bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of Viral Load Cycle Threshold Values in Patients with SARS-CoV-2 Associated Pneumonia with Real-Time PCR Method
Authors: Bakir Ayfer , Hosbul Tugrul , Cuce Ferhat , Artuk Cumhur , Taskin Gurhan , Caglayan Murat , Guney Mustafa , Kurkcu Muhammed Furkan , Yildiz Fatime , Erdal Harun , Erdem Gul
Published: November 2021

Introduction: In this study, we aimed investigate the relationship of SARS-CoV-2 viral load cycle threshold (Ct) values with pneumonia.

Methodology: A total of 158 patients in whom SARS-CoV-2 was confirmed in upper respiratory tract (URT) samples with molecular method and who had computed tomography (CT) of the chest, between April 2020 and June 2020 were included in this retrospective cross-sectional study.

Results: Mean age of 158 PCR positive patients was 45.22 ± 17.89 and 60.8% of them were male. Pneumonia was detected in 40.5% of the patients on their chest CT. A weak but significant correlation was found between SARS-CoV-2 Ct value detected with PCR in analysis of oropharyngeal/ nasopharyngeal (OP/NP) samples and chest CT score (Pearson’s r: 0.197, p = 0.01). No correlation was found between the first detected viral load Ct value and age, gender and mortality. There was no significant correlation between chest CT score and mortality. While the areas remaining under ROC curve for Ct value in analysis of OP/NP samples in prediction of chest CT score ≥ 1, ≥ 5 and ≥ 10 were 0.564, 0.640 and 0.703 respectively.

Conclusions: We found that the amount of SARS-CoV-2 viral load (inverse relationship with Ct) detected in OP/NP samples of patients with COVID-19 pneumonia did not reflect the increasing severity of pulmonary lesions on chest CT. Although primary target of SARS-CoV-2 is all epithelial cells of the respiratory tract we believe studies comparing viral loads in lower respiratory tract samples are needed to determine the severity of pulmonary disease.
Impact of socioeconomic status on the knowledge, attitudes, and practices about visceral leishmaniasis among dog owners
Authors: De Carvalho Amanda Gabriela , Luz João Gabriel Guimarães , Rodrigues Luane Dantas , Dias João Victor Leite , Fontes Cor Jesus Fernandes
Published: November 2021

Introduction: This cross-sectional study evaluated the impact of socioeconomic status on the knowledge, attitudes, and practices (KAP) concerning zoonotic visceral leishmaniasis (VL) among dog owners from the municipality of Rondonópolis—a highly endemic area for the disease in Central-Western Brazil.

Methodology: Data were collected between 2016 and 2017 during a household survey. A probabilistic sample of 404 dog owners were interviewed assessing sociodemographic characteristics, previous occurrence of VL cases, and KAP about human VL, vector, and canine VL. Responses regarding KAP were compared among social classes, which are indicators of socioeconomic status. Correct/appropriate answers were scored, and a multivariate Poisson regression analysis evaluated the impact of social class on scoring.

Results: The overall KAP regarding VL was limited. Dog owners from higher social classes differed from those of the lower classes regarding the recognition of abdominal distension (p = 0.026) and skin lesions (p < 0.001) as clinical manifestations of human and canine VL, respectively, knowledge of VL transmission (p = 0.020), use of topical repellents (p < 0.001), use of insecticide-impregnated collars (p = 0.003), and previous attempts of treatment for canine VL (p = 0.005). Higher scores were associated with the upper social classes (IRR = 1.18; CI = 1.08-1.29) adjusted by the age (IRR = 1.13; CI = 1.04-1.24) and the previous occurrence of human (IRR = 1.21; CI = 1.07-1.36) and canine (IRR = 1.25; CI = 1.14-1.36) VL in the household/neighbourhood of the respondents.

Conclusions: Improved KAP concerning VL was associated with better socioeconomic status of dog owners.
Determination of amino acids content of the Tagetes lucida Cav. by GC/MS
Authors: Slobodianiuk Liudmyla , Budniak Liliia , Marchyshyn Svitlana , Kostyshyn Liliya , Ezhned Maria
Published: November 2021

Plant raw materials are widely used for the prevention and treatment providing of many diseases. The interest is the in-depth research of the flowers, leaves, and herb of Tagetes lucida. Therefore, the study aimed to determine the content of primary metabolites, namely amino acids in the raw materials of this plant. The amino acids composition and content in flowers, leaves, and herb were determined by the GC/MS method. The results of the study revealed that the raw material of Tagetes lucida contains more bound and less free amino acids. Free and bound L-proline, L-isoleucine were present in all the analyzed samples in the greatest amount (1.909 mg/g and 20.999 mg/g, 0.804 mg/g and 18.908 mg/g in the flowers; 2.721 mg/g and 18.973 mg/g, 3.459 mg/g and 28.518 mg/g in the leaves; 6.436 mg/g and 18.817 mg/g, 0.245 mg/g and 0.222 mg/g in the herb). Another free amino acid with a high content in flowers (1.321 mg/g) and herb (0.825 mg/g) of Tagetes lucida was L-aspartic acid. In addition, high content of L-phenylalanine in bound form was found in the leaves (11.843 mg/g) of the study plant. These amino acids to be considered distinguishing markers of the Tagetes lucida. This research contributes to already known information of Tagetes lucida use as herbal medicine, nutraceutical, and food reinforcement.
Entre les salles de classe et le ministère. Ethnographie des traductions de la « performance » d’une administration scolaire béninoise tournée vers les « résultats »
Authors: Jarroux Pauline
Published: November 2021

Au tournant des années 2000, le Bénin a engagé des réformes visant à assurer la transparence et l’efficacité de la dépense publique. C’est l’une d’elles – la gestion axée sur les résultats – que j’étudie ici en prenant pour objet le cas de l’administration scolaire. Plutôt que d’étudier la mise en œuvre de cette réforme, je mets au jour les multiples opérations de négociations et de traductions qui lui donnent corps et la font exister. Fondée sur une enquête ethnographique de quinze mois passés dans deux services déconcentrés des enseignements maternel et primaire, l’analyse suit le fil rouge des visites et inspections de classe que mènent conseillers pédagogiques et inspecteurs. Depuis les salles de classe où elles doivent être réalisées jusqu’aux revues centrales du ministère où elles apparaissent fondues dans des taux et des pourcentages, ces activités – ainsi que ceux qui doivent les mener à bien – sont l’objet de divers dispositifs visant à les associer aux objectifs d’une gestion axée sur les résultats. Ces derniers non seulement transforment le fonctionnement des administrations, mais aussi façonnent l’image d’un État soucieux des performances de ses services.
Changer la mesure du temps. Gouvernement par l’avenir et discipline par les nombres dans les transports à Mexico
Authors: Gonzalez Leonor
Published: November 2021

La réforme des transports qui est en cours à Mexico depuis le début des années 2000 a transformé les modes d’organisation de ce secteur. En comparant une organisation informelle de microbus et une entreprise créée dans le cadre de cette réforme, je décris les pratiques de calcul, les dispositifs matériels de contrôle, les procédures d’institutionnalisation d’un marché et les discours de moralisation déployés comme autant de technologies politiques qui introduisent une nouvelle organisation du temps. Je montre en particulier comment ces mesures, qui organisent un mode de gouvernement fondé sur la projection métrique du futur, inculquent un mode de rapport à soi caractérisé par la responsabilisation des personnes. Les corps des individus, de même que les rapports qu’ils entretiennent entre eux, sont alors orientés vers de nouvelles formes de productivité. Ainsi le régime d’idées et de pratiques du développement urbain durable entraîne-t-il une réorganisation des rapports de dette locaux nécessaire à la circulation des marchandises de la transition écologique et à la captation par les marchés financiers internationaux des ressources de l’économie informelle.
La gestion des frontières par le traitement différencié des voyageurs. Réflexion croisée sur la France et les États-Unis
Authors: Galy Ariane Marie
Published: November 2021

Dans l’imaginaire collectif, la frontière a longtemps été représentée comme une ligne de démarcation entre deux États. Cette acception supposait son assimilation à un espace/territoire géographique qui se traverse et qui est sous l’autorité exclusive de l’État. Elle ne tient plus aujourd’hui. Traitée abondamment par la littérature, la frontière se caractérise désormais par une dissociation entre le lieu de son contrôle et son emplacement territorial, la multiplication des acteurs impliqués dans sa gestion et le renforcement des modalités de distinction entre voyageurs autorisés ou non autorisés à entrer dans le pays. J’aborde ici cette troisième caractéristique de la frontière. En m’appuyant sur l’étude comparée des programmes Global Entry et PARAFE, je suggère que, au-delà de pratiques classificatrices dédiées à l’inclusion ou à l’exclusion des voyageurs, les modalités de sélection qui prétendent accélérer le passage aux frontières reposent sur des processus d’« inclusion différenciée », eux-mêmes modulés par des modes de valuation et d’évaluation. L’étude de ces deux programmes amène à se pencher sur les évolutions générales des pratiques de contrôle frontalier en cours.
Les schémas régionaux d’aménagement, de développement durable et d’égalité des territoires face au défi de planifier les transitions
Authors: Diaz Isabel
Published: November 2021

Cinq ans après la parution de la loi « NOTRe », la première génération des « schémas d’aménagement, de développement durable et d’égalité des territoires » (SRADDET) affiche globalement des stratégies de rupture avec les modèles d’aménagement en vigueur : ils marquent un tournant quant à l’inscription des sujets environnementaux dans l’aménagement. L’élaboration de ces visions prospectives est certainement l’un des résultats les plus probants de ces premiers schémas. Pour autant il ne s’agit pas d’une nouvelle modalité de planification, ces schémas ayant eu à intégrer des schémas préexistants inscrits au sommet de la hiérarchie des schémas d’urbanisme. Entre un contexte très évolutif des politiques nationales de la transition écologique depuis 2015, l’urgence d’agir et l’affirmation du bloc local, les SRADDET devront trouver leur place. La dimension prescriptive très peu encadrée qui leur a été conférée par le législateur ne s’est pas révélée opératoire. Aussi dans la phase de mise en œuvre qui s’esquisse, les régions vont devoir affirmer leur rôle de chef de file et mobiliser les instances de dialogues avec les territoires et l’État pour faire vivre les avancées de ces documents.
Lex iniusta non est lex . Les enjeux d’un malentendu
Authors: Béal Christophe
Published: November 2021

Le droit naturel soutient l’hypothèse d’une connexion nécessaire entre le droit et la morale. Pour les positivistes, cette thèse impliquerait l’invalidité de toute loi injuste. Lex iniusta non est lex . Cette maxime a malheureusement été la source de nombreux malentendus. À travers cette formule, le positivisme attribue au droit naturel une thèse que personne ne défend réellement. Notre objectif est de comprendre la genèse de ce malentendu et d’exposer la manière dont les théories contemporaines du droit naturel tentent de démêler les confusions véhiculées par cette maxime. Le droit naturel ne conteste pas nécessairement la validité des lois injustes mais il permet, à partir de la signification « focale » des concepts juridiques, de comprendre en quoi ces lois sont à la fois juridiquement et moralement défectueuses.
Impact des deux confinements sur le recours aux soins d’urgence lors de l’épidémie de COVID-19 en Nouvelle-Aquitaine
Authors: Meurice Laure , Vilain Pascal , Maillard Laurent , Revel Philippe , Caserio-Schonemann Céline , Filleul Laurent
Published: November 2021

Introduction : Suite à l’émergence de l’épidémie de COVID-19 en France, plusieurs mesures de prévention ont été mises en place, dont le confinement de la population. Celui-ci a pour but de ralentir la circulation du virus et de protéger le système de santé, notamment hospitalier. L’objectif de cet article est de décrire l’activité des urgences hospitalières lors des deux confinements liés à l’épidémie de COVID-19 en Nouvelle-Aquitaine. Matériels et méthode : Une analyse descriptive rétrospective des passages aux urgences a été réalisée pour la période du 9 décembre 2019 au 20 décembre 2020. L’évolution du nombre de passages aux urgences a été analysée à l’échelle régionale selon les caractéristiques médicales (hospitalisation et diagnostic de recours). Résultats : Le recours aux soins d’urgence a diminué de 50 % au cours du premier confinement lié à l’épidémie de COVID-19 et de près de 30 % lors du deuxième. La part des hospitalisations a augmenté lors des deux confinements (respectivement + 48 % et + 20 %). Enfin, on observe un recours différencié pendant les deux confinements avec l’émergence du recours aux soins pour « Coronavirus », « AVC » ou « Dyspnées/insuffisance respiratoire », tandis que les pathologies de type « Infections ORL » ou « Infections cutanées » ne sont plus observées. Discussion : Les données du réseau Oscour ® ont permis de suivre l’épidémie de COVID-19 en Nouvelle-Aquitaine et l’impact des mesures de confinement de la population sur les urgences hospitalières de la région. Conclusion : La baisse du recours aux soins d’urgence, la hausse de la part des hospitalisations et les pathologies observées démontrent ainsi un recours pour les pathologies les plus graves lors des deux confinements.
Service sanitaire des étudiants en santé : ancrer l’éducation pour la santé dans le cursus des étudiants
Authors: Chapron Anthony , Metten Marie-Astrid , Maury Arnaud , Prestel Thierry , Bajeux Emma , Andres Émilie , de Bournonville Catherine , Fiquet Laure , Mathieu Romain , Degeilh Brigitte , Besnier Mélanie , Bastian Benjamin , Hurel Cynthia , Hauser Hélène , Garlantezec Ronan , Bellissant Éric
Published: November 2021

Introduction : Instauré au niveau national depuis 2018, le Service sanitaire des étudiants en santé (SSES) vise à les former à mener des actions d’éducation pour la santé. Méthode et résultats : Un dispositif pédagogique d’une durée équivalente à six semaines à temps plein a été mis en place en troisième année de médecine à Rennes (35). L’objectif est que les étudiants développent les compétences nécessaires pour mener des interventions fondées sur une démarche projet, auprès de publics variés, sur des thèmes prioritaires de santé publique. De nouvelles approches pédagogiques ont été développées pour intégrer au cursus médical l’apprentissage de la promotion et de l’éducation pour la santé. Des innovations ont été mises en place : travail sur la posture éducative, tutorat des étudiants de troisième année par des internes en médecine, forum de simulation des actions concrètes sous la supervision d’une double expertise thématique et populationnelle. Au-delà de l’acquisition de compétences en éducation pour la santé, la formation vise à susciter une démarche réflexive et s’appuie sur l’éducation par les pairs. Les 240 étudiants de la faculté préparent en trinôme leur projet tout au long de l’année universitaire. Leurs actions se déroulent sur une plage de dix demi-journées auprès d’une centaine d’établissements, dans la diversité des territoires de la subdivision. Elles permettent d’intervenir auprès d’environ 10 000 personnes par an. Discussion : L’éducation et la promotion de la santé occupent désormais une place centrale dans la formation des étudiants de troisième année, condition indispensable pour amorcer l’acquisition durable de ce champ de compétences par les futurs professionnels de santé.
Évaluation des performances des mutuelles de santé communautaire de Douala et Yaoundé, Cameroun
Authors: Misonge Kapnang Ivan , Gatsing Donatien , Sanou Sobze Martin , Matsida Megus Guiguine , Isah Mohamed
Published: November 2021

Introduction : La pérennité des mutuelles de santé au Cameroun n’est pas garantie, et celle-ci a tendance à échouer après une très courte période de fonctionnement. Il existe très peu d’études concernant la question de la performance des MS. Au vu de cela, nous voulons mesurer la performance en calculant les indicateurs financiers et économiques ainsi que d’autres permettant d’évaluer la satisfaction des bénéficiaires au niveau de deux mutuelles de santé communautaires. Il s’agit de la mutuelle de santé communautaire de Douala V (Musocom) et Yaoundé I (Mucamaadd). Méthodologie : Il s’agit d’une étude de type descriptif et analytique. L’échantillonnage a donc fait l’objet d’une méthode non probabiliste avec l’aide d’un questionnaire autoadministré et d’une grille d’évaluation. Résultats : L’étude a révélé une satisfaction globale de 69 %, un taux de disponibilité des outils et activités de gestion de 85,5 %, un ratio de solvabilité de 34,2 %, un ratio de couverture des charges de 37,4 %, un ratio d’équilibre de 50,9 %, un ratio des frais de fonctionnement de 76 % et un taux de sinistralité de 133 %. Il en ressort qu’il existe une association significative entre la satisfaction et le fait d’être dans un ménage ou petite et moyenne entreprise, d’adhérer par groupe de 6 à 11 personnes ou de plus de 22 personnes, de travailler dans le secteur privé ou d’être retraité et d’avoir un salaire supérieur à 100 000 FCFA (OR > 1, p - value  < 0,05). Discussion : La mesure de la performance a permis de dégager les difficultés, manquements liés à la professionnalisation, organisation et technicité des mutuelles de santé. Elle révèle une mesure de performance plus significative au sein de la Mucamaadd que de la Musocom suite à sa capacité constante de recherche d’amélioration dans ces services.
An efficient modified hybrid explicit group iterative method for the time-fractional diffusion equation in two space dimensions
Authors: Salama Fouad Mohammad ,   School of Mathematical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia, Hamid Nur Nadiah Abd , Ali Norhashidah Hj. Mohd , Ali Umair ,   Department of Applied Mathematics and Statistics, Institute of Space Technology, P. O. Box 2750, Islamabad 44000, Pakistan
Published: November 2021

In this paper, a new modified hybrid explicit group (MHEG) iterative method is presented for the efficient and accurate numerical solution of a time-fractional diffusion equation in two space dimensions. The time fractional derivative is defined in the Caputo sense. In the proposed method, a Laplace transformation is used in the temporal domain, and, for the spatial discretization, a new finite difference scheme based on grouping strategy is considered. The unique solvability, unconditional stability and convergence are thoroughly proved by the matrix analysis method. Comparison of numerical results with analytical and other approximate solutions indicates the viability and efficiency of the proposed algorithm.
Effects of chronic exposure to bisphenol A in adult female mice on social behavior, vasopressin system, and estrogen membrane receptor (GPER1)
Authors: Bonaldo Brigitta , Casile Antonino , Bettarelli Martina , Gotti Stefano , Panzica GianCarlo , Marraudino Marilena
Published: November 2021

Bisphenol A (BPA), an organic synthetic compound found in some plastics and epoxy resins, is classified as an endocrine disrupting chemical. Exposure to BPA is especially dangerous if it occurs during specific “critical periods” of life, when organisms are more sensitive to hormonal changes (i.e., intrauterine, perinatal, juvenile or puberty periods). In this study, we focused on the effects of chronic exposure to BPA in adult female mice starting during pregnancy. Three months old C57BL/6J females were orally exposed to BPA or to vehicle (corn oil). The treatment (4 µg/kg body weight/day) started the day 0 of pregnancy and continued throughout pregnancy, lactation, and lasted for a total of 20 weeks. BPA-treated dams did not show differences in body weight or food intake, but they showed an altered estrous cycle compared to the controls. In order to evidence alterations in social and sociosexual behaviors, we performed the Three-Chamber test for sociability, and analyzed two hypothalamic circuits (well-known targets of endocrine disruption) particularly involved in the control of social behavior: the vasopressin and the oxytocin systems. The test revealed some alterations in the displaying of social behavior: BPA-treated dams have higher locomotor activity compared to the control dams, probably a signal of high level of anxiety. In addition, BPA-treated dams spent more time interacting with no-tester females than with no-tester males. In brain sections, we observed a decrease of vasopressin immunoreactivity (only in the paraventricular and suprachiasmatic nuclei) of BPA-treated females, while we did not find any alteration of the oxytocin system. In parallel, we have also observed, in the same hypothalamic nuclei, a significant reduction of the membrane estrogen receptor GPER1 expression.
Cripple care in South Africa
Authors: Erlank Lydia
Published: November 2021

No abstract available.
Capacity building in screening and treatment of diabetic retinopathy in Asia-Pacific region
Authors: Silpa-archa Sukhum , Limwattanayingyong Jirawut , Tadarati Mongkol , Amphornphruet Atchara , Ruamviboonsuk Paisan
Published: November 2021

The focus of capacity building for screening and treatment of diabetic retinopathy (DR) is on health professionals who are nonophthalmologists. Both physicians and nonphysicians are recruited for screening DR. Although there is no standardization of the course syllabus for the capacity building, it is generally accepted to keep their sensitivity >80%, specificity >95%, and clinical failure rate <5% for the nonophthalmologists, if possible. A systematic literature search was performed using the PubMed database and the following search terms: diabetic retinopathy, diabetic retinopathy screening, Asia, diabetic retinopathy treatment, age-related macular degeneration, capacity building, deep learning, artificial intelligence (AI), nurse-led clinic, and intravitreal injection (IVI). AI may be a tool for improving their capacity. Capacity building on IVIs of antivascular endothelial growth factors for DR is focused on nurses. There is evidence that, after a supervision of an average of 100 initial injections, the trained nurses can do the injections effectively and safely, the rate of endophthalmitis ranges from 0.03 to 0.07%, comparable to ophthalmologists. However, laws and regulations, which are different among countries, are challenges and barriers for nonophthalmologists, particularly for nonphysicians, for both screening and treatment of DR. Even if nonphysicians or physicians who are nonophthalmologists are legally approved for these tasks, sustainability of the capacity is another important challenge, this may be achieved if the capacity building can be part of their career development. Patient acceptability is another important barrier for initiating care provided by nonophthalmologists, particularly in Asia. There are also collaborations between national eye institutes of high-income countries, nongovernment organizations, and local eye institutes to improve both the quality and quantity of ophthalmologists and retinal specialists in low-income countries in Asia. This approach may require more labor, cost, and time consuming than training nonophthalmologists.
Training of nonophthalmologists in diabetic retinopathy screening
Authors: Rani Padmaja K , Takkar Brijesh , Das Taraprasad
Published: November 2021

The burden of diabetes mellitus (DM) and diabetic retinopathy (DR) is at alarming proportions in India and around the globe. The number of people with DM in India is estimated to increase to over 134 million by 2045. Screening and early identification of sight-threatening DR are proven ways of reducing DR-related blindness. An ideal DR screening model should include personalized awareness, targeted screening, integrated follow-up reminders, and capacity building. The DR screening technology is slowly shifting from direct examination by an ophthalmologist to remote screening using retinal photographs, including telescreening and automated grading of retinal images using artificial intelligence. The ophthalmologist-to-patient ratio is poor in India, and there is an urban–rural divide. The possibility of screening all people with diabetes by ophthalmologists alone is a remote possibility. It is prudent to use the available nonophthalmologist workforce for DR screening in tandem with the technological advances. Capacity-building efforts are based on the principle of task sharing, which allows for the training of a variety of nonophthalmologists in DR screening techniques and technology. The nonophthalmologist human resources for health include physicians, optometrists, allied ophthalmic personnel, nurses, and pharmacists, among others. A concurrent augmentation of health infrastructure, conducive health policy, improved advocacy, and increased people’s participation are necessary requirements for successful DR screening. This perspective looks at the characteristics of various nonophthalmologist DR screening models and their applicability in addressing DR-related blindness in India.
Various models for diabetic retinopathy screening that can be applied to India
Authors: Rajalakshmi Ramachandran , Prathiba Vijayaraghavan , Rani Padmaja Kumari , Mohan Viswanathan
Published: November 2021

The increased burden of diabetes in India has resulted in an increase in the complications of diabetes including sight-threatening diabetic retinopathy (DR). Visual impairment and blindness due to DR can be prevented by early detection and management of sight-threatening DR. Life-long evaluation by repetitive retinal screening of people with diabetes is an essential strategy as DR has an asymptomatic presentation. Fundus examination by trained ophthalmologists and fundus photography are established modes of screening. Various modes of opportunistic screening have been followed in India. Hospital-based screening (diabetes care/eye care) and community-based screening are the common modes. Tele-ophthalmology programs based on retinal imaging, remote interpretation, and grading of DR by trained graders/ophthalmologists have facilitated greater coverage of DR screening and enabled timely referral of those with sight-threatening DR. DR screening programs use nonmydriatic or mydriatic fundus cameras for retinal photography. Hand-held/smartphone-based fundus cameras that are portable, less expensive, and easy to use in remote places are gaining popularity. Good retinal image quality and accurate diagnosis play an important role in reducing unnecessary referrals. Recent advances like nonmydriatic ultrawide field fundus photography can be used for DR screening, though likely to be more expensive. The advent of artificial intelligence and deep learning has raised the possibility of automated detection of DR. Efforts to increase the awareness regarding DR is essential to ensure compliance to regular follow-up. Cost-effective sustainable models will ensure systematic nation-wide DR screening in the country.
Impact of systemic parameters before commencing anti-vascular endothelial growth factor therapy for diabetic macular edema – Pan-Indian survey of retina specialists
Authors: Shanmugam Mahesh P , Shah Payal , Ramanjulu Rajesh , Mishra Divyansh
Published: November 2021

Purpose:

Intravitreal anti-vascular endothelial growth factor (VEGF) injection therapy has emerged as the mainstay of treatment in the management of diabetic macular edema (DME) today. Various systemic risk factors have to be considered before initiating anti-VEGF therapy. The aim of our study was to form a consensus on various systemic factors to consider before starting anti-VEGF therapy for DME.

Methods:

A questionnaire was created and sent across to various retina specialists across India. A Google™ form with various questions pertaining to what systemic parameters would one consider before giving anti-VEGF therapy for DME was sent to each of them by email/WhatsApp™/direct telephonic interview.

Results:

Of the 650 retina specialists contacted, 322 responded to the questionnaire. There was no difference in responses between private and institutional practitioners. The majority would consider RBS (85%), HbA1c (61%), blood pressure (63%), and renal function (57%) as a routine before administering the anti-VEGF injection, while the majority would not consider hemoglobin (63%) or lipid profile (55%) of the patient as a routine practice prior to administering the injection.

Conclusion:

In our study, most VR specialists prefer to consider RBS, HbA1c, BP, and renal profile (creatinine) routinely prior to anti-VEGF injection. We suggest that it is important to consider blood pressure control, glycemic control, HbA1c, Hb, lipid profile, and renal profile (UACR, eGFR, and creatinine) prior to anti-VEGF therapy in all diabetic patients and to discuss the need for statins in patients with dyslipidemias with the physician.
Current status and future possibilities of retinal imaging in diabetic retinopathy care applicable to low- and medium-income countries
Authors: Attiku Yamini , He Ye , Nittala Muneeswar Gupta , Sadda SriniVas R
Published: November 2021

Diabetic retinopathy (DR) is a leading cause of blindness among adults and the numbers are projected to rise. There have been dramatic advances in the field of retinal imaging since the first fundus image was captured by Jackman and Webster in 1886. The currently available imaging modalities in the management of DR include fundus photography, fluorescein angiography, autofluorescence imaging, optical coherence tomography, optical coherence tomography angiography, and near-infrared reflectance imaging. These images are obtained using traditional fundus cameras, widefield fundus cameras, handheld fundus cameras, or smartphone-based fundus cameras. Fluorescence lifetime ophthalmoscopy, adaptive optics, multispectral and hyperspectral imaging, and multicolor imaging are the evolving technologies which are being researched for their potential applications in DR. Telemedicine has gained popularity in recent years as remote screening of DR has been made possible. Retinal imaging technologies integrated with artificial intelligence/deep-learning algorithms will likely be the way forward in the screening and grading of DR. We provide an overview of the current and upcoming imaging modalities which are relevant to the management of DR.
Utility of a smartphone assisted direct ophthalmoscope camera for a general practitioner in screening of diabetic retinopathy at a primary health care center
Authors: Shah Dhaivat , Dewan Lubhavni , Singh Anukruti , Jain Deepika , Damani Tina , Pandit Rinal , Porwal Amit Champalal , Bhatnagar Sanjay , Shrishrimal Meghna , Patel Abhishek
Published: November 2021

Purpose:

To assess the use of smartphone-based direct ophthalmoscope photography for screening of diabetic retinopathy (DR) in known diabetic patients walking into a general practitioner’s clinic and referring them to a vitreoretinal specialist for further evaluation and management if required.

Methodos:

The study included 94 eyes of 47 walk-in patients in a general practitioner’s OPD who were known to have type 2 diabetes mellitus and were already on treatment for the same.

Results:

The study included 47 patients with diabetes with a mean age of 56.2 ± 9.4 years. The Cohen’s kappa values revealed that the diagnosis related to the DR status made using a camera was in substantial agreement with the clinical diagnosis (Kappa value: 0.770). The Cohen’s kappa values revealed that the diagnosis related to the DME made using a camera was in moderate agreement with the clinical diagnosis (Kappa value: 0.410). The agreement between the findings of the camera and clinical diagnosis was statistically significant (P < 0.05).

Conclusion:

Direct ophthalmoscope-based smartphone imaging can be a useful tool in the OPD of a general practitioner. These images can be assessed for retinopathy, and patients can be referred to a vitreoretinal specialist for further evaluation and management if needed. Hence, the burden of vision loss due to complications of DR in the rural sector can be abridged.
Prevalence of diabetic retinopahty in India: Results from the National Survey 2015-19
Authors: Vashist Praveen , Senjam Suraj S , Gupta Vivek , Manna Souvik , Gupta Noopur , Shamanna B R , Bhardwaj Amit , Kumar Atul , Gupta Promila
Published: November 2021

Purpose:

Diabetes mellitus (DM) and diabetic retinopathy (DR) contribute to ocular morbidity and are emerging as diseases with significant public health impact. Our aim was to assess the countrywide prevalence of DR and sight-threatening DR (STDR) among persons with diabetes and to evaluate the coverage of DR examinations among them.

Methods:

The present survey was planned to estimate the burden of DR in the population aged ≥50 years for assisting in the planning and prioritization of diabetic eye services. For this survey, 21 districts with a high prevalence of DM were selected among the 31 districts where the national blindness and visual impairment survey was conducted. The total sample size was 63,000 people aged 50 years and above. DR was assessed by dilated fundus examination with indirect ophthalmoscope and was graded according to Scottish DR grading. STDR included severe nonproliferative DR, proliferative DR, and clinically significant macular edema.

Results:

The prevalence of diabetes in the surveyed population was 11.8%. Among them, one-third were newly diagnosed DM, that is, diagnosed at the time of the survey. The study revealed that the prevalence of DR among persons with diabetes was 16.9%, the prevalence of STDR was 3.6%, and the prevalence of mild retinopathy was 11.8%. Risk factors for DR in the current study were duration of diabetes (>10 years, OR 4.8, 95% CI: 3.3–6.9), poor glycemic control (≥200 mg/dL, OR: 1.5, 95% CI: 1.2–1.7) and insulin treatment (OR: 2.6, 95% CI: 1.7–4.1).

Conclusion:

The current study highlights the substantial burden of DM and DR in India and the critical need to adopt a coordinated and multisectoral approach to reduce their prevalence. There is a need for early identification of persons with diabetes and their routine screening for DR along with availability of treatment facilities.
Featureless retina in diabetic retinopathy: Clinical and fluorescein angiographic profile
Authors: Shukla Dhananjay , Dhawan Anuradha , Kalliath Jay
Published: November 2021

Purpose:

“Featureless retina” (FLR) has been only briefly mentioned in textbooks; this deceptively benign appearance of diabetic retinopathy (DR) merits a detailed description. Here we report the clinical profile, diagnosis, and management of FLR.

Methods:

The case records of consecutive type 2 diabetic patients clinically diagnosed as FLR were reviewed. The case selection was based on suggestive signs (white thread-like arterioles and atrophic retina), asymmetric presentation of DR, and fluorescein angiographic (FA) demonstration of retinal capillary nonperfusion (CNP) with/without proliferative disease (PDR). Panretinal photocoagulation (PRP) was performed as needed. The extent of CNP was correlated with diabetic macular ischemia (DMI) and neovascularization on FA, and DMI was correlated with best-corrected visual acuity using Pearson Chi-square test (P < 0.05). IBM SPSS Statistics 26 was used for analysis.

Results:

Out of 46 patients, 21 (46%) patients had bilateral and 25 (54%) had unilateral involvement (67 eyes with FLR). PDR was clinically discernible in two (3%) eyes; 65 (97%) eyes had clinical features of mild-moderate NPDR. However, FA revealed extensive CNP areas in 49 (73%) and PDR in 59 (88%) eyes. DMI was found in 83% of the eyes which had best-corrected visual acuity <6/12; this association was statistically significant (P = 0.024). Fifty-seven (85%) eyes underwent panretinal photocoagulation (PRP) for extensive CNP or PDR.

Conclusion:

Behind the mild-moderate clinical profile of FLR lay extensive CNP and PDR, which were unmasked by FA, with a complete overhaul of the treatment and follow-up.
Does myopia decrease the risk of diabetic retinopathy in both type-1 and type-2 diabetes mellitus?
Authors: Thakur* Swapnil , Verkicharla* Pavan Kumar , Kammari Priyanka , Rani Padmaja Kumari
Published: November 2021

Purpose:

To study the relationship between the severity of myopia and the severity of diabetic retinopathy (DR) in individuals with type 1 or type 2 diabetes mellitus (DM).

Methods:

This retrospective study was conducted using data from electronic medical records from a multicentric eyecare network located in various geographic regions of India. Individuals with type 1 or type 2 DM were classified according to their refractive status. Severe nonproliferative DR (NPDR), PDR, or presence of clinically significant macular edema (CSME) with any type of DR was considered as vision-threatening diabetic retinopathy (VTDR).

Results:

A total of 472 individuals with type-1 DM (mean age 41 ± 10 years) and 9341 individuals with type-2 DM (52 ± 9 years) were enrolled. Individuals with a hyperopic refractive error had a significant positive association with the diagnosis of VTDR (odds ratio (OR) 1.26; 95%CI 1.04–1.51, P = 0.01) and moderate nonproliferative DR (OR 1.27; 95%CI 1.02–1.59, P = 0.03) in type-2 DM; however, no significant association was found in type-1 DM. After adjusting for age, gender, anisometropia, and duration of diabetes, the presence of high myopia (< - 6 D) reduced the risk of VTDR in type 2 DM (OR 0.18; 95% CI 0.04–0.77, P = 0.02), but no association was found in type 1 DM. Mild and moderate myopia had no significant association with any forms of DR in both type-1 and type-2 DM.

Conclusion:

Hyperopic refractive error was found to increase the risk of VTDR in persons with type 2 DM. High-myopic refractive error is protective for VTDR in type 2 DM, but not in type-1 DM.
Prevalence, risk factors and association with glycemic levels of presbyopia in South Indian population
Authors: Srinivasan Ramyaa , Paramasivan Gaurav , Sharma Abhishek , Surya Janani , Sharma Tarun , Raman Rajiv
Published: November 2021

Purpose:

To determine the prevalence of presbyopia and its association with elevated glycemic levels in subjects ≥40 years of age in the South Indian population of Chennai.

Methods:

This was a retrospective study. Subjects were included from the Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular genetics Study (SN-DREAMS 1). Demographic data, detailed medical and ocular history, comprehensive eye examination, and biochemical investigations were performed. Glycosylated hemoglobin results were categorized as controls (4%–5.6%), prediabetic (5.7%–6.4%), and diabetic (≥6.5%) groups. The given presbyopic correction was divided into two groups as within and outside donders limit. Prevalence rates and mean values were determined and compared among the three glycemic groups. The Student t test, the Chi-square test, and multivariate logistic regression analyses were performed.

Results:

The overall prevalence of presbyopia from our previously conducted SN-DREAMS 1 population of 1414 patients was 79.77% (95% CI: 0.775–0.818). In total, 1128 participants were included for our current secondary analysis with a mean age of 54.40 years (range: 40–83). The number of subjects within and outside donders limit was 1044 (92.55%) and 84 (7.44%), respectively. In each age group (40–49, 50–59, ≥60) regardless of being within or outside donders limits, an increasing trend in the prevalence of presbyopia was noted based on increasing glycemic levels.

Conclusion:

Our study demonstrated a high prevalence of presbyopia in the South Indian population of Chennai. Findings show that the prevalence of presbyopia in different age groups increases with worsening diabetes status.
Intravitreal anti-vascular endothelial growth factor with and without topical non-steroidal anti-inflammatory in centre-involving diabetic macular edema
Authors: Mohan Sashwanthi , Chawla Gajendra , Surya Janani , Raman Rajiv
Published: November 2021

Purpose:

Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is the mainstay in the management of center-involving diabetic macular edema (CI-DME). Topical nonsteroidal anti-inflammatory drugs (NSAIDs) have been used to treat CI-DME as well. Whether there is any benefit of using both together has not been explored. The aim of this study was to compare visual acuity and OCT outcomes in patients with CI-DME who receive intravitreal anti-VEGF with and without topical NSAIDs in CI-DME.

Methods:

This was A retrospective observational study in two centers in India. The study compared visual and OCT parameters of patients with CI-DME treated with intravitreal anti-VEGF monotherapy (group 1, N = 100) versus intravitreal anti-VEGF therapy with topical NSAIDs (group 2, N = 50) over 1-year follow-up. Continuous and categorical parameters were compared using parametric and nonparametric tests, respectively.

Results:

Over the 1-year follow-up, group 2 received more mean number of intravitreal injections (group 1: 2.26 ± 1.71 vs. group 2: 3.74 ± 2.42; P < 0.0001). There were no differences between the groups in visual acuity and OCT thickness at 1-year follow-up.

Conclusion:

Combination therapy of topical NSAIDs with intravitreal anti-VEGF did not show any beneficial effects in terms of visual outcomes, reduction in central subfoveal thickness, or reduction in the mean number of injections in our study.
Factors protecting against diabetic retinopathy in a geriatric Indian cohort
Authors: Hamati Jacquelyn N , Das Anthony Vipin , Sai Prashanthi Gumpili , Behera Umesh C , Narayanan Raja , Rani Padmaja K
Published: November 2021

Purpose:

Diabetic retinopathy (DR) is a potentially sight-threatening complication of diabetes mellitus. The majority of cases are in older adults. This study aims to evaluate modifiable and nonmodifiable protective factors against DR in a geriatric Indian population.

Methods:

This retrospective observational study uses data from a multitiered ophthalmology network to evaluate several demographic and clinical variables against diabetic retinopathy and visual acuity.

Results:

Our data show that high myopia, the female sex, and no cataract surgery are associated with lower prevalence of DR (OR = 0.21, 0.65, and 0.76, respectively; P < 0.001). We also found that among those with DR, people categorized as payers, retirees, and those living in urban or metropolitan areas have better visual acuity (OR = 0.65, 0.65, 0.83, and 0.73, respectively; P < 0.001). Among those with DR, females, presence of cataracts, and no cataract surgery had lower associations with sight-threatening DR (STDR) (OR = 0.68, 0.37, and 0.76, respectively; P < 0.001). Prevalence of DR decreased in older age groups while controlling for DM duration.

Conclusion:

It is probable that high myopia, the female sex, and better glycemic control are protective against DR and STDR in our study cohort of adults over 60 years of age. It is possible that occupations involving manual labor, delayed cataract surgery, and living past the age of 70 are also protective against DR.
The ORNATE India project: Building research capacity and capability to tackle the burden of diabetic retinopathy-related blindness in India
Authors: Conroy Dolores , Ramakrishnan Radha , Raman Rajiv , Rajalakshmi Ramachandran , Rani Padmaja Kumari , Ramasamy Kim , Mohan Viswananthan , Das Taraprasad , Sadanandan Rajeev , Netuveli Gopal , Sivaprasad Sobha
Published: November 2021

The ORNATE India project is an interdisciplinary, multifaceted United Kingdom (UK)–India collaborative study aimed to build research capacity and capability in India and the UK to tackle the burden of diabetes-related visual impairment. For 51 months (October 2017–December 2021), this project built collaboration between six institutions in the UK and seven in India, including the Government of Kerala. Diabetic retinopathy (DR) screening models were evaluated in the public system in Kerala. An epidemiological study of diabetes and its complications was conducted through 20 centers across India covering 10 states and one union territory. The statistical analysis is not yet complete. In the UK, risk models for diabetes and its complications and artificial intelligence-aided tools are being developed. These were complemented by joint studies on various aspects of diabetes between collaborators in the UK and India. This interdisciplinary team enabled increased capability in several workstreams, resulting in an increased number of publications, development of cost-effective risk models, algorithms for risk-based screening, and policy for state-wide implementation of sustainable DR screening and treatment programs in primary care in Kerala. The increase in research capacity included multiple disciplines from field workers, administrators, project managers, project leads, screeners, graders, optometrists, nurses, general practitioners, and research associates in various disciplines. Cross-fertilization of these disciplines enabled the development of several collaborations external to this project. This collaborative project has made a significant impact on research capacity development in both India and the UK.
Impact of diabetic retinopathy on pulse wave analysis-derived arterial stiffness and hemodynamic parameters: A cross-sectional study from Gujarat, India
Authors: Solanki Jayesh D , Kakadia Param J , Mehta Hemant B , Kakadia Jagdeep M , Shah Chinmay J
Published: November 2021

Purpose:

Type 2 diabetes mellitus (T2DM) is known to produce diabetic retinopathy (DR). Pulse wave analysis (PWA) provides arterial stiffness (AS) and central hemodynamic (CH) parameters. We studied the effect of DR on AS and CH parameters in type 2 diabetics (T2D).

Methods:

We performed a cross-sectional study on 47 T2Ds attending a private ophthalmology clinic screened for DR by optical coherence tomography angiography and divided into NDR (non-DR), NPDR (non-proliferative DR), and PDR (proliferative DR). Mobil-o-graph (IEM, Germany) based oscillometric PWA yielded AS and CH parameters. They were further compared between groups stratified by DR with P value set at 0.05.

Results:

Participants had a mean age 62, mean diabetes duration 9 years, high mean BMI, and high prevalence of physical inactivity, hypertension, and poor diseases control. Significant differences were lacking in NPDR, NDR, and PDR in rate pressure product (mean 112.71 vs 116.06 vs 119.57), central pulse pressure (mean 46.50 vs 43.09 vs 42.72), stroke work (mean 153.36 vs 132.36 vs 146.08), augmentation index (mean 29.43 vs 33.14 vs 31.64), and aortic pulse wave velocity (mean 10.06 vs 9.08 vs 9.06). There was no clear pattern of distribution of most parameters among the three subgroups.

Conclusion:

We found a lack of association between DR and cardiovascular ageing studied by AS and hemodynamic parameters. It suggests a possible difference in risk factors for both of these aftermaths of T2DM and calls for further prospective studies with a large sample size.