bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and safety of novel twincretin tirzepatide a dual GIP and GLP-1 receptor agonist in the management of type-2 diabetes: A Cochrane meta-analysis
Authors: Dutta Deep , Surana Vineet , Singla Rajiv , Aggarwal Sameer , Sharma Meha
Published: February 2022

Background:

Till date, there is no Cochrane meta-analysis available which has analyzed efficacy and safety of tirzepatide in type-2 diabetes. This meta-analysis was undertaken to address this knowledge gap.

Methods:

Electronic databases were searched for randomized controlled trials (RCTs) involving people with diabetes receiving tirzepatide compared to a placebo/active comparator. Primary outcome was to evaluate changes in HbA1c. Secondary outcomes were to evaluate alterations in blood–glucose, glycemic targets, weight, lipids, and adverse events.

Results:

From 34 articles initially screened, data from six RCTs involving 3484 patients were analyzed. Over 12–52 weeks, individuals receiving tirzepatide had significantly greater lowering of HbA1c [mean difference (MD) = -0.75% (95% confidence interval (CI): -1.05 to -0.45); P < 0.01; I
2 = 100%], fasting glucose [MD = -0.75 mmol/L (95% CI: -1.05 to– -0.45); P < 0.01; I
2 = 100%], 2-h post-prandial-glucose [MD = -0.87 mmol/L (95% CI: -1.12 to -0.61); P < 0.01; I
2 = 99%], weight [MD = -8.63 kg (95% CI: -12.89 to -4.36); P < 0.01; I
2 = 100%], body mass index [MD = -1.80 kg/m2 (95% CI: -2.39 to -1.21); P < 0.01; I
2 = 99%], and waist circumference [MD = -4.43 cm (95% CI: -5.31 to -3.55); P < 0.01; I
2 = 95%] as compared to dulaglutide, semaglutide, degludec, or glargine. Patients receiving tirzepatide had higher odds of achieving HbA1c <6.5% compared to active controls [odds ratio (OR) = 4.39 (95% CI: 2.44–7.92); P < 0.01; I
2 = 90%]. Tirzepatide use had significantly higher odds of weight loss >5% [OR = 19.18 (95% CI: 2.34–157.17); P < 0.01; I
2 = 99%], >10% [OR = 21.40 (95% CI: 2.36–193.94); P < 0.01; I
2 = 98%], and >15% [OR = 32.84 (95% CI: 2.27–474.33); P = 0.01; I
2 = 96%] compared to active-control group. Treatment-emergent adverse events [risk ratio (RR) = 1.43 (95% CI: 1.14–1.80); P < 0.01; I
2 = 40%] and severe adverse events [RR = 1.00 (95% CI: 0.64–1.57); P = 1.00; I
2 = 49%] were not different. High data heterogeneity and the presence of publication bias limits the grading of current data from “moderate to low.”

Conclusion:

Tirzepatide has impressive glycemic efficacy and weight-loss data over 1-year clinical use. The need for higher grade, long-term efficacy, and safety data remains.
Evaluation of Glucocorticoids Utilization in Central Kerala using Pharmacy Sales Overview
Authors: Mathew Sara , Finny Philip , Samuel Johnson Abel K. , Maria Mridula , Samuel Preethy S. , Armstrong Lois J. , David Alice
Published: February 2022

Background:

Misuse of prescription drugs is a major public health problem in India and developing countries. Emerging evidence indicates that glucocorticoids are a class of drugs that are silently misused. These drugs are inexpensive and easily available as over-the-counter drugs in India are widely used by local practitioners and self-prescribed by patients for swift symptomatic relief of febrile illnesses, joint pain, asthma, other respiratory illnesses, and skin diseases. Many people have become dependent on glucocorticoids unintentionally and remain completely unaware of the metabolic changes occurring in their bodies.

Methodology:

A descriptive cross-sectional study involving 38 pharmacies in Thiruvalla municipality of South India was conducted to indirectly assess the utilization of glucocorticoids in the region using a pharmacy sales overview.

Results:

Most people approach pharmacies with prescriptions than without. A high majority of pharmacists do not have any knowledge about the uses (37%) or adverse effects (66%) of glucocorticoids. More than 50% of the community pharmacies have more than 1% of their sales attributed to glucocorticoids when compared with the total sales volume of drugs.
Ultrasound biomicroscopy as a tool in the evaluation and management of ocular hypotony in uveitis
Authors: Ganesh Sudha K , Nair Nivedita , Thatikonda Divya
Published: February 2022

Purpose:

Chronic uveitis can lead to hypotony that may result in severe visual impairment. We highlight the use of ultrasound biomicroscopy (UBM) as an imaging tool to decide the modality of therapy and management of uveitic hypotony.

Methods:

This was a retrospective hospital-based interventional case-series study that included a total of 36 eyes of 25 patients with uveitic hypotony seen between January 1997 and January 2020.

Results:

Thirty-six eyes of 25 patients with uveitic ocular hypotony were included. Unilateral involvement was seen in 56%. The median age of presentation was 21 years with a median follow-up of 21.5 months. Anterior uveitis was noted in 13.88%, intermediate uveitis in 52.77%, and panuveitis in 33.33% eyes. UBM findings commonly noted were pars plana membranes, supraciliary effusion, blunted ciliary process, and ciliary body traction. Other findings included ciliochoroidal detachment and ciliary body edema. Moreover, 22.2% eyes were managed with medical therapy alone, whereas 77.8% eyes received both medical and surgical intervention based on UBM findings. Furthermore, 66.7% eyes showed improvement in intraocular pressure, 13.9% eyes maintained the same IOP, whereas 19.4% eyes had worsening of IOP at final follow-up.

Conclusion:

We found UBM as a useful imaging tool in evaluating and judiciously deciding the mode of management of uveitic hypotony.
Cross sectional study of depression, anxiety and quality of life in glaucoma patients at a tertiary centre in North Kerala
Authors: Ajith Bindu S , Najeeb Nimitha , John Arino , Anima V N
Published: February 2022

Purpose:

To determine the magnitude and direction of association of anxiety and depression and the quality of life (QoL) in persons with glaucoma.

Methods:

This prospective cross-sectional study in conducted in a tertiary eye center in north Kerala included glaucoma patients and normal subjects aged 40–80 years. The Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), Glaucoma Quality of Life (GQOL), and glaucoma evaluation were performed for all participants. One-way analysis of variance was used for statistical analysis.

Results:

The study included 148 subjects with glaucoma and 150 subjects without glaucoma. The prevalence of depression (35.81%) and anxiety (25.0%) was significantly higher in glaucoma patients. In a multivariate regression model, PHQ-9 (adjusted OR: 2.39, 95% CI: 1.31–4.38, P < 0.001), GAD-7 (adjusted OR: 2.06, 95% CI: 1.01–4.19, P = 0.01) and GQOL (coefficient: 6.92, 95% CI: 4.52–9.31, P = < 0.001) was significantly associated with glaucoma. The GAD-7 score was significantly higher (P = 0.02) in PACG compared to POAG in moderate and severe anxiety. ADL scores (one-way ANOVA, P = 0.001) and GQOL scores (one-way ANOVA, P < 0.001) were significantly associated with vision impairment and blindness.

Conclusion:

Depression and anxiety are common in glaucoma patients, indicating the need for screening protocols using PHQ and GAD scales to identify persons at risk. The lack of ophthalmic risk factors associated with depression and anxiety emphasizes the importance of psychological evaluation and combined management with a psychiatrist in glaucoma management.
Assessment of retinal manifestations of Parkinson’s disease using spectral domain optical coherence tomography: A study in Indian eyes
Authors: Verghese Shishir , Berkowitz Sean T , Shah Virna M , Shah Parag , Priya S , Saravanan Veerappan R , Narendran Venkatapathy , Selvan V A
Published: February 2022

Purpose:

To assess the retinal manifestations of Parkinson’s disease using optical coherence tomography.

Methods:

A prospective case-control study comparing 30 eyes from 15 patients with Parkinson’s disease and 22 eyes from 11 healthy age-matched controls. Total macular subfield thickness and the thickness of the ganglion cell layer, nerve fiber layer, and peripapillary retinal nerve fiber layer were measured with spectral-domain optical coherence tomography (SD-OCT).

Results:

The mean age of PD patients was 68.4 years ± 10.64 (range: 46–82) and in the control group was 66.36 ± 5.22 (range: 64–68). The average disease duration in patients with PD was 6.7 ± 2.8 years (range: 2–10 years). The mean best-corrected visual acuity in PD was 20/26 and 20/20 in controls, with P = 0.0059, which was significant. Significant difference was also found in the contrast sensitivity between both groups. Structural differences in the central macular thickness (P = 0.0001), subfield thicknesses in the superior (P = 0.003), inferior (P = 0.001), nasal (P = 0.004), and temporal subfields (P = 0.017) was seen. Severe thinning of the ganglion cell layer was seen in PD patients (P = 0.000) as well as of the nerve fiber layer (P = 0.004). Peripapillary retinal nerve fiber thickness measured showed significant thinning in superotemporal (P = 0.000), superonasal (P = 0.04), inferonasal (P = 0.000), inferotemporal (P = 0.000), nasal (P = 0.000), and temporal quadrants (P = 0.000).

Conclusion:

Visual dysfunction was observed in patients with PD along with structural alterations on OCT, which included macular volumes, ganglion cell layer, and peripapillary retinal nerve fiber layer.
Volcano explosion in the eye: Expulsive choroidal haemorrhage
Authors: Sharma Namrata , Agarwal Tushar , Titiyal Jeewan S , Vajpayee Rasik B. , Roop Prakhyat
Published: February 2022

Background :

This video shows the dreaded complication of expulsive suprachoroidal haemorrhage in a penetrating keratoplasty . It teaches the various measures that help in preventing and managing the challenge peri-operatively.

Purpose:

This video is intended to sensitize the corneal surgeons about this rare complication using real-time surgical video and prepare them to face this challenge by demonstrating the preventive and mitigating strategies.

Synopsis:

A patient who was suitably taken up for an autokeratoplasty had expulsive choroidal haemorrhage in the non-seeing eye. This complication was managed using glycerin-preserved donor corneal button. Further, the video discusses various pre-operative and intra-operative optimizations to avoid such a complication and mitigate the damage caused by it, should it ever happen during a surgery.

Highlights:

Expulsive choroidal haemorrhage can be a traumatizing event and one must be mentally prepared to manage it. Pre-operative high-risk factors should always be managed and intra-operative maneuvers performed to prevent the complication, as shown in the video. Video link: https://youtu.be/s_ImBugPELw
Innovative models for vitreoretinal training during COVID-19 times
Authors: Mohan Roshni , Agasti Mimansaa , Nair Megha
Published: February 2022

Background:

Vitreoretinal training has been badly affected during the COVID-19 times. Due to lockdown, the number of patients reaching the hospital has dwindled. Hence we propose two simple cost-effective ways to improve resident training.

Purpose:

To highlight two simple eye models RETILAPP and RETISURGE, and their use in resident training. This video also highlights how to make and customise laser and surgery eye models and its advantages .

Synopsis:

By using 3D printing, two simple, economical and reusable eye models have been proposed to improve resident training especially during COVID-19 times.

Highlights:

Use of simple easily available materials and 3D printing to make sustainable eye models for practise as against the simulator based learning. Video link: https://youtu.be/dJau9N-sHUE
Achoo - God bless you!
Authors: Shah Dhaivat
Published: February 2022

Background:

“Achoo” is the sound that is correlated with sneezing. A sneeze, in rare occasions, it can cause Valsalva retinopathy. Usually, small bleeding gets absorbed with time. But if the haemorrhage stays for a longer period of time, it can lead to de-hemoglobinization of blood which can cause damage to the photoreceptors. If such a damage occurs over the macula, it can cause irreversible visual loss. Hence, prompt and meticulous treatment is indicated in such cases. One such case is described here where a lady suffered from a sudden bout of sneezing and presented to us after a month later. A large sub-internal limiting membrane (ILM) bleed was noted over the macula. Hence a vitrectomy with ILM peeling with drainage of blood was advised. She recovered 20/40 visual acuity one month following surgery.

Purpose:

This video emphasizes on diagnosis of sub-ILM hemorrhage and the technique in which the sub-ILM bleed can be drained in the modern era of microincision vitreoretinal surgeries.

Synposis:

A key aspect in such cases is to distinguish sub-ILM from sub-hyaloid bleed. Subtle differentiating points on imaging are described in the video. In cases of sub-ILM hemorrhage, the most important surgical step after performing a core vitrectomy is a good posterior vitreous detachment (PVD) induction. After that, ILM peeling is carried out with the help of finesse loop and ILM peeling forceps. Using proportional vacuum and aspiration alternatively from the cutter, the hemorrhage is displaced and drained. This step can prevent damage to the underlying retinal tissue. After the macula hemorrhage is completely cleared, an air-fluid exchange is done.

Highlights:

Teaching points include: 1. Diagnostic markers for sub-ILM hemorrhage; 2.The method of PVD induction in cases of Sub ILM hemorrhage; and 3.Technique of drainage of sub-ILM hemorrhage using proportional vacuum and aspiration function of the cutter. Video link: https://youtu.be/hBhfLDy9o-Y
Clinical profile and outcome of ocular manifestation in Marfans syndrome in India
Authors: Shah Shreya , Shah Mehul , Chandane Pradeep , Makhloga Sakshi , Thorat Deeksha , Sanghani Meera
Published: February 2022

Purpose:

Marfan syndrome (MFS) is a genetic disorder associated with considerable morbidity and mortality. Presently, well-documented information on this condition is not available in India.

Methods:

In this retrospective cohort study, we recruited patients with clinically diagnosed MFS who presented to the outpatient department using revised Ghent nosology. We retrieved complete ophthalmic information, including vision, anterior and posterior segments, exported from electronic medical records, and relevant investigations, surgical details, and follow-up data were obtained in a specific, pretested format.

Results:

Our cohort consisted of 86 eyes of 43 patients and had a male preponderance. The prevalence was 20.5 per 100,000 individuals. The mean age of the patients was 23.9 years. All eyes were treated either optically with refraction or surgically using lensectomy and vitrectomy with suture supported scleral fixated intraocular lens (IOL), which significantly affected the visual outcome (P = 0.000).

Conclusion:

Although considered a rare disease, MFS is commonly found in the ophthalmological setting. Refraction and surgery (lensectomy with scleral fixated IOL) may improve the vision significantly.
Outcomes and risk factors for failure of trabeculectomy with mitomycin C in children with traumatic glaucoma - A retrospective study
Authors: Shah Chintan , Sen Pradhnya , Mohan Amit , Peeush Parimal , Jain Elesh , Prasad Kailash , Sen Alok , Tripathi Shubhi
Published: February 2022

Purpose:

To determine surgical outcomes and risk factors for failure of trabeculectomy with mitomycin C (TMMC) in pediatric traumatic glaucoma.

Methods:

Children who underwent TMMC post trauma from January 2014 to December 2019 were reviewed. Demographic features, ocular findings, and surgery details were noted. Surgical success was defined as achieving intraocular pressure (IOP) within 6–21 mm Hg.

Results:

Seventy-one eyes of seventy patients underwent TMMC. The mean age of the patients was 11.28 ± 3.63 years with a male/female ratio of 13:1. The median time from trauma to IOP rise was 13 days. The majority of the patients (n = 64, 90.1%) had close globe injury. Baseline IOP was 39.3 ± 10.5 mm Hg. Results of the surgery were noted at the last visit. Cumulative success was noted in 51 (71.8%) eyes, while 20 (28.2%) eyes were labeled failures. Mean IOP reduced from 39.3 ± 10.5 to 14.5 ± 8.1 mm Hg. Mean visual acuity improved from 2.3 ± 0.93 to 1.19 ± 1.08 logMAR. Post surgery, the mean follow-up of the patients was 20.3 ± 11.4 months. Age <6 years (RR 3.6), elevated IOP at 1 month after TMMC (RR 2.19), and hypotony within a week of surgery (RR 1.81) were found as independent risk factors of surgical failure.

Conclusion:

TMMC is effective in reducing IOP in traumatic glaucoma. Young age and inability to control IOP within normal ranges in the immediate period after surgery are important risk factors of failure.
Vogt Koyanagi Harada disease following a recent COVID-19 infection
Authors: Anthony Eliza , Rajamani Archana , Baskaran Prabu , Rajendran Anand
Published: February 2022

A 23-year-old female presented with a 3-day history of bilateral (OU) diminution of vision 3 weeks after COVID-19 infection. Best corrected visual acuity (BCVA) was 20/30 in right eye and 20/40 in left eye. Anterior segment showed OU 1+ cells in anterior chamber and anterior vitreous face. Fundus OU showed disc hyperemia and multiple pockets of subretinal fluid (SRF), confirmed on optical coherence tomography. Fundus fluorescein angiography showed multiple pin point leaks suggestive of Vogt Koyanagi Harada disease. Oral corticosteroids 1 mg/kg/day were started. At 2-months’ follow-up, her BCVA improved to 20/25 OU with complete resolution of SRF.
Post-corneal transplant Candida keratitis – Incidence and outcome
Authors: Sati Alok , Wagh Sangeeta , Mishra Sanjay K , Kumar Sonali V , Kumar Pradeep
Published: February 2022

Purpose:

To report the risk factors, clinical characteristics, and outcomes of Candida keratitis following corneal transplantation in India.

Methods:

On retrospective review of medical records of 789 patients, 31 eyes developed a graft infection following corneal transplantation or keratoprosthesis and we could identify the Candida infection in only five. These cases were operated at two tertiary care centers in India. These five records were reviewed for demographics, risk factors (local and systemic) for graft infection, characteristics of infective lesion, corneal scraping results, treatment plan, and the final outcome following management.

Results:

The median age of the subjects with the Candida graft infection was 62.4 ± 10.33 years (range, 62–71 years). All patients were males. The predominant risk factors included repeat corneal transplantation (5/5), prolonged usage of topical steroids (5/5), and epithelial defects (4/5). The clinical characteristics included infiltrates of variable configuration like powdery deposits, white plaque, fluffy white infiltrate, and crystalline keratopathy. The smear showed budding yeasts in all five cases whereas culture was positive in four out of five cases. The final outcome with antifungals (systemic [4/5] and topical [5/5]) is variable. Two eyes underwent evisceration, two eyes had scar formation in the failed grafts, and one patient succumbed to the systemic disease 1-month post-corneal infection.

Conclusion:

Candida keratitis, in India, seems to be an emerging pathology following corneal transplantation and has a varied presentation. Though the outcomes following management seem to be grim, however, such infection can easily be avoided by a timely reduction of the risk factors.
Secondary glaucoma after intravitreal dexamethasone implant (Ozurdex) injection in patients with retinal disorder: A retrospective study
Authors: Sweta VD , Shibi Dev BN , Sandhya R
Published: February 2022

Purpose:

To investigate the rate of secondary glaucoma after intravitreal (IV) dexamethasone implant (ozurdex) 0.7 mg injection in a retinal disorder over a clinical treatment period of 2 years in a tertiary eye care center.

Methods:

Retrospective study based on the records of patients receiving IV ozurdex 0.7 mg implant for T/t of cystoid macular edema (CME), diabetic macular edema (DME), macular edema due to central retinal vein occlusion/branch retinal vein occlusion (CRVO/BRVO), and choroidal neovascular membrane (CNVM) at a tertiary eye care hospital for 2 years with 6 months of follow-up. The post-T/t intraocular pressure (IOP) and antiglaucoma medication (AGM) required was recorded at day 1, 1 week, 1, 2, 3, 4, and 6 months and analyzed for secondary IOP spike or ocular hypertension defined as IOP >21 mmHg at any point in time. The patients with pre-existing glaucoma and lost to follow-up were excluded.

Results:

A total of 102 eyes of 80 patients were included in the study. The mean baseline IOP was 14.40 + 2.97 mmHg, post-injection was 15.01 + 3.22 mmHg at day 1, 15.15 + 3.28 mmHg at 1 week, 15.96 + 3.62 mmHg at 1 month, 16.26 + 3.95 mmHg at 2 months, 15.41 + 3.33 mmHg at 3 months, 15.38 + 3.28 mmHg at 4 months, and 14.27 + 2.69 mmHg at 6 months. No significant difference was seen from baseline IOP at day 1 (P = 0.163), 1 week (P = 0.086), and 6 months (P = 0.748). Statistically significant difference was seen at 1 month (P = 0.0009), 2 months (P = 0.0001), 3 months (P = 0.023), and 4 months (P = 0.026). The mean IOP peak at 2 months recovered to baseline by 6 months subgroup IOP trend shows a similar variation and the results are consistent with the studies in the literature. About 19/102 (18.62%) eyes showed an IOP spike post-T/t. The maximum was seen at 2 months; 16 eyes showed a rise in the range 22–25 mmHg; 8 in the range 26–30 mmHg; and 1 eye had 34 mmHg and required multiple AGM—no surgical intervention was needed.

Conclusion:

A secondary IOP spike post-IV ozurdex 0.7 mg seen in 18.62% of the cases require AGM. The IOP monitoring should be meticulously performed for the variations and secondary IOP spike management to prevent irreversible damage to the optic nerve and visual field.
Prisms in the treatment of diplopia with strabismus of various etiologies
Authors: Anilkumar Sasikala E , Narendran Kalpana
Published: February 2022

Purpose:

We aimed to study the success of prism in regard to diplopia resolution score and associated factors in patients presenting with symptomatic diplopia arising from various etiologies.

Methods:

In this descriptive, retrospective study diplopia resolution among 31 patients who were prescribed prism were analyzed.

Results:

Fifty-four patients were evaluated for diplopia and 31 were included for the study done over 3 years. The mean follow-up was 15 months. Esotropia, exotropia, and hypertropia were seen in 39%, 51%, and 19.4% of patients, respectively. Furthermore, 71% received Fresnel prism and 29% were given ground glass prism. The mean prism power prescribed was 13.3 PD. 87% had complete resolution of diplopia; 96.8% continued usage of prism. High success rates were seen among patients with decompensated strabismus, sixth and fourth nerve palsy. Horizontal prism and oblique prism in the form of Fresnel prism yielded complete resolution of diplopia (P = 0.028). There was no association between the success of prism and etiology (P 0.058), history of trauma (P = 0.212), and type of deviation (P = 0.387). The study showed that oblique Fresnel prism can be considered for combined deviation.

Conclusion:

Our study showed prism to be effective in alleviating diplopia over a varied range of etiologies.
Epitope Identification and Designing a Potent Multi-epitope Vaccine Construct against SARS-CoV-2 Including the Emerging Variants
Authors: Srinivasan Sivasubramanian , Selvaraj Gracy Fathima , Gopalan Vidya , Padmanabhan Padmapriya , Ramesh Kiruba , Govindan Karthikeyan , Chandran Aswathi , Dhandapani Prabu , Krishnasamy Kaveri , Kitambi Satish Srinivas
Published: February 2022

Introduction:

The emergence of a novel coronavirus in China has turned into a SARS-CoV-2 pandemic with high fatality. As vaccines are developed through various strategies, their immunogenic potential may drastically vary and thus pose several challenges in offering immune responses against the virus.

Methods:

In this study, we adopted an immunoinformatics-aided approach for developing a new multi-epitope vaccine construct (MEVC). In silico approach was taken for the identification of B-cell and T-cell epitopes in the Spike protein, for MEVC various cytotoxic T-lymphocyte, helper T-lymphocyte, and B-cell epitopes with the highest affinity for the respective HLA alleles were assembled and joined by linkers.

Results:

The computational data suggest that the MEVC is nontoxic, nonallergenic and thermostable and elicit both humoral and cell-mediated immune responses. Subsequently, the biological activity of MEVC was assessed by bioinformatic tools using the interaction between the vaccine candidate and the innate immune system receptors TLR3 and TLR4. The epitopes of the construct were analyzed with that of the strains belonging to various clades including the emerging variants having multiple unique mutations in S protein.

Conclusions:

Due to the advantageous features, the MEVC can be tested in vitro for more practical validation and the study offers immense scope for developing a potential vaccine candidate against SARS-CoV-2 in view of the public health emergency associated with COVID-19 disease caused by SARS-CoV-2.
The frequency of osteoporosis in patients with predialysis chronic renal failure and the factors affecting the development of osteoporosis
Authors: Karatas A , Erdem E , Arıcı YK , Canakci E , Turkmen E , Turker NT
Published: February 2022

Background:

Osteoporosis is a common public health problem in chronic kidney patients. The risk factors for osteoporosis in patients with nondialysis CKD have not been fully investigated. It is not known exactly whether the risk factors of osteoporosis in the general population are also valid for the nondialysis CKD patients. Aims: This study aims to determine the frequency of osteoporosis and the risk factors for osteoporosis in nondialysis CKD patients.

Patients and Methods:

Our study was performed with 283 nondialysis stage 3-5 CKD patients. According to the BMD results, the patients were classified into groups as normal, osteopenia and osteoporosis according to World Health Organization criteria. Monocyte/high-density lipoprotein-cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) were calculated individually for all cases.

Results:

According to our BMD results, 67 (24%) patients were found to have osteoporosis. In the osteoporosis patient group, compared to the normal BMD group, females were higher and the mean age was higher (P = 0.025, P = 0.028). Body mass index (BMI) and eGFR were lower in the osteoporosis group (P = 0.013). Parathyroid Hormone and Platelet-to-lymphocyte ratio in the patients in the osteoporosis group was higher than of those in the normal group (P = 0.026, P = 0.035). In the multivariate logistic regression analysis, advanced age, female gender, and low BMI were determined as independent risk factors for the development of osteoporosis in nondialysis CKD patients.

Conclusion:

Advanced age, female gender and low BMI are the risk factors for osteoporosis in nondialysis CKD patients. It may be a rational approach to measure BMD for the diagnosis of osteoporosis in nondialysis CKD patients who are elderly, female and have low BMI.
Simple surgical approach for treatment of ankyloblepharon filiforme adnatum
Authors: Akagun N
Published: February 2022

Ankyloblepharon flliforme adnatum (AFA) is a rare congenital abnormality of the eyelids. Upper and lower eyelids are joined by single or multiple bands. It is usually isolated but can be associated with ophtalmic and systemic diseases. AFA is potentially amblyopic condition. Treatment is quick, safe, and minimizes the risk of amblyopia. We report a case of newborn with isolated AFA at birth, treated by surgical excision of the band tissue.
Signet ring cell carcinoma metastasis in the bone marrow accompanied by cancer related thrombotic microangiopathy as a first presentation
Authors: Baysal M , Alkış N , Tosun S
Published: February 2022

Cancer related thrombotic microangiopathies usually cause a diagnostic dilemma for hematologists and clinicians. In this case report, we presented a fifty-nine-year-old man who was admitted to our hospital with microangiopathic hemolytic anemia and thrombocytopenia due to the carcinoma metastasis to the bone marrow. As a result of rapid evaluations, it was revealed that the histological subtype of the cancer was signet ring cell carcinoma, and despite all the interventions, the patient died at a very short time after the initial presentation. Regardless of all the innovations in the diagnosis and treatment of thrombotic microangiopathies, cancer-associated thrombotic microangiopathy is still fatal and deadly today.
Marfan Syndrome with Aortic Root Disease, Severe Heart Failure and Aortic Dissection- Two Case Reports
Authors: Njoku PO , Mbadiwe NC , Onwubere BJ , Ejim EC , Anisiuba BC , Iyidobi TC , Onyema CT
Published: February 2022

Marfan syndrome is an uncommon inheritable connective tissue disease which affects the cardiovascular system. This paper presents two cases of Marfan Syndrome with predominant aortic root disease that were seen at the Cardiology Clinic of University of Nigeria Teaching Hospital, Enugu, Nigeria. Their biography, clinical features and echocardiography parameters were captured using structured questionnaire. Both were young males in their 4th decade of life, and had advanced aortic root diseases which were complicated by left ventricular failure in both, while one of them had aortic dissection and ischemic stroke. Young adult Nigerians with Marfan syndrome presented with advanced aortic root diseases, heart failure, aortic dissection and stroke.
INFLUÊNCIA DO USO DO SISTEMA DE CONTROLE GERENCIAL E DA ESTRATÉGIA ORGANIZACIONAL NO DESEMPENHO DA INOVAÇÃO
Authors: Lopes Iago França , Beuren Ilse Maria , Gomes Tayse
Published: February 2022

O papel dos Sistemas de Controle Gerencial (SCG) no desempenho da inovação tem desafiado as crenças da natureza mecanicista dos sistemas em ambientes inovadores. Assim, este estudo objetiva verificar a influência do uso do SCG no desempenho da inovação mediado pela estratégia organizacional em empresas brasileiras com perfil inovador. Uma pesquisa de levantamento foi realizada em empresas com foco em inovação e tecnologia, estabelecidas no Brasil. O instrumento de pesquisa foi enviado on-line, via plataforma Google Forms®, para diretores, gestores e coordenadores destas empresas e a amostra final resultou em 150 questionários válidos. Os resultados da modelagem de equações estruturais permitem aceitar parcialmente a hipótese de pesquisa, de que a relação entre o uso do SCG e o desempenho da inovação é mediada pela estratégia organizacional, nas tipologias de liderança em custos e de diferenciação. Esses achados alinham-se aos preceitos teórico-empíricos de Baines e Langfield-Smith (2003), de que não há relacionamentos diretos que ligam o design da organização, a tecnologia e os sistemas de avaliação de desempenho. Tal implica compreender os SCG como elementos proativos da criação de vantagem competitiva e da maximização das atividades de inovação no ambiente organizacional, cujo escopo também se constitui na principal contribuição deste estudo.
CARACTERÍSTICAS DOS SISTEMAS DE CUSTOS GERENCIAIS DE SUBSIDIÁRIAS ALEMÃS OPERANDO NO BRASIL: UMA ANÁLISE SOB A PERSPECTIVA DO ISOMORFISMO E DO DECOUPLING
Authors: Souza Rodrigo Paiva , Ramalho Leticia Damo Ferreira , Guerreiro Reinaldo
Published: February 2022

Este trabalho investigou práticas de gerenciamento de custos em subsidiárias de empresas alemãs operando no Brasil, com objetivo de avaliar a ocorrência de pressões isomórficas (coercitivas, miméticas e normativas) e o nível de decoupling nessas organizações. As pressões isomórficas tencionam para a uniformização de práticas, enquanto que o decoupling diz respeito ao uso apenas cerimonial dessas práticas. O método empregado foi o survey, sendo coletadas 27 respostas de gestores de subsidiárias alemãs de grande e médio porte que operam no Brasil. Os resultados trazem evidências de que há uma forte associação entre as práticas da subsidiária e da matriz, revelando elementos de pressão isomórfica coercitiva e mimética, já as pressões isomórficas normativas se mostraram menos marcantes. O nível de decoupling encontrado entre matriz e subsidiária foi baixo. O estudo contribui para a literatura e prática de gestão de custos, indicando que as pressões isomórficas da matriz contribuem para redução dissociação de práticas de contabilidade e gerenciamento de custos entre filial e matriz (decoupling).
ASSURANCE DOS RELATÓRIOS DE SUSTENTABILIDADE NO BRASIL: QUAIS FATORES PODEM INFLUENCIAR A SUA OCORRÊNCIA?
Authors: Borges Silveira Gabriela , Alberton Luiz
Published: February 2022

A asseguração externa tem sido empregada no sentido de atribuir credibilidade aos relatórios de sustentabilidade (RS), de modo a influenciar a percepção sobre o nível de legitimidade das organizações. Desse modo, esta pesquisa teve como objetivo identificar os fatores que podem influenciar a ocorrência da asseguração dos RS. A amostra deste estudo compreende as empresas brasileiras listadas na B3 em 2017 e que divulgaram seus RS durante o período de 2012 a 2016. Por meio da técnica de regressão logística em painel de efeitos mistos, buscou-se testar a relação entre a probabilidade da adoção da asseguração dos RS e as variáveis Setor Ambientalmente Sensível, Pressão do Setor, Comitê de Sustentabilidade, Global Reporting Initiative e Oportunidade de Crescimento, além das variáveis de controle apontadas pela literatura, que são: Tamanho, Rentabilidade, Endividamento e Setor. De acordo com os resultados, Pressão do Setor, Comitê de Sustentabilidade, Diretrizes da GRI e Tamanho são fatores que podem influenciar a adoção da asseguração dos RS. Esses achados sugerem que a busca das empresas por legitimidade por meio dessa prática ocorre em empresas maiores e mais evidentes, e pode resultar de práticas amplamente adotadas em seu setor, do monitoramento das questões de sustentabilidade exercido por comitês especializados ligados à estrutura de governança corporativa e da adoção de práticas de relato que atribuem qualidade e credibilidade aos RS.
INTELLIGIBILITY VS READABILITY: UNDERSTANDABILITY MEASURES OF FINANCIAL INFORMATION
Authors: Valentim Telles Samantha , Meirelles Salotti Bruno
Published: February 2022

Decision-making is influenced by information, which must be understood so it can be useful. However, measuring understandability is not a simple task. Previous studies use readability metrics as proxies for understandability, but readability is a shallow metric ignoring discourse and language components. This research analyzes the notes to the financial statements using intelligibility metrics, an alternative to readability measures. Our sample comprised 44 Brazilian firms that presented their Portuguese notes (native language) and English (non-native) from 2012 to 2015. Focusing on the notes of Financial Instruments and Provisions, we found that, for most indexes where firms had worse readability levels, they showed better intelligibility levels. It indicates that both metrics measure different things. Our results also indicated that language impacts these metrics and that firms did not improve their information quality after the guideline OCPC 07 from the Brazilian Accounting Standards Committee.
CEU Summer University Call for Applications
Authors: Božič Anja
Published: February 2022

How did the notion of civic participation change throughout history, and how were these changes reflected in the foundations of political thought? In what forms of expression did it surface in various written and visual media of the Middle Ages and the Early Modern period? These questions will be the focus of the summer university course.
Microfoundations of Strategic Decision Rationality in M&R : A Dyadic Investigation between Germany and China.
Authors:   , Arnold Nicole
Published: February 2022

Mergers and acquisitions (M&A) have become one of the primary strategies to increase corporate wealth but often fail to reach expected targets. While the notion of the bounded-rational man has been emphasised, the microfoundations of executives` factual decision-making processing, cognition and behaviour remain a source of debate. Extant research presents scattered, mostly unilateral studies and leaves a bridge to further explore and connect the disparate determinants that effect executives` level of rationality and organisational judgement in the complex realm of M&A. Data was collected from a sample of 30 senior M&A executives and consultants from Germany and China through semi-structured interviews. Within the post-positivist paradigm, the qualitative study employs a phenomenological approach and extends the theoretical framework with data from the lived experiences of these strategic decision-makers. Executives` mental and observable characteristics become explicit in the interfering circumstances and dependencies of M&A decision specifics in which these are deployed. In the dyadic perspective, findings highlight an experience-intuitive, a socio-structural, and a risk-dynamic path as significant in executives` strategic decisions, where ego becomes the enemy of rationality and societal norms its friend. A dynamic typology of behavioural momentum is then developed, proposing seven dimensions that direct non-rational behaviour in strategic M&A decision-making. This framework, grounded in system theory and dual-process models, summarises the relevant cues that affect the ease of perception and evaluation of realities which subsequently promote the relative dominance of cognition over rationale in such decisions. The conclusions emphasise that SDM models would be more complete when considering the underlying microfoundations of executive`s (inter-)actions in a content- and context-sensitive manner pertaining to the environment, organisation, target, decision practices and their interdependencies. It is also argued that conscious reflection of experiential perspectives becomes a necessary competence of decision-makers and top management teams (TMTs) to improve their business practice.
Conhecimento atual sobre os tentaculitoideos devonianos das bacias do Amazonas e Parnaíba, Brasil, depositados em instituições brasileiras
Authors: Comniskey Jeanninny Carla , Ghilardi Renato Pirani , Bosetti Elvio Pinto
Published: February 2022

Os tentaculitoideos são encontrados em afloramentos do Devoniano das bacias do Paraná (Formações Ponta Grossa e São Domingos), Amazonas (Formações Maecuru e Ererê) e Parnaíba (Formação Cabeças). Foram analisadas 39 amostras de coleções científicas provenientes do Devoniano Médio das bacias do Amazonas e do Parnaíba, com principal objetivo de realizar uma revisão sistemática e refinar o conhecimento acerca da distribuição estratigráfica e paleogeográfica do grupo. As espécies encontradas foram: Tentaculites trombetensis, Tentaculites stubeli, Tentaculites eldredgianus, Tentaculites oseryi e Styliolina clavulus. As espécies T. eldredgianus, T. trombetensis e S. clavulus foram encontradas em afloramentos do Eifeliano até o Givetiano, enquanto T. oseryi apenas no Givetiano e T. stubeli no Eifeliano. As primeiras ocorrências de tentaculitoideos para a América do Sul são registradas no Siluriano, o que corrobora a hipótese de que durante o Siluriano Inferior ocorreu um grande aumento da diversidade e quantidade de tentaculitoideos no mundo.
Considerações paleobiogeográficas baseadas em braquiópodes devonianos (Delthyridoidea, Strophodontoidea e Chonetoidea) das bacias do Amazonas e Parnaíba
Authors: Fonseca Vera Maria Medina da
Published: February 2022

Revisões sistemáticas de braquiópodes devonianos das bacias do Amazonas e Parnaíba reforçaram a constatação prévia da coexistência de formas dos domínios das Américas Orientais, Malvinocáfrico e do Velho Mundo, além de formas endêmicas nelas. Uma causa provável dessa composição mista é a posição paleogeográfica das bacias brasileiras e, sobretudo, a idade eifeliana-givetiana das macrofaunas, coincidente com as idades estimadas para o desaparecimento dos domínios Malvinocáfrico e das Américas Orientais. Estrofodontoides eram abundantes no Eodevoniano-Mesodevoniano dos domínios das Américas Orientais e do Velho Mundo, enquanto no Brasil as poucas formas identificadas restringem-se à Formação Maecuru. A ausência destas formas nas outras formações aqui tratadas, aliada à presença de gêneros malvinocáfricos nelas, amplia a provável influência das faunas ‘malvinocáfricas’ a partir do Eifeliano nas bacias do Norte e Nordeste do Brasil. Nos Chonetoidea, foi verificado um padrão similar entre as formas e a dinâmica da mistura de faunas das formações Maecuru/Pimenteira e Ererê/Membro Passagem com aquelas da região sul-saariana, no noroeste da África. Interessante também é a relação dessas paleofaunas brasileiras com as da Armórica (Europa norte-gondwânica) no Devoniano. Alguns táxons de braquiópodes e outros grupos, como os crinoides, sugerem uma troca faunística entre essas regiões durante o Devoniano.
Distribuição de metais pesados e isótopos de Pb em sedimentos do rio Amapari, setor de Pedra Branca do Amapari – Porto Grande, Amapá, Brasil
Authors: Silva Danúbia Tavares da , Lafon Jean Michel , Corrêa José Augusto Martins
Published: February 2022

Este trabalho apresenta dados mineralógicos e geoquímicos de metais pesados e de isótopos de Pb em sedimentos recentes, provenientes do rio Amapari e alguns de seus tributários, na região da Serra do Navio, parte central do estado do Amapá. Os sedimentos têm composição mineralógica formada essencialmente por quartzo, caulinita, muscovita e gibbsita, e apresentam grande heterogeneidade geoquímica e isotópica de Pb. Os resultados geoquímicos mostraram que os sedimentos têm altos teores de metais pesados e sofreram os mesmos processos de enriquecimento para todos os metais investigados. Os metais estão principalmente associados a minerais de Fe, e os argilominerais tiveram um papel secundário na concentração desses metais. A variação significativa na composição isotópica do Pb permitiu construir uma isócrona no diagrama 207Pb/204Pb vs. 206Pb/204Pb, com idade de 2169 ± 140 Ma, indicando que os sedimentos são provenientes essencialmente das unidades paleoproterozoicas (rochas supracrustais e granitoides associados), sem contribuição significativa das unidades do embasamento arqueano. Não foi evidenciada correlação entre a localização dos pontos em relação às áreas com atividades de mineração e aos teores dos metais.
First record of the genus Cranichis Sw. (Orchidaceae) for the state of Pará, Brazil
Authors: Hall Climbiê Ferreira , Koch Ana Kelly , Francener Augusto , De Barros Fábio
Published: February 2022

Cranichis is a Neotropical genus with about 53 species, five of which are known from Brazil. Cranichis muscosa is only known in Brazil from the states of Amazonas, Paraná and São Paulo. In this paper, a new record of C. muscosa is presented for the state of Pará, expanding the occurrence of the species.
Clinician Productivity During Student Full Time Clinical Experiences
Authors: Dehan Jamie , Avery Michele , Elmer Trevor , Colgrove Yvonne
Published: February 2022

Purpose: Clinical education is an essential part of physical therapy education. Clinicians who provide student clinical training have the primary responsibility of patient care and meeting their job demands including meeting productivity standards. Adding a student to the mix is often perceived as negatively impacting productivity. The purpose of this study is to examine the impact on clinician productivity in direct patient care while hosting a student for a clinical experience. This study (a) investigates differences seen when hosting a DPT student or a PTA student; (b) compares differences seen influenced by which curricular stage the student is in for the clinical experience; and (c) investigates the impact on productivity while hosting a student across various clinic settings. Method: Clinical instructors for DPT and PTA students from three academic institutions were asked to participate while hosting one of the institution’s students. Information was taken on daily hours worked, number of patients seen, and units billed for the week before the student arrived and during the student’s full-time clinical experience. Data collected was analyzed for changes over time and for comparison of baseline data to collective (net) averages for all weeks in which the student was present. Sub-analysis was done on curricular timing of the rotations (initial, intermediate, or final), types of settings (inpatient, outpatient or other), and types of students. Results: While there were several significant changes over time in the components assessed, there were no significant differences when comparing baseline productivity components to the collective weekly averages. Conclusion: It appears that hosting students during full-time clinical experiences does not affect the overall productivity. There is generally the predictable drop initially that recovers to baseline around week 4 while either maintaining or increasing productivity during the remaining weeks to produce a net neutral or positive impact. This study works to ultimately disprove the common belief that clinician productivity is negatively impacted while hosting a student during a clinical experience.
Impact of Pro Bono Clinic on Attitudes, Beliefs, and Confidence Towards Cultural Competence in First-year Doctoral Physical Therapy Students
Authors: Morris Scarlett , Xia RuiPing , Klaassen Troy , Johnson Trey
Published: February 2022

Purpose: Cultural competence is an essential skill for healthcare providers in our increasingly ethnically diversified society. There is an unmet need for educating future culturally competent physical therapists. The purpose of this study was to investigate the impact of pro bono clinic on cultural competence in first-year doctoral physical therapy students. Method: Forty-two participants completed a survey before and after attending three individual sessions of mentored pro bono clinical experiences during their first semester. The survey assessed participants’ attitudes and beliefs (Part I), and self-perceived level of confidence (Part II) towards cultural competence. Wilcoxon signed-rank tests were performed. Results: The mean scores increased from pretest (4.13 ± 0.55) to posttest (4.22 ± 0.48) for Part I (5: highest scale) and from 7.34 ± 0.96 to 8.01 ± 0.79 for Part II (10: highest level) but were not significant. Overall findings showed a positive impact which was reflected by students’ narrative comments post-participation (Part III). Conclusion: This study is novel due to limited evidence in this area, especially the effect of an early intervention. Pro bono clinic participation may be an effective approach that could be incorporated early in curriculum across allied health science education.