapagliflozin-based combination therapies for cardiorenal protection in Indian patients with T2DM.

Materials and Methods:

This cross-sectional, digital questionnaire-based study involved diabetologists and consulting clinicians from pan-India and was conducted between October 2022 and March 2023.

Results:

Of the 982 clinicians, 871 completed the study. According to 90.93% and 47.19% of clinicians, most patients with T2DM were in the age group of 40–60 years, and cardiovascular (CV) risk is present in 3 in 10 of T2DM patients, respectively. As the initial choice of oral antidiabetic class (other than metformin), 43.86% of clinicians preferred sodium-glucose cotransporter-2 inhibitors (SGLT2i). Dapagliflozin is the most effective SGLT2i in reducing mortality/hospitalization in T2DM patients with HF (70.38%). In T2DM patients with CV/renal risk, 66.02% of clinicians recommended dapagliflozin with sitagliptin (10 mg + 100 mg strength) as SGLT2i plus dipeptidyl peptidase-4 inhibitors (DPP4i) fixed-dose combination (FDC). The use of a triple-drug FDC of dapagliflozin plus sitagliptin plus metformin was strongly recommended by 74.40% of clinicians. Early initiation and intensification with a combination of SGLT2i and DPP4i in young T2DM patients (30–50 years) inadequately managed on metformin was highly recommended (94.58%). The majority of clinicians opined that SGLT2i should be initiated in all T2DM patients with comorbidities to prevent HF complications (97.58%), and SGLT2i is underutilized in India for the treatment of HF in T2DM patients (89.21%).

Conclusion:

The overall observations provide insights into the usage patterns of dapagliflozin-based combination therapies for cardiorenal protection among Indian T2DM patients.