bluuebunny/crossref_metadata_2025 huggingface dataset:
Associated Risk Factors and Clinical Outcomes of Bloodstream Infections among COVID-19 Intensive Care Unit Patients in a Tertiary Care Hospital
Authors: Shivalingappa Mahalakshmamma Dasarahalli , Gachinmath Supriya , Narayan Shiva Kumar
Published: June 2024

Introduction:

The COVID-19 infection is an ongoing public health crisis causing millions of deaths worldwide. COVID-19 patients admitted to the intensive care unit (ICU) are more vulnerable to acquire secondary bloodstream infections (sBSIs) which cause a significant morbidity and mortality. Thus, we aim to assess the risk factors of sBSIs and outcomes in COVID-19 ICU patients.

Methods:

One hundred blood culture samples with growth (cases) and other 100 blood culture with no growth(controls) were collected.. All the demographic data, laboratory data and antimicrobial resistance pattern were analysed . Blood culture bottle received in the Microbiology laboratory were loaded into Automated blood culture system. Flagged bottles were processed for final identification by MALDI TOF and automated antibiotic susceptibility testing. Flagged bottles were processed for final identification by MALDI TOF and automated antibiotic susceptibility testing.

Results:

Raised C-reactive protein (CRP) (P = 0.0035), interleukin-6 (P = 0.0404), mechanical ventilation (MV) (P = 0.024), prior antimicrobial exposure (P = 0.002), longer ICU stay with median 11 days (P = 0.022), and higher mortality rate (P = 0.001) were significantly associated with the BSI. A significant proportion of BSIs were Gram-negative bacteria (n = 115) such as Acinetobacter baumannii 38 (33%) and Klebsiella pneumoniae 30 (26%). Monomicrobial organisms in blood yielded a higher proportion in our study 72 (72%). The highest resistance for Acinetobacter species (50) was observed with ceftazidime 29 (96.6%) amikacin 48 (96%), meropenem 48 (96%), cefotaxime 47 (94%), ciprofloxacin 46 (92%), and netilmicin 46 (92%). K. pneumoniae was highly resistant to cefotaxime 29 (96.6%), ceftazidime 29 (96.6%), ciprofloxacin 22 (73.3%), and cefuroxime 21 (70%). Among Gram-positive organisms, Enterococcus species showed that a resistance for high-level gentamicin and penicillin was 66.6%.

Conclusions:

Raised CRP, need of MV, prior antimicrobial exposure, and longer ICU stay should alarm clinicians for BSI. Hence, our study highlights the associated risk factors for BSI and emphasizes adherence to hospital infection control policies and antibiotic stewardship program.
Detection of Chlamydial Heat Shock Protein 60 and 10 Antibody among Female Infertility
Authors: Dhivya Gopi , Sridharan Kopula Sathyamoorthy , Nellepalli Sanjeeva Reddy , Kumar P. Kennedy , Ramesh Arunagiri , Katta Divya
Published: June 2024

Introduction:

Of the many sexually transmitted pathogens, Chlamydia trachomatis is increasingly being associated with long-term sequelae such as infertility, apart from causing genital tract infections. Many inflammatory responses directed against chlamydial infection can cause tubal damage resulting in infertility. For example, chlamydial heat shock protein 60 (cHSP60) and cHSP10 along with humoral immune response. The aim of our study is to detect the presence of immunoglobulin G (IgG) antibodies against Major Outer Membrane Protein (MOMP), cHSP60, and cHSP10 among female infertility.

Methods:

A total number of 230 female infertility patients attending the Outpatient Department of Reproductive Medicine, SRIHER, were included in the study. Detailed history documented in the proforma. Serological detection of C. trachomatis IgG antibody against MOMP, cHSP60, and cHSP10 antibody was done by enzyme-linked immunosorbent assay (ELISA).

Results:

C. trachomatis IgG antibody against MOMP was detected in 15 (6.5%) of 230 females. High seropositivity to cHSP60 antibodies was detected among females of tubal factor infertility (TFI). Our study showed that cHSP60 antibodies (3.4%) were more common than cHSP10 (2.6%).

Conclusion:

Our study suggest cHSP60 or cHSP10 antibody detection by ELISA along with TFI is helpful for diagnosis and early institution of therapy. The accuracy of TFI prediction could be increased by the detection of anti-MOMP and cHSP60 over cHSP10 among secondary infertility than primary. The most probable reason for high seropositivity among secondary infertility patients may be due to repeated infection and chronicity because of longer active sexual life.
Paradoxical Reaction during Treatment of Tuberculous Meningoencephalitis in a Patient with Systemic Lupus Erythematosus
Authors: Versiani Isadora Lemos , Nimer Gabriela Flor , Moura Carolina Braga , Xavier Arthur Ferreira , Gaudio Rodrigo Cutrim , Lopes Fernanda Cristina Rueda , Braune Caroline Bittar
Published: June 2024

Tuberculous paradoxical reaction presents as clinical deterioration during appropriate tuberculosis therapy and is a separate entity from treatment failure and drug resistance. We describe a case of central nervous system paradoxical reaction following tuberculous meningoencephalitis treatment in an immunocompromised patient with systemic lupus erythematosus.
Assessment of Fluoride Release and Recharge of Giomer After Recharge With Two Different Topical Fluoride Materials and Two Durations: An In Vitro Study
Authors: Almuhtady Sura Sulaiman , Al-Naimi Raya Jasim
Published: June 2024

Aims:

The objectives of this study were to determine the fluoride release from a giomer after 24 h, 1 week, and 1 month) and to examine the recharge ability of the giomer after recharge with two different topical fluoride materials and two different durations.

Materials and Methods:

This is an in vitro study that involved the use of 72 specimens of the tested material; the specimens were divided randomly into three main groups (24 h., 1 week, and 1 month group). Each group consisted of 24 specimens, out of which 12 specimens were recharged with fluoride varnish (six specimens for 12 h and six specimens for 24 h.) and 12 specimens were recharged with APF gel (six specimens for 1 min and six specimens for 4 min). First fluoride release was measured from the tested specimens, and then all of the tested specimens were recharged with different topical fluoride materials with different durations. One-way analysis of variance (ANOVA) and Duncan’s multiple range test were used to determine the significant differences among the groups. The statistical results were considered significant at P ≤ 0.05.

Results:

The statistical ANOVAs showed there were no statistical significant variations in the mean values of release of all specimens in the 24-h and 1-week group, but there was a highly statistically significance difference in the mean values of release of all specimens in the 1-month group, and after recharge with FV (12 h; 24 h) and APF gel (1 min; 4 min), there was a highly statistically significance difference in the mean values of fluoride release after recharge in the groups (24 h, 1 week, and 1 month).

Conclusions:

The amount of fluoride released from the giomer was more in the 24-h. group than in other groups. Recharge with APF gel released more fluoride than fluoride varnish. Increasing the time of giomer contact with the recharging material resulted in a greater uptake of fluoride.
Effectiveness of Patchouli Leaf Extract (Pogostemon cablin) with Varying Concentrations as an Acrylic Denture Cleanser against the Growth of Candida albicans: An Experimental Laboratory Study
Authors: Liana Rahmayani , Pocut Aya Sofya , Cut Fera Novita , Poppy Andriany , Ratu Silvia Rahmah
Published: June 2024

Aims:

A removable denture is a prosthesis that can be removed from the patient’s mouth for inspection, cleaning, and repair if damaged and has a positive effect on their quality of life. One of the characteristics of denture from acrylic resin materials is the porous properties that can lead to the accumulation of residual plaque, thereby increasing the number of microorganisms, such as Candida albicans fungi. Infection due to C. albicans can cause inflammation in the mucosa of the oral cavity commonly called denture stomatitis. The purpose of this study was to determine the effectiveness of denture cleaning ability of patchouli leaf extract (Pogostemon cablin) against C. albicans growth on acrylic resin base.

Materials and Methods:

The type of research used is post–test-only control group design to see whether denture cleaners from patchouli leaf extract are effective in inhibiting the growth of C. albicans on acrylic resin bases. C. albicans that has been cultured and then mixing it with a 0.9% NaCl solution until turbidity was obtained that is in accordance with the MacFarland standard or comparable with 1 × 108 CFU/mL. The number of samples in this study were 30 samples with a diameter of 10 mm and a thickness of 2 mm divided into five groups with three different concentrations, namely 25%, 50%, 75%, 0.2% chlorhexidine, and water as a negative control. Statistical analysis tests using univariate test to see the number of C. albicans, one-way ANOVA test to see the effect of soaking and LSD test to see the obstacle.

Results:

The one-way ANOVA test shows a value of P = 0.000. The treatment groups with concentrations of 25%, 50%, 75% and 0.2% chlorhexidine to the water group with a value of P = 0.000, and the least average number of Candida Albicans colonies was found in concentrations of 25% and 50%.

Conclusion:

Immersion of acrylic resin dentures in patchouli leaf extract effectively inhibits the growth of C. albicans, especially at concentrations of 25% and 50%, therefore patchouli leaf extract can be recommended as a denture cleaning agent.
Orthopedic Trauma Epidemiology in Pediatric Patients at a Tertiary Care Trauma Center in North India
Authors: Afaque Syed Faisal , Verma Vikas , Fatima Farhat , Singh Ajai
Published: June 2024

Introduction:

In North India, orthopedic trauma, which refers to injuries affecting the bones, joints, and soft tissues, occurs frequently in pediatric patients. The aim of this study is to investigate the epidemiology, etiology, mechanisms of injury, and outcomes of orthopedic trauma in pediatric patients who are admitted to a tertiary care trauma center located in North India.

Materials and Methods:

This prospective study was carried out over 1 year between January 2019 and December 2019, which included 479 pediatric orthopedic trauma patients between the age group of 0 and 18 years. The collected data were systematically classified and analyzed with respect to the mode of trauma, type of injury, and outcome across various age groups and genders.

Results:

Age of children ranged from 0 to 18 years, of which 298 (62.2%) were male and 181 (37.8%) were female. Most fractures occurred at aged 9–12 years (38.4%) and the trend decreased with age. Fall injuries were the most common mode of trauma (49.9%, n = 239) followed by road traffic accident (29.4%, n = 141). Among operated patients, most injuries were closed (47.2%, n = 138) followed by compound injuries (32.2%, n = 94) and crush injuries (20.6%, n = 60). Sixty-three percentage of patients recovered well with independent functional status, while 30% recovered with supported functional status/residual deformity.

Conclusion:

Orthopedic trauma in pediatric population is growing up and prehospital care is lagging which is more required than adult counterpart. An effective and aggressive management of accident prevention programme is required, which should also include changes in lifestyle and environment, overcoming obstacles such as ignorance, inadequate resources, and illiteracy.
Comparative Analysis of Utility and Efficacy of Ozone Therapy versus Laser Therapy in Periarthritis Shoulder
Authors: Kumar Sunil , Kumar Harish , Singh Prashant Pratap , Kumar Dinesh , Mishra Vyutpanna , Ahmad Ishan
Published: June 2024

Introduction:

Adhesive capsulitis of shoulder due to uncertain etiology of glenohumeral joint characterized by spontaneous onset of pain and reduction in the arc of active and passive movements at glenohumeral joint and essentially normal radiograph. It is considered a self-limiting condition with a natural history of 1–3 years while some have refractory course. Most of adhesive capsulitis patients are successfully treated with nonsurgical treatment such as non-steroidal anti-inflammatory drugs (NSAIDS), oral/intra-articular corticosteroids, and hydrodialtation, among nonsurgical modalities, ozone and laser are newer, safe, and show promising results in adhesive capsulitis management. A current study was done to compare between ozone therapy and laser therapy in terms of efficacy and utility in periarthritis shoulder.

Materials and Methods:

All patients who presented with shoulder pain and stiffness at the orthopedics outpatient department of tertiary care center of rural North India, on the basis of clinical history and examination, those who were diagnosed with adhesive capsulitis and fulfilling the inclusion criteria and exclusion criteria were included in the study, after obtaining proper informed and written consent, cases were randomized into two groups for laser and ozone therapy.

Results:

A total of 55 patients were included in the study, among them, 42 patients (20 patients in the laser and 22 in the ozone group) were followed up to a final follow-up of 6 months and 13 patients lost their follow-up. Disabilities of the arm, shoulder, and hand questionnaire (DASH) score ozone group showed a gradual decline from the preinjection score of 55.68–17.78 at 6 months. In the laser group, there is also a decline in DASH scores from the pretreatment score of 57.56–23.34 at 6 months. Difference in DASH score was insignificant up to 4 weeks across both groups. On follow-up after 4 weeks up to 6 months showed a significant difference in DASH score across both groups. Decline in the ozone group was more as compared to the laser group (P < 0.026).

Conclusion:

Both ozone and laser are safe and effective modalities of treatment of adhesive capsulitis but ozone is more effective in long term.
Synovial Fluid Alpha-defensin Lateral Flow Assay is Specific but Not Sensitive for Periprosthetic Joint Infection in Revision Arthroplasty: A Propensity Score-matched Analysis
Authors: Yu Sze Hon , Yuen Chiu Kwong , Wong Constance , Amy Cheung , Hong Cheung Man , Kwan Chan Vincent Wai , Hilda Luk Michelle , Keung Chan Ping , Fu Henry
Published: June 2024

Background:

Synovial fluid alpha-defensin lateral flow assay (ADLFA) is a quick adjunctive test in diagnosing periprosthetic joint infection (PJI) after primary arthroplasty. However, evidence is lacking for postrevision arthroplasty cases. Thus, we investigated the performance of ADLFA in revision cases and compared it to a control cohort of primary arthroplasty cases.

Methods:

One hundred eleven suspected PJI cases with previous total knee or hip arthroplasty between 2017 and 2021 were retrospectively included; they were minimally followed up for 12 months after joint aspiration. Cases were stratified into the revision and control (primary) group using propensity score matching in a 1:2 ratio. The 2018 Musculoskeletal Infection Society criteria were the gold standard for PJI and the Delphi-based consensus criteria for persistent infection.

Results:

After matching, the two groups exhibited comparable baselines. The sensitivity and specificity for revision cases were 50.0% (95% confidence interval [CI] =23.0%–77.0%) and 100.0% (95% CI = 83.2%–100.0%), respectively, and for primary cases, it was 75.0% (95% CI = 55.1%–89.3%) and 100.0% (95% CI = 90.3%–100.0%), respectively. Thus, ADLFA was less sensitive for revision arthroplasty but equally specific for both primary and revision cases. Furthermore, the sensitivity for ADLFA varied considerably between revision surgeries for septic causes and aseptic causes, but specificity remained 100.0%.

Conclusion:

ADLFA was highly specific but not sensitive in diagnosing PJI in postrevision arthroplasty cases. It is suited as a convenient confirmatory adjunct alongside the existing criteria.
Assessment of Femoral and Tibial Component Rotation in Total Knee Arthroplasty Performed Using “Tensioned Gap” and “Free-floating Range of Motion” Techniques: A Computed Tomography-based Observational Study
Authors: Chandel Aaditya , Saini Naresh Kumar , Pankaj Amite
Published: June 2024

Background:

Total knee arthroplasty (TKA) has an excellent success rate for the treatment of advanced arthritis of the knee. Component malrotation is one of the main causes of poor outcomes. We performed this study to assess the accuracy of the “Tensioned gap” and “Free-floating Range of Motion” techniques in TKA for rotational alignment of femoral and tibial components, respectively, which do not depend on anatomical landmarks.

Materials and Methods:

This prospective observational study included 64 TKA performed on 36 patients (24 females and 12 males), during 2015–2018. The average age was 59.9 ± 7.12 years (range 50–71 years). All patients were operated on with cemented fixed-bearing cruciate substituting TKA with posterior stabilization. Femoral component rotation was determined by the “Tensioned Gap” technique, and tibial component rotation was determined by the “Free-floating Range of Motion” technique. The measurement of femoral and tibial component rotation was performed on a computed tomography scan.

Results:

The mean femoral component rotation was 2.73° ± 0.93° of external rotation, range: 1.0°–4.7° of external rotation. The mean tibial component rotation was 0.30° ± 3.97° of internal rotation, range: 10° of internal rotation to 6° of external rotation.

Conclusion:

We concluded that the “tensioned gap technique” is found to be a reliable and reproducible technique for the rotational alignment of the femoral component. Considering the number of TKA performed annually, and the data derived from the present study, the “Range of Motion” technique is not found to be a notable intraoperative method for determining the rotational position of the tibial component in relation to tibial tuberosity.
Pattern of Presentation of Retinal Vein Occlusion in a Referral Eye Hospital in Dhaka, Bangladesh
Authors: Otabor-Olubor Osayem Joseph , Anyika Fidelis Uzozie
Published: June 2024

Background:

Retinal vein occlusion (RVO) is an important cause of loss of vision of vascular origin, second only to diabetes retinopathy.

Aim:

This study aims to determine the pattern of presentation of RVO in a tertiary ophthalmic hospital.

Study Design:

The study design involves a hospital-based retrospective observational study.

Materials and Methods:

This study was carried out at the Retina Eye Hospital in Dhaka, Bangladesh, from June 2017 to December 2017. Details of bio-data, ophthalmic and systemic history, and ophthalmic findings were collected from the case files of 89 patients and analyzed.

Results:

The results revealed that findings from 89 eyes of 89 patients were analyzed comprising 52 females and 37 males giving a female-to-male ratio of 1.4:1 with a mean age of 52.83 years (SD ± 10.444) and with a range of 31–77 years.

Conclusion:

The study revealed that all the patients presented with sudden visual deterioration, with a mean duration of presenting complaints of 6.134 weeks, and a range of 0.3–24 weeks. Branch RVO was the predominant type (69.7%). Hypermetropia was the most common refractive error (40.4%), and hypertension was the most prevalent risk factor for patients with RVO (60.7%).
Chitosan alleviates symptoms of Parkinson’s disease by reducing acetate levels, which decreases inflammation and promotes repair of the intestinal barrier and blood–brain barrier
Authors: Wang Yinying , Chen Rongsha , Shi Guolin , Huang Xinwei , Li Ke , Wang Ruohua , Cao Xia , Yang Zhongshan , Zhao Ninghui , Yan Jinyuan
Published: June 2024

Studies have shown that chitosan protects against neurodegenerative diseases. However, the precise mechanism remains poorly understood. In this study, we administered chitosan intragastrically to an MPTP-induced mouse model of Parkinson's disease and found that it effectively reduced dopamine neuron injury, neurotransmitter dopamine release, and motor symptoms. These neuroprotective effects of chitosan were related to bacterial metabolites, specifically short-chain fatty acids, and chitosan administration altered intestinal microbial diversity and decreased short-chain fatty acid production in the gut. Furthermore, chitosan effectively reduced damage to the intestinal barrier and the blood-brain barrier. Finally, we demonstrated that chitosan improved intestinal barrier function and alleviated inflammation in both the peripheral nervous system and the central nervous system by reducing acetate levels. Based on these findings, we suggest a molecular mechanism by which chitosan decreases inflammation through reducing acetate levels and repairing the intestinal and blood-brain barriers, thereby alleviating symptoms of Parkinson's disease.
Persistent alterations in gray matter in COVID-19 patients experiencing sleep disturbances: a 3-month longitudinal study
Authors: Zhou Kaixuan , Duan Gaoxiong , Liu Ying , Peng Bei , Zhou Xiaoyan , Qin Lixia , Liang Lingyan , Wei Yichen , Zhang Qingping , Li Xiaocheng , Qin Haixia , Lai Yinqi , Lu Yian , Zhang Yan , Huang Jiazhu , Huang Jinli , Ouyang Yinfei , Bin Bolin , Zhao Mingming , Liu Jun , Yang Jianrong , Deng Demao
Published: June 2024

JOURNAL/nrgr/04.03/01300535-202510000-00030/figure1/v/2024-11-26T163120Z/r/image-tiff

Sleep disturbances are among the most prevalent neuropsychiatric symptoms in individuals who have recovered from severe acute respiratory syndrome coronavirus 2 infections. Previous studies have demonstrated abnormal brain structures in patients with sleep disturbances who have recovered from coronavirus disease 2019 (COVID-19). However, neuroimaging studies on sleep disturbances caused by COVID-19 are scarce, and existing studies have primarily focused on the long-term effects of the virus, with minimal acute phase data. As a result, little is known about the pathophysiology of sleep disturbances in the acute phase of COVID-19. To address this issue, we designed a longitudinal study to investigate whether alterations in brain structure occur during the acute phase of infection, and verified the results using 3-month follow-up data. A total of 26 COVID-19 patients with sleep disturbances (aged 51.5 ± 13.57 years, 8 women and 18 men), 27 COVID-19 patients without sleep disturbances (aged 47.33 ± 15.98 years, 9 women and 18 men), and 31 age- and gender-matched healthy controls (aged 49.19 ± 17.51 years, 9 women and 22 men) were included in this study. Eleven COVID-19 patients with sleep disturbances were included in a longitudinal analysis. We found that COVID-19 patients with sleep disturbances exhibited brain structural changes in almost all brain lobes. The cortical thicknesses of the left pars opercularis and left precuneus were significantly negatively correlated with Pittsburgh Sleep Quality Index scores. Additionally, we observed changes in the volume of the hippocampus and its subfield regions in COVID-19 patients compared with the healthy controls. The 3-month follow-up data revealed indices of altered cerebral structure (cortical thickness, cortical grey matter volume, and cortical surface area) in the frontal-parietal cortex compared with the baseline in COVID-19 patients with sleep disturbances. Our findings indicate that the sleep disturbances patients had altered morphology in the cortical and hippocampal structures during the acute phase of infection and persistent changes in cortical regions at 3 months post-infection. These data improve our understanding of the pathophysiology of sleep disturbances caused by COVID-19.
Spatial transcriptomics combined with single-nucleus RNA sequencing reveals glial cell heterogeneity in the human spinal cord
Authors: Chen Yali , Wei Yiyong , Liu Jin , Zhu Tao , Zhou Cheng , Zhang Donghang
Published: June 2024

JOURNAL/nrgr/04.03/01300535-202511000-00032/figure1/v/2024-12-20T164640Z/r/image-tiff

Glial cells play crucial roles in regulating physiological and pathological functions, including sensation, the response to infection and acute injury, and chronic neurodegenerative disorders. Glial cells include astrocytes, microglia, and oligodendrocytes in the central nervous system, and satellite glial cells and Schwann cells in the peripheral nervous system. Despite the greater understanding of glial cell types and functional heterogeneity achieved through single-cell and single-nucleus RNA sequencing in animal models, few studies have investigated the transcriptomic profiles of glial cells in the human spinal cord. Here, we used high-throughput single-nucleus RNA sequencing and spatial transcriptomics to map the cellular and molecular heterogeneity of astrocytes, microglia, and oligodendrocytes in the human spinal cord. To explore the conservation and divergence across species, we compared these findings with those from mice. In the human spinal cord, astrocytes, microglia, and oligodendrocytes were each divided into six distinct transcriptomic subclusters. In the mouse spinal cord, astrocytes, microglia, and oligodendrocytes were divided into five, four, and five distinct transcriptomic subclusters, respectively. The comparative results revealed substantial heterogeneity in all glial cell types between humans and mice. Additionally, we detected sex differences in gene expression in human spinal cord glial cells. Specifically, in all astrocyte subtypes, the levels of NEAT1 and CHI3L1 were higher in males than in females, whereas the levels of CST3 were lower in males than in females. In all microglial subtypes, all differentially expressed genes were located on the sex chromosomes. In addition to sex-specific gene differences, the levels of MT-ND4, MT2A, MT-ATP6, MT-CO3, MT-ND2, MT-ND3, and MT-CO2 in all spinal cord oligodendrocyte subtypes were higher in females than in males. Collectively, the present dataset extensively characterizes glial cell heterogeneity and offers a valuable resource for exploring the cellular basis of spinal cord-related illnesses, including chronic pain, amyotrophic lateral sclerosis, and multiple sclerosis.
Topical administration of GLP-1 eyedrops improves retinal ganglion cell function by facilitating presynaptic GABA release in early experimental diabetes
Authors: Shao Yu-Qi , Wang Yong-Chen , Wang Lu , Ruan Hang-Ze , Liu Yun-Feng , Zhang Ti-Hui , Weng Shi-Jun , Yang Xiong-Li , Zhong Yong-Mei
Published: June 2024

Diabetic retinopathy is a prominent cause of blindness in adults, with early retinal ganglion cell (RGC) loss contributing to visual dysfunction or blindness. In the brain, defects in y-aminobutyric acid (GABA) synaptic transmission are associated with pathophysiological and neurodegenerative disorders, whereas glucagon-like peptide-1 (GLP-1) has demonstrated neuroprotective effects. However, it is not yet clear whether diabetes causes alterations in inhibitory input to RGCs and whether and how GLP-1 protects against neurodegeneration in the diabetic retina through regulating inhibitory synaptic transmission to RGCs. In the present study, we used the patch-clamp technique to record GABA subtype A receptor-mediated miniature inhibitory postsynaptic currents (mIPSCs) in RGCs from streptozotocin-induced diabetes model rats. We found that early diabetes (4 weeks of hyperglycemia) decreased the frequency of GABAergic mIPSCs in RGCs without altering their amplitude, suggesting a reduction in the spontaneous release of GABA to RGCs. Topical administration of GLP-1 eyedrops over a period of 2 weeks effectively countered the hyperglycemia-induced downregulation of GABAergic mIPSC frequency, subsequently enhancing the survival of RGCs. Concurrently, the protective effects of GLP-1 on RGCs in diabetic rats were eliminated by topical administration of exendin-9-39, a specific GLP-1 receptor antagonist, or SR95531, a specific antagonist of the GABA subtype A receptor. Furthermore, extracellular perfusion of GLP-1 was found to elevate the frequencies of GABAergic mIPSCs in both ON- and OFF-type RGCs. This elevation was shown to be mediated by activation of the phosphatidylinositol-phospholipase C/inositol 1,4,5-trisphosphate receptor/Ca2+/protein kinase C signaling pathway downstream of GLP-1 receptor activation. Moreover, multielectrode array recordings revealed that GLP-1 functionally augmented the photoresponses of ON-type RGCs. Optomotor response tests demonstrated that diabetic rats exhibited reductions in visual acuity and contrast sensitivity that were significantly ameliorated by topical administration of GLP-1. These results suggest that GLP-1 facilitates the release of GABA onto RGCs through the activation of GLP-1 receptor, leading to the de-excitation of RGC circuits and the inhibition of excitotoxic processes associated with diabetic retinopathy. Collectively, our findings indicate that the GABA system has potential as a therapeutic target for mitigating early-stage diabetic retinopathy. Furthermore, the topical administration of GLP-1 eyedrops represents a non-invasive and effective treatment approach for managing early-stage diabetic retinopathy.
Insights into spinal muscular atrophy from molecular biomarkers
Authors: Xing Xiaodong , Liu Xinzhu , Li Xiandeng , Li Mi , Wu Xian , Huang Xiaohui , Xu Ajing , Liu Yan , Zhang Jian
Published: June 2024

Spinal muscular atrophy is a devastating motor neuron disease characterized by severe cases of fatal muscle weakness. It is one of the most common genetic causes of mortality among infants aged less than 2 years. Biomarker research is currently receiving more attention, and new candidate biomarkers are constantly being discovered. This review initially discusses the evaluation methods commonly used in clinical practice while briefly outlining their respective pros and cons. We also describe recent advancements in research and the clinical significance of molecular biomarkers for spinal muscular atrophy, which are classified as either specific or non-specific biomarkers. This review provides new insights into the pathogenesis of spinal muscular atrophy, the mechanism of biomarkers in response to drug-modified therapies, the selection of biomarker candidates, and would promote the development of future research. Furthermore, the successful utilization of biomarkers may facilitate the implementation of gene-targeting treatments for patients with spinal muscular atrophy.
Chronic dacryocystitis: An insight into bacteriology and antimicrobial sensitivity pattern
Authors: Sethi Vibhuti , Mittal Himanshu Kumar , Tuli Rajeev
Published: June 2024

CONTEXT:

Adequate management of chronic dacryocystitis is an essential prerequisite before any intraocular surgery owing to a grave risk of endophthalmitis. The knowledge of bacteriology of chronic dacryocystitis would accentuate the choice of effective antimicrobial agents and thus help in reducing the irrational use of antimicrobial agents and subsequent development of drug resistance.

AIMS:

We aimed to identify the causative bacterial flora and study the antimicrobial sensitivity and resistance pattern in cases of chronic dacryocystitis.

SETTINGS AND DESIGN:

This was a cross-sectional observational study.

SUBJECTS AND METHODS:

Conjunctival swabs were obtained from both eyes from 102 patients with clinical evidence of chronic dacryocystitis. Specimens for microbiological analysis were obtained, either from the conjunctival cul-de-sac and everted puncta by applying pressure over the lacrimal sac area or from the refluxing material after irrigating the lacrimal sac with sterile saline. The specimens were sent for culture and sensitivity in the department of microbiology. Ethical approvals were duly obtained.

STATISTICAL ANALYSIS USED:

Percentage assessment was used for statistical analysis.

RESULTS:

The cultures showed the presence of Staphylococcus aureus in 50% of bacterial isolates obtained from the involved eyes, followed by coagulase-negative Staphylococcus in 11.53% of isolates and Enterococcus also in 11.53% of isolates. It was observed that cefoxitin was the most sensitive antibiotic against Gram-positive organisms, followed by vancomycin and clindamycin, whereas maximum resistance was seen for penicillin and ofloxacin. For Gram-negative organisms, imipenem was found to be most sensitive, followed by gentamicin and co-amoxiclav, whereas maximum resistance was seen for ciprofloxacin.

CONCLUSIONS:

It was concluded that Gram-positive bacteria predominantly S.
aureus was the most commonly isolated bacteria in cases of chronic dacryocystitis as compared to Gram-negative bacteria and cefoxitin was found to be the overall most effective antibiotic for Gram-positive bacteria.
All trans retinoic acid-induced bilateral disc edema in a case of acute promyelocytic leukemia
Authors: Panigrahi Pradeep Kumar , Mishra Suchismita , Samal Priyanka , Sahoo Disha , Yadav Tanya
Published: June 2024

An 18-year-old female presented with sudden onset bilateral vision loss. Extensive retinal hemorrhages were seen in both eyes. Systemic examination lead to a diagnosis of acute promyelocytic leukemia. The patient was treated with all trans retinoic acid (ATRA) and other medications in the induction phase. Bilateral disc edema was noted during the second consolidation cycle with ATRA. Complete resolution of bilateral disc edema was attained in three weeks’ time after discontinuing ATRA.
Endophthalmitis caused by Hathewaya histolytica: A diagnostic dilemma
Authors: Pattnaik Lolly , Panigrahi Pradeep Kumar , Sahu Suneeta , Hanisha Dega , Sahoo Disha
Published: June 2024

A 76-year-old male presented with pain, redness, and decreased vision in the left eye for 5 days. The patient had undergone combined cataract extraction and vitrectomy for a macular hole 2 weeks back. The vision had reduced to the perception of light in the left eye. Clinical examination revealed lid edema, conjunctival congestion, hazy cornea, and exudative membrane in the pupillary axis with no view of the fundus. Ultrasound examination of the left eye showed plenty of moderate reflective dot echoes. The patient was diagnosed with postoperative endophthalmitis and underwent vitrectomy with intravitreal injection of antibiotics. Growth of Hathewaya
histolytica was obtained from the vitreous sample. The organism was sensitive to imipenem. Three weeks following the presentation, visual acuity had improved to counting fingers at one meter in the left eye. This is the first report of endophthalmitis due to H.
histolytica. Ophthalmologists should be aware of such ocular infections due to a rare microorganism.
Boergen modification of Harada-ito surgery with and without vertical muscle surgery for acquired unilateral superior oblique muscle palsy
Authors: Farvardin Hajar , Farvardin Hadi , Farvardin Majid
Published: June 2024

PURPOSE:

The purpose is to report the results of the Boergen modification of the Harada-Ito procedure with and without simultaneous vertical muscle surgery in patients with acquired unilateral superior oblique muscle palsy.

PATIENTS AND METHODS:

Files of patients with acquired unilateral superior oblique muscle palsy who were treated with Boergen modification of the Harada-Ito procedure were studied retrospectively. For each patient, age at the time of surgery, the presence of diplopia, compensatory head posture, and ocular deviation before and after surgery were retrieved. Results were evaluated 6 months after surgery.

RESULTS:

A total of 12 patients with a mean age of 32 years at the time of surgery (range 15–45 years) were included. The underlying etiology was head trauma in eleven patients. The modified Harada-Ito procedure alone was done for three cases (Group 1), and a simultaneous combination of this procedure and vertical muscle surgery was performed in nine patients (Group 2). The average intorsional effect in the primary position was 9.2° (8° in Group 1 and 9.6° in Group 2). The average correction of hypertropia in the primary position was 8.2 prism diopters (PD) (1 PD in Group 1 and 10.6 PD in Group 2). Diplopia in the primary position and downgaze were resolved in eleven patients and ten patients, respectively. Four patients had a compensatory head tilt at their last follow-up.

CONCLUSIONS:

Boergen modification of the Harada-Ito procedure, alone and combined with vertical muscle surgery, successfully corrected primary position diplopia in the majority of the patients.
Manifestations of COVID-19 in the posterior eye segment – Up-to-date
Authors: Marzoog Basheer Abdullah
Published: June 2024

Since coronavirus disease infection-19 (COVID-19) entry to the cells is angiotensin enzyme receptor (ACEII) dependent, extrapulmonary manifestations have been suspected. Ocular manifestations reported in several studies to involve the anterior as well as posterior eye segments. However, the predominance of the anterior eye segment reduced the attention of the scientific community on the posterior eye segment. Our results showed that the incidence of changes in the posterior eye segment is 1/5 of the anterior eye segment. Posterior eye segment manifestations include acute macular neuroretinopathy and paracentral middle maculopathy, central retinal vein/artery occlusion, reactivation of previous uveitis, varicella zoster virus-related acute retinal necrosis in an immunocompromised patient, chorioretinitis, macular hemorrhage, paracentral acute middle maculopathy, retinal detachment, and vitritis with outer retinal abnormalities. The pathogenesis of posterior eye segment manifestations under COVID-19 includes viremia, autoimmune vasculitis, hyperimmune response, coagulopathy, and cytokine storm. A full ophthalmological examination is crucial for patients recovering from COVID-19. The paper provided up-to-date manifestations with potential underlying pathophysiological mechanisms of development, as well as pathogenetic therapy.
Exploring the health and ocular hazards of gadget usage in optometry students after COVID-19 lockdown: A qualitative study
Authors: Madheswaran Gopinath , Nair Athira , Balasubramaniam Saranya Sachi , Balasubramaniam Chinnasamy
Published: June 2024

BACKGROUND:

Prolonged screen time and abnormal postures can cause backache, neck pain, headache, and finger pain. Studies have shown that excessive usage of gadgets has increased during the coronavirus disease 2019 (COVID-19) pandemic, causing health and ocular hazards. This study used qualitative research methods to understand the health and ocular effects of gadget usage following the COVID-19 postlockdown in optometry students.

MATERIALS AND METHODS:

A qualitative study using a semi-structured face-to-face interview was conducted for undergraduate and postgraduate students in different optometry institutes who underwent at least 3 months of online teaching learning during the pandemic after obtaining informed consent. The interviews were conducted online; the sessions were audio-recorded, transcribed, and analyzed. Thematic analyses were conducted to understand the challenges faced.

RESULTS:

Twenty participants were interviewed, of which 70% (n = 14) were females. Thematic analysis identified seven major themes: gadget usage (frequency of usage, type of device, and time spent), challenges during online classes (comprehension, distraction, and network issues), ocular effects (asthenopic symptoms and ocular symptoms), health effects (musculoskeletal disorders), ways to relieve symptoms, recreational activities (breaks and entertainment), and environment and ergonomics (posture and study area and preferred lighting). All the participants reported ocular/health-related symptoms, including eye strain, burning sensation, headache, back pain, finger pain, and neck pain post the lockdown period due to prolonged gadget usage and poor ergonomic postures.

CONCLUSIONS:

Given the significant increase in digital usage following the pandemic, the study’s findings are currently relevant. The prolonged usage of gadgets and poor ergonomic postures have led to ocular and musculoskeletal problems among optometry students. To improve gadget usage without any health-related consequences, students should have access to information regarding ergonomics, increasing the blink rate, and taking regular digital breaks.
Demographic profile, prevalence, pattern, and risk factors for retinal vein occlusion in Liberia: A retrospective study
Authors: Singh Gurcharan , Pillai Shayri
Published: June 2024

PURPOSE:

This study aims to describe the demographic profile, prevalence, pattern, and risk factors for retinal vein occlusion (RVO) in patients over 40 years of age presenting to the Liberia Eye Centre, John F Kennedy Memorial Medical Centre, Monrovia, Liberia.

SUBJECTS AND METHODS:

A retrospective study was conducted on patients presenting to Liberia Eye Centre from July 2017 to February 2021. A total of 17506 new patients were examined during this period out of which 10813 patients were over 40 years of age. Data were collected from the electronic medical record system database. The variables in the collected data included age, gender, location, laterality of eye affected, uncorrected visual acuity, best-corrected visual acuity, intraocular pressure, ocular diagnosis, systemic risk factors, and associated complications.

RESULTS:

Of the 10813 patients, RVO was found in 111 patients with an overall prevalence rate of 1.03% (95% confidence interval 0.80–1.2). Central RVO (CRVO) was more common than branch RVO (BRVO) in the defined population with similar proportions of both genders. The mean age for any RVO was 64.45 ± 12.27 standard deviation (SD) years (P = 0.734). Majority of the cases of RVO were from Lofa (n = 20; 18%). Fifty-five (61.1%) patients had hypertension, 5 (5.6%) had diabetes mellitus, and 6 (6.7%) had dyslipidemia. More than one systemic risk factor was present in 24 (26.7%) patients. However, none of the systemic risk factors were statistically significant. Visual acuity was most affected in patients with CRVO, with a visual acuity of <3/60 in 45 (63.4%) patients compared to 12 (30.0%) in BRVO patients. Glaucoma was present in 34 (30.6%) patients. The most common ocular complication was macular edema (n = 62, 55.8%) followed by vitreous hemorrhage (n = 8, 7.2%).

CONCLUSIONS:

RVO was detected in 1.03% of the study population over the age of 40 years in Liberia, CRVO being more common than BRVO. The clinical presentation of RVO in the Liberian population for the first time provides insight into the burden of the disease and opportunity for further research.
Comparison of Calcium, Vitamin D and PTH in Different Subgroups of Steroid Sensitive Nephrotic Syndrome
Authors: Sultana Jakia , Rahman Farhana , Luna Sharmin A. , Hassan Md. Nazmul , Fazal Abul , Rabby Jamal E. , Mamun Abdullah-Al , Jesmin Tahmina , Rahman Habibur , Roy Ranjit R. , Uddin Golam M. , Begum Afroza
Published: June 2024

Background:

Steroid-sensitive nephrotic syndrome (SSNS) is frequently associated with alteration of calcium and vitamin D metabolism, including hypocalcemia, reduced serum vitamin D metabolites, and elevated levels of parathyroid hormone (PTH). These alterations occur usually due to intestinal malabsorption of calcium as well as excessive urinary losses of various vitamin D metabolites and their binding proteins which, in turn, lead to a decrease in bone mineral density. So, early identification and management of the abnormal levels of calcium, vitamin D, and PTH can ameliorate growth retardation.

Objective:

Our aim is to compare the level of calcium, vitamin D, and PTH in different subgroups of SSNS.

Materials and Methods:

This cross-sectional study was carried out in the Department of Paediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from January 2018 to June 2019. A total of 45 patients with previously diagnosed SSNS, aged 2–18 years of both sexes, were included in this study. The children were divided into three groups of 15 each. Group I comprised of 15 patients who presented with infrequent relapse nephrotic syndrome(IRNS), Group II comprised 15 patients who hadfrequent relapse nephrotic syndrome or steroid dependent nephrotic syndrome (FRNS/SDNS), and Group III comprised of 15 patients who were in remission for last 3 months without any medication. Then serum calcium, vitamin D, and PTH levels were compared among the study population.

Results:

A total of 45 patients were studied. Serum calcium was significantly lower in groups I and II compared to group III (P < 0.05). Mean serum PTH levels were 34.02 ± 15.33, 50.52 ± 19.22, and 40.33 ± 14.58 pg/mL in groups I, II, and III, respectively. Among the study group, vitamin D levels were deficient in 26 (58%), insufficient in 14 (31%), and sufficient in 5 (11%) children. Among the subgroups, mean serum vitamin D levels were 8.98 ± 1.96 ng/mL in patients with IRNS, 4.27 ± 1.37 ng/mL in FRNS/SDNS group, and 18.49 ± 7.34 ng/mL in patients who were in remission for more than 3 months. Serum vitamin D levels were low in groups I and II compared to group III, with statistically significance (P < 0.001).

Conclusion:

This study finding concluded that mean serum vitamin D levels were low in all the subgroups of SSNS children which were statistically significant. Specifically, all children with frequent relapse and steroid dependent nephrotic syndrome were vitamin D deficient.
Bilateral Nephromegaly Mimicking Nephroblastoma: A Rare Initial Presentation of Acute Lymphoblastic Leukemia in a Bangladeshi Child
Authors: Karim Md. Anwarul , Nahar Ashrafun , Jamal Chowdhury Yakub , Begum Afroza , Ray Ranjit R. , Begum Momena , Jesmin Tahmina , Mamun Abdullah A.
Published: June 2024

Bilateral renal enlargement at the time of diagnosis of acute leukemia is very unusual. More than half of pediatric acute leukemia patients show features like hepatomegaly, splenomegaly, pallor, fever, and bruising at the time of diagnosis, however renal infiltration and nephromegaly are common in advanced-stage pediatric patients. Here, we have described a rare and unusual presentation of Acute lymphoblastic leukemia, in an 11-month-old male infant from Bangladesh who presented with bilateral nephromegaly along with nodular skin lesion overhead. Initial peripheral blood film has normal findings and USG of abdomen report bilateral Wilm’s tumor but later on the infant developed abnormal blood counts and subsequently diagnosis of acute lymphoblastic leukemia was made based on bone marrow aspiration findings. Renal involvement of acute leukemia should be considered in a child presenting with unexplained bilateral renal enlargement with or without renal function abnormalities.
Autoimmune Encephalitis: Evolving Clinical Spectrum and Updated Management
Authors: Fatema Kanij
Published: June 2024

Autoimmune encephalitis (AIE) is a noninfectious encephalitis which is an emerging entity due to the detection of autoantibody. It is mostly triggered by viral infections, tumor, etc. Clinical clues to diagnosis are acute or subacute onset of seizure, movement disorder, psychiatric or behavioral disorder, autonomic disturbances, etc. Detection of autoantibody from cerebrospinal fluid (CSF) or serum plays important role in the diagnosis. Extreme delta brush, diffuse slowing or epileptic discharges may be found in electroencephalopgram (EEG). Magnetic resonance imaging (MRI) of brain findings are nonspecific, and may be normal or abnormal. Timely and appropriate immunotherapy is very important for better outcomes. Maintenance therapy is needed to prevent the relapse. This review will highlight the epidemiology, pathogenesis, clinical spectrum, investigation, and management of AIE.