bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of Wireless Kundt’s Tube Kit as an Experiment Tool in Determining Speed of Sound and Proposing for a Hearing Test
Authors: Suprapto Nadi , Rosyidi Achmad Ichsan , Mubarok Husni , Adam Alif Syaiful
Published: February 2022

As a part of contextual learning, laboratory activity supports the physics concept attainment. The everyday physics in real-life occur from the concept of sound, by hearing a sound every day. For further application, the sound wave concept needs to be understood by a particular experiment. For gaining that purpose, this study develops Wireless Kundt's Tube kit. The study has two essential purposes: determining sound speed through the kit and examining the kit as an alternative for a hearing test. The study utilized the ADDIE research design: Analyze-Design-Develop-Implement-Evaluate stages. Specifically, the apparatus bravely brands as wireless Kundt's Tube use Bluetooth connection to integrate the smartphone's central apparatus and have easier accessibility to the students' gadget. This final kit has tried to students in 11th grade of a senior public school in East Java, Indonesia, to demonstrate how to gain their feedback. This kit passed the media and content validity as part of learning media development. The study gained a sound speed of 303.03 m/s and proposed the hearing test's idea as replacing the function of turning fork in a traditional test. It means Wireless Kundt's Tube can apply to the following instruction process as the motivational part for physics learning and a hearing test.
Flesch-Kincaid Measure as Proxy of Socio-Economic Status on Twitter
Authors: Ahmed Samara , Rajput Adil , Sarirete Akila , Chowdhry Tauseef J.
Published: February 2022

Social media gives researchers an invaluable opportunity to gain insight into different facets of human life. Researchers put a great emphasis on categorizing the socioeconomic status (SES) of individuals to help predict various findings of interest. Forum uses, hashtags and chatrooms are common tools of conversations grouping. Crowdsourcing involves gathering intelligence to group online user community based on common interest. This paper provides a mechanism to look at writings on social media and group them based on their academic background. We analyzed online forum posts from various geographical regions in the US and characterized the readability scores of users. Specifically, we collected 10,000 tweets from the members of US Senate and computed the Flesch-Kincaid readability score. Comparing the Senators’ tweets to the ones from average internet users, we note 1) US Senators’ readability based on their tweets rate is much higher, and 2) immense difference among average citizen’s score compared to those of US Senators is attributed to the wide spectrum of academic attainment.
Upregulation of Checkpoint Ligand Programmed Death-Ligand 1 in Patients with Paroxysmal Nocturnal Hemoglobinuria Explained by Proximal Complement Activation
Authors: Anliker Markus , Drees Daniela , Loacker Lorin , Hafner Susanne , Griesmacher Andrea , Hoermann Gregor , Fux Vilmos , Schennach Harald , Hörtnagl Paul , Dopler Arthur , Schmidt Stefan , Bellmann-Weiler Rosa , Weiss Günter , Marx-Hofmann Astrid , Körper Sixten , Höchsmann Britta , Schrezenmeier Hubert , Schmidt Christoph Q
Published: February 2022

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hemolytic disease driven by impaired complement regulation. Mutations in genes encoding the enzymes that build the GPI anchors are causative, with somatic mutations in the PIG-A gene occurring most frequently. As a result, the important membrane-bound complement regulators CD55 and CD59 are missing on the affected hematopoietic stem cells and their progeny, rendering those cells vulnerable to complement attack. Immune escape mechanisms sparing affected PNH stem cells from removal are suspected in the PNH pathogenesis, but molecular mechanisms have not been elucidated. We hypothesized that exuberant complement activity in PNH results in enhanced immune checkpoint interactions, providing a molecular basis for the potential immune escape in PNH. In a series of PNH patients, we found increased expression levels of the checkpoint ligand programmed death-ligand 1 (PD-L1) on granulocytes and monocytes, as well as in the plasma of PNH patients. Mechanistically, we demonstrate that complement activation leading to the decoration of particles/cells with C3- and/or C4-opsonins increased PD-L1 expression on neutrophils and monocytes as shown for different in vitro models of classical or alternative pathway activation. We further establish in vitro that complement inhibition at the level of C3, but not C5, inhibits the alternative pathway–mediated upregulation of PD-L1 and show by means of soluble PD-L1 that this observation translates into the clinical situation when PNH patients are treated with either C3 or C5 inhibitors. Together, the presented data show that the checkpoint ligand PD-L1 is increased in PNH patients, which correlates with proximal complement activation.
Age-Dependent Reduction in Asthmatic Pathology through Reprogramming of Postviral Inflammatory Responses
Authors: Hazan Guy , Eubanks Anna , Gierasch Carrie , Atkinson Jeffrey , Fox Carolyn , Hernandez-Leyva Ariel , Rosen Anne L , Kau Andrew L , Agapov Eugene , Alexander-Brett Jennifer , Steinberg Deborah , Kelley Diane , White Michael , Byers Derek , Wu Kangyun , Keeler Shamus P , Zhang Yong , Koenitzer Jeffrey R , Eiden Elise , Anderson Neil , Holtzman Michael J , Haspel Jeffrey
Published: February 2022

Asthma is a chronic disease of childhood, but for unknown reasons, disease activity sometimes subsides as children mature. In this study, we present clinical and animal model evidence suggesting that the age dependency of childhood asthma stems from an evolving host response to respiratory viral infection. Using clinical data, we show that societal suppression of respiratory virus transmission during coronavirus disease 2019 lockdown disrupted the traditional age gradient in pediatric asthma exacerbations, connecting the phenomenon of asthma remission to virus exposure. In mice, we show that asthmatic lung pathology triggered by Sendai virus (SeV) or influenza A virus is highly age-sensitive: robust in juvenile mice (4–6 wk old) but attenuated in mature mice (>3 mo old). Interestingly, allergen induction of the same asthmatic traits was less dependent on chronological age than viruses. Age-specific responses to SeV included a juvenile bias toward type 2 airway inflammation that emerged early in infection, whereas mature mice exhibited a more restricted bronchiolar distribution of infection that produced a distinct type 2 low inflammatory cytokine profile. In the basal state, aging produced changes to lung leukocyte burden, including the number and transcriptional landscape of alveolar macrophages (AMs). Importantly, depleting AMs in mature mice restored post-SeV pathology to juvenile levels. Thus, aging influences chronic outcomes of respiratory viral infection through regulation of the AM compartment and type 2 inflammatory responses to viruses. Our data provide insight into how asthma remission might develop in children.
Enhanced UVA LED-Cured Conformal Coatings for Printed Circuit Boards
Authors: Pfeiffenberger Neal T. , Biria Saeid
Published: February 2022

Conformal coatings are thin polymeric layers applied on (RF)/microwave printed circuit boards, chips, dies and other electronic components to protect them from moisture and corrosion. Despite this protection, exposure to excessive humidity can cause delamination, increase dissipation factors and dielectric constants of the coating, and changing circuit switching-speed. In this paper, we will discuss dielectric performance of UVA LED-curable resin formulations with enhanced flexibility and adhesion as a new approach compared to traditional mercury UV curable conformal coatings. These advances reduce the potential for delamination, delivering greater protection of different applications, especially those for extreme environments.
PNPLA3/adiponutrin I148M gene variant in nonalcoholic fatty liver disease in Egyptian children and adolescents
Authors: Ata Dina S. , Awad Mohy A.E. , Eid Manal A.E. , ElShafey Khaled I. , Taha Ola A.
Published: February 2022

Objective

The aim was to explore the possible association of the PNPLA3/adiponutrin I148M gene variant with nonacholic fatty liver disease (NAFLD) and its severity in overweight and obese Egyptian children and adolescents as such reports are lacking in Egyptian population.

Participants and methods

In total, 80 overweight and obese NAFLD children and 40 healthy controls were subjected to clinical assessment, laboratory assessment, and genotyping assay for PNPLA3-I148M gene variant.

Results

There were no significant differences in the distribution of genotypes of the PNPLA3-I148M gene variant between the studied NAFLD patients and controls. In NAFLD children, 62 (77.5%) cases were CC genotype (homozygous for the wild allele), 12 (15%) cases were CG genotype (heterozygous for the risk allele), and six cases (7.5%) were GG genotype (homozygous for the risk allele). The frequency of the C allele (the common allele) was 85%, whereas the frequency of the G allele (the risk allele) was 15%. There was significant increase in mean values of alanine aminotransferase and gamma-glutamyl transferase (P<0.05) and significant increase in the frequency of patients with higher grades of steatosis among the NAFLD patients who were homozygous or heterozygous for the risk G allele (GG and CG genotypes) compared with those with no G allele (wild CC genotype). There were significant positive correlations between PNPLA3-I148M gene variant and obesity indicators among NAFLD children.

Conclusions

Polymorphisms in the PNPLA3-I148M gene variant may not contribute to NAFLD susceptibility in Egyptian children due to ethnic differences. However, the presence of polymorphisms in the PNPLA3-I148M gene variant may get worse in liver enzymes (alanine aminotransferase and gamma-glutamyl transferase) and grades of steatosis in NAFLD patients.
The many faces of neurofibromatosis type 1 in the pediatric brain
Authors: El-Beheiry Ahmed A. , Omar Tarek E. , Abougabal Ahmed M.
Published: February 2022

Background

Neurofibromatosis type 1 (NF1) is the most common neurocutaneous syndrome. It is diagnosed based on a group of clinical criteria that were established by the National Institute of Health in 1988, yet, NF1 remains a challenging disorder to diagnose, mainly in the pediatric-age group.

Aim

The purpose of this study was to highlight the different MRI findings encountered in the brain of NF1 pediatric patients in order to evaluate if some of these findings can be added to the diagnostic criteria of NF1 and to assess the role of MR spectroscopy in differentiating non-neoplastic from tumefactive neoplastic lesions.

Patients and methods

This study was a single-center retrospective review of available brain MRIs from 40 children with NF1 in the period from June 2018 to January 2020. MRI examinations were done on a 1.5-Tesla MRI scanner. Magnetic resonance spectroscopy (MRS) was done in selected cases to differentiate foci of abnormal signal intensity (FASI) from neoplastic tumefactive lesions and assess the grade of such neoplastic masses.

Results

The studied group included 23 females (57.5%) and 17 males (42.5%) with mean age of 7.4±4.4 years. The findings encountered in MRI included FASI in all 40 patients (100%), brain neoplastic lesions in 24 patients (52.5%),18 of which were optic pathway gliomas and six were nonoptic gliomas, while five patients (12.5%) showed thickened corpus callosum. MRS was significantly different in tumefactive neoplastic lesions from FASI with elevated choline and reduced N-acetyl aspartate (NAA) in the former. Choline/creatine, NAA/choline, and NAA/creatine ratios were 3.7±0.93, 0.20±0.17, and 0.37±0.06, respectively, in neoplastic lesions compared with 0.74±0.13, 1.5±0.18, and 1.5±0.13, respectively, in FASI.

Conclusion

Pediatric neuroradiologists should be familiar with the different pathologies encountered within the brain of NF1 patients, not just obvious optic pathway gliomas, but more importantly the underlooked FASI. We recommend that these FASI should be included in the diagnostic criteria for NF1. MRS is also recommended to differentiate questionable tumefactive neoplastic lesions from FASI.
Is microRNA-451 expression a useful hemolytic marker in children with β-thalassemia? A pilot study
Authors: Imbaby Salma A.E. , El Chazli Yasmine , Eldabah Nermeen
Published: February 2022

Background

Beta-thalassemia (BT) is the most prevalent inherited hemoglobin disorder in Egypt. MicroRNA-451 (miR-451), an erythroid cell-specific miRNA, is upregulated during erythroid maturation and suggested to be a hemolytic marker.

Aim

The aim was to investigate plasma miR-451 value as a hemolytic marker, the authors conducted a pilot study on patients with BT attending a hematology clinic in Egypt.

Patients and methods

The patients with BT were categorized as transfusion dependent (TDT) and nontransfusion-dependent (NTDT). A total of 29 patients were included: 13 TDT (4.5–14.8 years), 16 NTDT (3.2–17.6 years), and 10 controls aged 3–14 years. The miR-451 expression in the plasma of patients was compared with the controls using real-time quantitative polymerase chain reaction.

Results

Plasma miR-451 expression was higher among patients with BT compared with controls (P=0.272). Similarly, there was a higher expression among the TDT subgroup than the NTDT subgroup (P=0.288). Patients with a severe disease phenotype showed a higher level of miR-451 expression when compared with mild and moderate cases (P=0.301) and among splenectomized patients (P=0.10). Plasma miR-451 did not significantly differentiate between patients with BT and normal controls (area under curve=0.621; P=0.17). In controls, the hemoglobin, red blood cells, and platelet count were significantly correlated with the plasma miR-451 (P=0.03, 0.008, and 0.008, respectively). However, in patients with BT, the alkaline phosphatase significantly correlated with miR-451 (P=0.007).

Conclusion

The expression of miR-451 was more in patients with TDT than NTDT and controls, but this was not statistically significant. Plasma miR-451 failed to differentiate between controls and patients with BT. More studies are needed to determine its significance in the clinical practice.
Serum ferritin level as a noninvasive marker for detection and staging of hepatocellular injury, liver fibrosis, and steatosis in children and adolescents with nonalcoholic fatty liver disease
Authors: Hassan Ahmed A. , El-Aziz Awad Mohiee E.-D.A. , Soliman Hanan H. , Usef Reda A.F. , Ata Dina S.
Published: February 2022

Background

Pediatric nonalcoholic fatty liver disease (NAFLD) is a global health problem. Recently, serum ferritin level (SFL) has been reported to be correlated with NAFLD and the degree of liver fibrosis and steatosis.

Aim

The aim was to assess serum ferritin level as a noninvasive marker for detection and staging hepatocellular injury, liver fibrosis, and steatosis diagnosed by FibroScan in children and adolescents with NAFLD disease proven with ultrasound.

Patients and methods

The authors assessed serum ferritin in 40 children with NAFLD diagnosed ultrasonography as well as 20 age-matched and sex-matched healthy controls. The authors also assessed the correlation between SFL and the different stages of hepatic fibrosis and steatosis assessed by FibroScan.

Results

The authors found thatthe values of serum ferritin were significantly higher in patients than controls (P=0.0001). Moreover, there was a positive correlation between SFL and ultrasonographic grades of liver steatosis, FibroScan liver fibrosis grades, and FibroScan liver steatosis controlled attenuation parameter score and its values among patients with NAFLD. Area under the receiver operating characteristic curve (0.995) shows serum ferritin (ng/ml) has significant sensitivity as a diagnostic marker for liver fibrosis degrees diagnosed by FibroScan and liver steatosis stage diagnosed by FibroScan with area under the receiver operating characteristic curve of 1.000 among the studied patients with NAFLD (P=0.0001). Moreover, it has significant sensitivity as a diagnostic marker for liver steatosis grades diagnosed by abdominal ultrasonography among the studied patients with NAFLD (P=0.0001).

Conclusion

The data suggest that SFL can be used as a noninvasive marker for diagnosis and staging of hepatocellular injury, liver fibrosis, and steatosis in children and adolescents with NAFLD.
Secondary Delusion of Pregnancy in an Antipsychotic Naïve Patient
Authors: Gupta Parul , Spoorthy Mamidipalli Sai , Patil Pradeep Shriram
Published: February 2022

Delusion of pregnancy is relatively rare phenomenon encountered in psychiatric patients but is reported frequently in developing countries. It can be associated with both psychiatric and neurological disorders. We are reporting a case of delusion of pregnancy that developed in a drug-naïve young woman secondary to auditory hallucination with normal body mass index with no neurological cause due to paranoid schizophrenia. Till date, only seven such cases were reported where auditory hallucinations were reported along with the belief in pregnancy. It should be differentiated from pseudocyesis/pseudopregnancy/simulated pregnancy/Couvade syndrome. Workup should include the identification of the psychosocial/cultural factors leading to the development of this phenomenon, although pharmacological treatment remains the mainstay of the treatment.
Study of Xmn-I polymorphism in β-thalassemic children in Egypt
Authors: Sedky Amina , Assem Hala , Bedewy Ahmed , Adel Nashwa , Yousef Maha
Published: February 2022

Background

β-thalassemia (βT) has a wide spectrum of clinical severity that may be attributed to the wide variations in βT gene mutations. β-Globin mutations with the Xmn-I site might be associated with elevated fetal hemoglobin levels, which in turn may affect the severity of βT phenotype.

Aim

To investigate the frequency of Xmn-I polymorphism (−158 C>T) among Egyptian children with βT, and to examine the relationship between Xmn-I polymorphism and βT phenotypes.

Patients and methods

This cross-sectional study was conducted on 112 βT patients (55 males and 57 females) with a mean age of 8.34±3.71 years (2–16 years). Laboratory investigations included complete blood count, hemoglobin electrophoresis, β-globin mutation, identification of Xmn-I polymorphism by two methods: PCR–restriction fragment length polymorphism and amplification refractory mutation system.

Results

All patients (76 with βT major and 36 with βT intermedia) were negative for the Xmn-I SNP whether in homozygous (+/+) or heterozygous (+/−) state.

Conclusion

This study demonstrated that Xmn-I polymorphism was not detected in the studied patients and this supports the low frequency of this polymorphism in other Egyptian studies.
Association of Physical Activity with Lipid Profile in Healthy Subjects: A Cross Sectional Study in Tertiary Care Hospital from Central Rural India
Authors: Bondge Babita , Jain Jyoti , Warkad Mangesh , Joshi Madhura , More Subhash , Janaarthanan Saiprasath
Published: February 2022

Context:

Physical activity is an important factor for healthy aging, and lack of it has been associated with chronic noncommunicable diseases (NCDs). Research in sedentary behavior has indicated that it is an independent risk factor of morbidity and mortality, separate from lack of physical activity.

Methods:

This cross-sectional study was conducted in the department of medicine in a tertiary care hospital on apparently healthy relatives of patients without chronic NCDs. Metabolic equivalents of tasks (METs) were calculated by the global physical activity questionnaire (GPAQ).

Statistical Analysis:

We correlated the various parameters [age, sex, body mass index (BMI), waist-hip ratio (WHR), and lipid panel with METs] by Pearson correlation coefficient.

Observations and Results:

Total of 750 patients with a mean age of 42.55 ± 10.93 years were included, and 389 (51.9%) were male in the present study. In our study, a strong negative correlation was found between physical activity and BMI, moderate negative correlation between physical activity with triglycerides (TG), total cholesterol (TC), and WHR. There was a high degree of positive correlation between sedentary lifestyle (SLS) duration with BMI and TC. A moderate degree positive correlation was found between SLS duration and WHR, TG, and low-density lipoproteins (LDL).

Conclusion:

The clinician should be aware of various obesity indices, and it was found that lipid profile is inversely correlated with physical activity and directly correlated with SLS in healthy individuals. Lifestyle changes and exercise may reduce obesity and lipid disorders and thereby reduce further development of complications in those patients.
Evaluation of Hypersensitivity Reactions with Leuprolide Acetate and Triptorelin Acetate in Children
Authors: Metbulut Azize Pınar , Adıgüzel Keziban Toksoy , İslamoğlu Candan , Boyraz Mehmet , Mısırlıoğlu Emine Dibek
Published: February 2022

Introduction:

Gonadotropin releasing hormone analogues (GnRHa) are commonly used to treat central precocious puberty (CPP). Generally, they are well-tolerated; however adverse reactions have been reported. Local adverse events occur in 10-15% of the patients who were treated with GnRHa. Anaphylactoid reactions with GnRHa are very rarely seen. The aim of this study is to report our clinical experience with hypersensitivity reactions seen in pediatric patients receiving leuprolide acetate (LA) and triptorelin acetate (TA) in CPP at the single pediatric tertiary medical center and to evaluate the incidence rate of hypersensitivity reactions.

Methods:

This retrospective study included children with CPP who were treated with GnRHa (LA and TA) at our hospital between January 2013 and December 2020. We analyzed clinical characteristics of patients who experienced adverse reactions and analyzed the incidence rate.

Results:

Seven side effects (adverse reactions) (0.69%) were observed among total of 1010 CPP patients who were treated with TA and LA. Sterile abscesses were observed in 3 patients (0.29%). None of the patients had an anaphylaxis. Tremors of both hands, a vomiting episode, an urticarial rash, and musculoskeletal stiffness were observed in one patient each.

Conclusion:

In our study, mild reactions were seen in 7 patients. GnRHa can be safely used and well-tolerated medications; but exceedingly rare, severe reactions can be developed.
Correlation Between Serum AMH Levels and Cardiometabolic Indices in PCOS Women
Authors: Mitra Subarna , Saharia Gautom K. , Jena Saubhagya K.
Published: February 2022

Introduction:

Polycystic ovary syndrome (PCOS) has a predilection for several cardio-metabolic disorders in future. Levels of anti-Mullerian hormone (AMH), a marker of ovarian ageing, are higher in women with PCOS women than in controls. However, whether and how AMH concentrations influence the cardio-metabolic risk in PCOS is yet to be established.

Objectives:

This study was done to determine the correlation between AMH levels and various cardiometabolic parameters in women with PCOS and to compare AMH levels in PCOS with and without metabolic syndrome (MS).

Materials and Methods:

In total, 144 women aged 20–40 years and diagnosed as PCOS by the Rotterdam criteria were included in this cross-sectional study. Their anthropometry and blood pressure were recorded. Fasting lipid profile, fasting glucose, fasting insulin, homeostasis model assessment-insulin resistance, total testosterone, and AMH were estimated. The correlation between AMH and cardiometabolic parameters was determined.

Results:

Serum AMH levels had no correlation with any component of MS. The AMH values were comparable between those with and without MS despite differences in the metabolic profile (11.39 ± 5.31 vs 11.56 ± 5.64 ng/mL, P = 0.861).

Conclusion:

AMH levels do not correlate with components of MS so it may not be useful as an indicator of cardiovascular risk, insulin resistance, or MS in PCOS.
Standard Clinical Screening Tests, Sural Radial Amplitude Ratio and F Wave Latency Compared to Conventional Nerve Conduction Studies in the Assessment of Sensorimotor Polyneuropathy in Patients with Type 2 Diabetes Mellitus
Authors: Ramanathan Saraswathi , Thomas Raji , Chanu Asem Rangita , Naik Dukhabandu , Jebasingh Felix , Sivadasan Ajit , Thomas Nihal
Published: February 2022

Background and Aims:

The measuring tools used for assessment of neuropathy include various questionnaires, monofilament testing, Biothesiometry and the gold standard test, nerve conduction studies (NCS). This study aims to evaluate the diagnostic accuracies of Michigan Neuropathy Screening Instrument (MNSI), Biothesiometry, Semmes Weinstein Monofilament (SWMF), Sural Radial Amplitude Ratio (SRAR) and minimal F wave latency as compared to conventional NCS and arrive at a simple diagnostic algorithm for early detection of Diabetic Peripheral Neuropathy (DPN).

Methods:

In a cross-sectional observational study on 48 Type 2 diabetes mellitus patients, MNSI, Biothesiometry, SWMF and NCS including F waves and SRAR were done and diagnostic accuracies (sensitivity, specificity, positive and negative predictive values) calculated taking NCS as gold standard.

Results:

MNSI, Biothesiometry, SWMF, SRAR and minimal F wave latency had a sensitivity of 64.3%, 78.6%, 14.3%, 100% and 78.6% and specificity of 67.7%, 52.9%, 94.1%, 23.53% and 76.47% respectively, with reference to NCS. Based on combined sensitivities and specificities, we arrived at a simple algorithm for early diagnosis of DPN, which showed that DPN could either be diagnosed or ruled out in 75% of the patients by a combination of the Biothesiometry, SRAR and left lower limb minimal F wave latency results.

Conclusions:

In the setting of an outpatient, multidisciplinary diabetic clinic, simple tests such as questionnaires, monofilament testing and biosthesiometer could be performed with greater ease while considering NCS as the gold standard. This algorithm, combining Biothesiometry, SRAR and left lower limb minimal F wave latency would be less time consuming and help in early diagnosis of DPN.
Clinical Characteristics, Outcomes, and Progression to Type 2 Diabetes in Women with Hyperglycemia in Pregnancy
Authors: Nabi Tauseef , Rafiq Nadeema , Trigotra Suchet , Mishra Smriti
Published: February 2022

Context:

Women with hyperglycemia in pregnancy (HIP) are at increased risk of developing type 2 diabetes (T2D).

Aim:

The present study intended to study the incidence of postpartum diabetes among HIP women and predict its risk factors.

Settings and Design:

This was a prospective observational study done on 178 women with HIP diagnosed after the first trimester, attending the tertiary care hospitals between December 2018 and March 2020.

Materials and Methods:

Demographics, clinical variables, and feto-maternal outcomes were recorded. The postpartum glycemic status was determined using a 75 g oral glucose tolerance test (OGTT) at 1 and 6 months.

Statistical Analysis:

All analyses were performed with SPSS software (version 21.0).

Results:

The mean age of women with HIP was 30.2 ± 6.1 years, with 38% having a family history of diabetes. Eighty percent of the women delivered full-term babies and 71.3% underwent a cesarean section. Gestational hypertension was present in 21.9% of patients. Macrosomia was present in 4.6% of the babies, hypoglycemia in 6.7%, and spontaneous abortion occurred in 7.7%. Postpartum OGTT at 6 months was completed by 76.4% of participants. The incidence of diabetes and glucose intolerance postpartum was 11.7 and 16.2%, respectively at 6 months. Logistic regression analysis showed that maternal obesity, diagnosis of HIP at an earlier trimester (<24 weeks), need for insulin treatment during pregnancy, signs of insulin resistance and fasting and 2-h plasma glucose >100 (>5.6 mmol/L) and >195 mg/dL (>10.9 mmol/L), respectively, and glycated hemoglobin > 6.5% (>48 mmol/mol) increased the risk of having postpartum diabetes significantly.

Conclusion:

The incidence of postpartum glucose intolerance in women with HIP is high. Prospective diabetes evaluation is required and intervention should be considered in women with HIP who have obesity, diagnosis of HIP at an earlier trimester, signs of insulin resistance, and require insulin treatment during pregnancy.
The Spectrum of CYP21A2 Gene Mutations from 16 Families of Congenital Adrenal Hyperplasia: Genotype-Phenotype Correlation
Authors: Sridhar Subbiah , Govindhan Ramajayam , Soundian Balasankar , Poomarimuthu Maheshkumar , Nallan Karuppasamy , kumar Santhanakrishnan Ramesh , Eagappan Subbiah , Natarajan Vasanthiy , Jayaraman Sangumani
Published: February 2022

Aim:

Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder of the adrenal steroidogenic pathway. The most common form of CAH is due to 21-hydroxylase deficiency resulting from mutations in CYP21A2 gene. The present study aimed to identify CYP21A2 common gene mutations, phenotype correlation, and to analyze the segregation pattern in CAH patients, parents, and siblings.

Materials and Methods:

Sixteen families having at least one classic CAH child in each family, a total of 58 subjects were recruited. The presence of six most common gene mutations, namely, Intron 2 (c.293-13A/C>G), c.844G>T (p.Val282Leu), c.1019G>A (p.Arg340His), c.92C>T (p.Pro31Leu), c.955C>T (p.Gln319*), and c.518T>A (p.Ile173Asn) in CYP21A2 gene were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) using specific primers.

Results:

Out of 16 classic CAH females analyzed, salt-wasting (SW) form was present in 12 (75%) and simple virilizing form in four (25%) children. Isolated clitoromegaly was the most common clinical presentation followed by ambiguous genitalia. The most common mutation observed in CAH patient population was Intron 2 (c.293-13A/C>G) (100%) followed by p.Pro31Leu (98%), p.Gln319* (93%), p.Val282Leu (91.4%), and p.Ile173Asn (19%). Although p.Arg340His mutation was not observed in this study. Interestingly, Intron 2 (c.293-13A/C>G) homozygous was observed in 31.3% of the entire study cohort and p.Ile173Asn mutation was found to be associated with SW form.

Conclusions:

Our results suggested a high prevalence of CYP21A2 gene mutations among CAH patients and heterogeneous mutation spectrum in their families of south Indian cohort. The outcomes afford valuable evidence for premarital and prenatal screening as well as planning suitable programs to prevent the development of CAH in Indian population.
Outcomes of trabeculectomy in eyes with refractory acute primary angleclosure in Indian eyes
Authors: Krishnamurthy Rashmi , Senthil Sirisha , Rao Harsha L , Mandal Anil K , Garudadri Chandrasekhar
Published: February 2022

Purpose:

To report the outcomes of trabeculectomy in eyes with refractory acute primary angle-closure attack.

Methods:

Patients with acute primary angle-closure attack and who underwent trabeculectomy for medically uncontrolled intraocular pressure within 2 months of presentation were retrospectively analyzed. Primary outcome was intraocular pressure (IOP). Secondary outcome measures were visual acuity, number of antiglaucoma medication (AGM), complications, and risk factors for failure of trabeculectomy.

Results:

Thirty-five eyes of 31 patients with median (interquartile range) follow-up of 3 (0.5, 9) years were included in the study. Median age at presentation was 55 (47, 60) years. Median duration of symptoms at presentation was 10 (4, 16) days and median time from presentation to surgery was 13 (6, 25) days. Median IOP reduced from 42 (36, 46) to 13 (12, 16) mmHg (P < 0.001) and median number of AGM reduced from 3 (1, 3) to 0 (0, 0) after trabeculectomy at the end of 1 year. The probability of complete and qualified success was 88% (95% confidence interval [CI]: 72%–95%) and was 97% (95% CI: 81%–99%) at 1 year, respectively. Failure was noted in six eyes. Subsequent cataract surgery was needed in 13 eyes (37%) with a median duration from trabeculectomy being 6.75 (1, 11) years. None of the preoperative, intraoperative, or postoperative factors tested were associated with failure (P > 0.10 for all associations on Cox proportional hazard regression analysis).

Conclusion:

In medically unresponsive cases of acute primary angle-closure attack, primary trabeculectomy seems safe and effective in Indian eyes.
Neuroprotection in glaucoma
Authors: Vishwaraj C R , Kavitha Srinivasan , Venkatesh Rengaraj , Shukla Aakriti Garg , Chandran Premanand , Tripathi Shweta
Published: February 2022

Neuroprotective therapies in glaucoma may play a role in preventing ischemia and oxidative damage that results in apoptosis of retinal ganglion cells and optic nerve damage. Although intraocular pressure (IOP) is the only known modifiable risk factor for glaucoma, disease progression commonly occurs despite IOP control, suggesting that factors other than IOP play a role in its pathogenesis and can potentially act as targets for neuroprotection. Factors including mediators of apoptosis, ischemic changes, poor ocular blood flow and neurotoxins have been hypothesized to play a role in glaucoma progression. Neuroprotective targets include glutamate-induced neurotoxicity, nitric oxidase synthetase, neurotropins, calcium channel receptors, free radicals, vascular insufficiency, the rho-kinase pathway, and more. Drugs related to these factors are being evaluated for their role in neuroprotection, although this area of investigation faces several challenges including limited evidence for these agents’ efficacy in clinical studies. Additionally, while IOP-lowering therapies are considered neuroprotective as they generally slow the progress of glaucoma progression, they are limited by the extent of their effect beyond IOP control. The aim of this article is to review the current treatment options available for neuroprotection and to explore the drugs in the pipeline.
Assessing the efficacy of 3D-printed ear protectors on mask adherence at an academic ophthalmology center
Authors: Meer Elana , Nguyen Brian J , Choi Daniel J , O’Brien Joan M , Addis Victoria M , Tapino Paul J
Published: February 2022

Purpose:

In the ophthalmology setting, given the close proximity required for the clinical exam, appropriate mask usage and fit is essential. This study aims to assess how a simple, cost-effective 3D-printed face mask ear protectors (EP) attachment may decrease discomfort, increase compliance, and improve fit in an academic institution’s Ophthalmology department.

Methods:

Face mask EPs were distributed to patients and providers in the Ophthalmology department. A validated questionnaire was administered before and 2 weeks after EP usage. The survey included questions on demographics and frequency of mask usage during a spectrum of activities. Descriptive statistics were performed with Fischer’s t test.

Results:

Post-EP responses demonstrated an increased likelihood of mask usage across all activities, although not statistically significant. The greatest change was during outdoor activities, with a 14.3% increase in highest utilization. Post-EP, all subjects were very likely to wear masks while shopping and 91.7% while in the workplace. EP usage decreased the number of noncompliant individuals while spending time with friends and family by 93.3%. Almost no subjects reported mask removal of >15 times per hour post-EP. The increase in mask compliance was greatest for low mask utilizers. 91.9% reported improved comfort, 91.9% reported improved fit, and 81.6% reported increased mask usage.

Conclusion:

Our results suggest that simple cost-effective 3D-printed ear protectors may improve fit, comfort, and overall mask compliance. The results of this study should drive broader public health efforts to further investigate whether mask attachments can improve overall mask compliance through better comfort and fit.
Cost analysis of pediatric cataract surgery in a tertiary eye care hospital in Western India
Authors: Kapse Rajesh R , Agarwal Stuti S , Rishikeshi Nikhil , Deshpande Madan , Kulkarni Sucheta , Deshpande Rahul , Dole Kuldeep
Published: February 2022

Purpose:

To assess the cost of pediatric cataract surgery in a tertiary eye care hospital from a provider’s perspective.

Methods:

Retrospective review of direct costs incurred for pediatric cataract surgery for the financial year April 1, 2018, to March 31, 2019. The cost analysis was done by standard costing methods. The fixed cost included the cost of land, buildings, construction, maintenance, personnel, operation theater (OT), and Out patient department (OPD) equipment. The variable cost included the cost of consumables used during surgery. The indirect costs were not considered.

Results:

The per-patient fixed facility cost was INR 1.52 ($0.02), maintenance cost was INR 39.06 ($0.55), OPD equipment and consultation were INR 19.64 ($0.28), OT equipment was INR 467.95 ($6.61), the cost for personnel was INR 5,300.33 ($74.92), and the cost of consumables varied between INR 16,418 ($314.44) and INR 22,313 ($397.76), with the choice of intraocular lenses (IOL) being the main determining factor. The net average cost for a pediatric cataract surgery varied between INR 22,246.50 ($ 314.44) and INR 28,141.50 ($ 397.76).

Conclusion:

Pediatric cataract surgeries are cost-intensive. High-volume surgeries and an increase in the number of patients in OPD reduce the fixed facility cost. But there is an overall increase in human resource (HR) and consumable cost owing to economic and technological reforms. However, the impact of operating a child, thereby, increasing his/her blindness-free years probably outweighs the cost and justifies it. High patient inflow, increased number of surgeries, and bulk purchase of consumables help in decreasing the cost.
Merits of multicolor imaging for tractional retinal detachment
Authors: Gadde Santosh Gopi Krishna , Sridharan Akhila , Gurram Nikitha Reddy , Poornachandra B , Govindasamy Nivedhitha , Jayadev Chaitra
Published: February 2022

Purpose:

To compare multicolor imaging (MCI) with Optos color fundus photography (OCFP) for the evaluation of morphology and extent of preretinal membranes in diabetic tractional retinal detachments (TRD).

Methods:

In this retrospective study, 30 eyes with diabetic TRDs were imaged using the MCI feature of the Heidelberg Spectralis Spectral-domain optical coherence tomography (SD-OCT) and color photo using the Optos Daytona ultra-widefield fundus camera. Two investigators independently graded and determined the agreeability between the two modalities with respect to the extent of the TRD and preretinal membranes on the SD-OCT B-scan images.

Results:

The MCI provided better visualization of the attachments and traction points of the posterior hyaloid face and preretinal membranes and is comparable to the SD-OCT B-scan images. The inter-rater agreeability rates for OCFP had a Kappa (κ) value of 0.37, while the MCI had a κ value of 0.46. When comparing between images of different wavelengths, grading using infrared reflectance (IR) had a poor agreement (−0.04 ± 0.04) while green reflectance (GR) (0.46 ± 0.32) and blue reflectance (BR) (0.53 ± 0.19) had a moderate agreement. The composite MCI and GR images also had comparatively higher intraclass coefficient when compared to the OCFP (0.25 [−0.09–0.55]) and IR (−0.03 [−0.39–0.34]) images.

Conclusion:

MCI is more sensitive for determining the extent of TRDs and for the detection of secondary membranes when compared to OCFP, thus, aiding in better surgical planning.
Orbital dermoid cyst
Authors: Bansal Rolika , Honavar Santosh G , Talloju Shiva Shankar , Mulay Kaustubh
Published: February 2022

Background:

Dermoid cyst, a developmental benign choristoma, is the most common orbital tumor of childhood, arising from ectodermal sequestration along the lines of embryonic fusion of mesodermal processes, lined by keratinized stratified squamous epithelium and expanding slowly due to constant desquamation and dermal glandular elements. Approximately 80% are found in the head and neck region and comprise 3-9% all orbital masses.

Purpose:

It is mandatory to know about the variable presentations of orbital dermoids and the surgical techniques that can be adopted based on the site, extent, age and aesthetic needs, presence of inflammation and possibility of intraoperative rupture.

Synopsis:

Orbital dermoids can be classified as juxta-sutural, sutural or soft tissue cysts; superficial or deep; intraosseous or extraosseous, and intraorbital or extraorbital. These smooth, painless, mobile or partially mobile lesions mostly present at the fronto-zygomatic suture with proptosis, displacement, ptosis or diplopia, depending on depth and extent. Therefore, it is important to understand the various presentations and the appropriate surgical techniques.

Highlights:

We describe the embryological origin, types and clinical features of dermoids in this video and demonstrate the surgical and minimally invasive techniques for their management. Video link: https://youtu.be/-q3xD2igjcQ
A neophyte gonioscopist’s animative and videographic atlas with focal points for effective practice
Authors: Ramesh Prasanna Venkatesh , Parthasarathi Sathyan
Published: February 2022

Background:

Though various gonioscopy teaching platforms are available, they predominantly comprise of real time scenarios and videos. For a beginner, we suggest providing animations of the real time scenario for cognitive training; and then putting them in real time scenarios for a better concept application and practice.

Purpose:

This video highlights the basic tips and tricks needed to perform gonioscopy with metaphorical conceptual learning matching the 2D and 3D animations with real time scenarios.

Synopsis:

Simple and practical scenarios with technical details on how to perform gonioscopy and various challenges are shown. All the animations and videos are created by us, tailored to a neophyte. The following concepts are covered: normal angle (animation versus real-time), dynamicity of the gonioscopic dates of person, methods of gonioscopy - direct and Indirect, precautions and slit lamp adjustment, bubble trouble, patient examination, iris process versus peripheral anterior synechiae (animation versus real-time), patient examination (angle viewing order) for different lens, how to remove gonioscopy lens from the eye, static versus dynamic gonioscopy, situations where gonioscopy is contraindicated, grading of the angle (with animations), clinical scenarios (pseudoexfoliation, pigment dispersion, angle recession and aniridia), and surgical scenarios (patent ostium and blocked ostium).

Highlights:

Multiple animations and real-time videos with focal points for effective practice are the highlights of this video. Video link: https://youtu.be/fFmPmqgdjyM
Post-operative outcomes of small-incision lenticule extraction in patients with moderate to high astigmatism
Authors: Arulmozhi Varman N V , Varman Aadithreya , Balakumar Dinesh
Published: February 2022

Purpose:

To evaluate the visual outcomes of patients who underwent small-incision lenticule extraction (SMILE) for the treatment of myopic astigmatism with high cylinders (>2.5 diopters, D).

Methods:

Forty-two eyes of myopic astigmatism with a spherical error of magnitude between − 0.5 and − 6.0 Ds, cylindrical error of − 2.5 to − 4.5 Dcyl were included in the retrospective study. All patients were tested preoperatively and on days 1, 10, and 30 for uncorrected distance visual acuity, manifest refraction, and corrected distance visual acuity. Additional preoperative assessments were done including measurement of corneal thickness, corneal topography, and examination for ocular surface disease. All procedures were performed by a single experienced surgeon. VisuMax laser system (Carl Zeiss Meditec AG, Jena, Germany) was utilized for all the corrective refractive procedures.

Results:

Forty-two eyes were included. The logarithm of the minimum angle of resolution Uncorrected distance visual acuity (UDVA) was 1 ± 0.25 preoperatively and 0.00 ± 0.00 on postoperative day 30. There was no loss of corrected distance visual acuity (CDVA) lines.

Conclusion:

SMILE is a successful procedure in the treatment of both myopic spherical and cylindrical refractive errors including high cylindrical errors >-3 to − 4.5 Dcyl.
Lowering of intraocular pressure after phacoemulsification in primary open-angle and angle-closure glaucoma: Correlation with lens thickness
Authors: Kader Mohideen Abdul , Pradhan Arkaprava , Shukla Aakriti Garg , Maheswari Devendra , Ramakrishnan R , Midya Debahuti
Published: February 2022

Purpose:

To assess anterior chamber configuration changes during phacoemulsification in primary angle-closure suspect (PACS/PAC) and primary open-angle glaucoma (POAG).

Methods:

Prospective observational comparative study of anterior segment optical coherence tomography (AS-OCT) findings before and after phacoemulsification on three groups of patients (PACS/PAC, POAG, and controls). Data were collected over a period of 9 months. Main outcome measures included mean change in anterior chamber depth (ACD), angle opening distance (AOD), and trabecular iris space area (TISA).

Results:

153 patients (51 PACS/PAC, 51 POAG, and 51 controls) were included in the study. Change in all parameters (ACD, AOD at 500 um, and AOD at 750 um) between the groups demonstrated a greater change in PACS/PAC as compared to POAG and controls. AOD at 750 μm in the temporal quadrant, which has been considered to be having the highest correlation or best representation of the angle, increased in all groups after phacoemulsification (463.59 ± 10.99 vs. 656.27 ± 9.73 mm in PACS; 521.29 ± 16.36 vs. 674.37 ± 8.72 mm in POAG; 549.27 ± 12.40 vs. 702.82 ± 13.04 mm in controls, (P < 0.001). After phacoemulsification, intraocular pressure (IOP) decreased by 2.75 ± 1.17 mm Hg in PACS/PAC (P < 0.001), 2.14 ± 1.33 mm Hg in POAG and 1.90 ± 1.25 mm Hg in controls and it was statistically significant in the PACS group compared to control (P < 0.001).

Conclusion: Phacoemulsification with intraocular lens implantation is associated with increase in the ACD and angle parameters and a corresponding decrease in IOP. Findings were more pronounced in PACS/PAC suggesting early phacoemulsification may be a treatment option in this group.
Winning the battle of refractory hypotony
Authors: Maheshwari Devendra , Shyam Priyanka , Pawar Neelam , Ramakrishnan Rengappa
Published: February 2022

Background:

Trabeculectomy, a mainstay in the management of glaucoma is associated with various complications, the most dreaded being hypotony.

Purpose :

We present a challenging case of late-onset refractory hypotony following trabeculectomy.

Synopsis:

A 64-year-old male patient diagnosed with primary open angle glaucoma in the right eye underwent combined surgery. Three weeks later, he presented with hypotony which responded well with medical management and then he was lost to follow-up. Two years later, he presented with severe hypotony with shallow choroidal detachment in the right eye, which failed to respond to medical management. Compression sutures were placed over the bleb which also failed to work. Subsequently bleb repair was done with corneal patch graft, which helped resolve the bleb leak, with an improvement in visual acuity and intraocular pressure.

Highlights:

This video highlights the importance of prompt and timely intervention of an overfiltering bleb in preventing irreversible visual loss. Video link: https://youtu.be/8DrxzqQ4qP4