bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimization and evaluation of tear protein elution from Schirmer’s strips in dry eye disease
Authors: Koduri Madhuri Amulya , Prasad Deeksha , Pingali Tejaswini , Singh Vijay Kumar , Shanbhag Swapna S , Basu Sayan , Singh Vivek
Published: April 2023

Purpose:

Extraction of tear protein from Schirmer’s strip is a prerequisite for the proper identification and screening of biomarkers in dry eye disease. The study compares different methods of extraction of tear proteins from the Schirmer’s strip.

Methods:

Reflex tear was collected from healthy controls (HC; n = 12), Stevens–Johnson syndrome (SJS; n = 3) and dry eye disease (DED; n = 3) patients using capillary tube. This tear was used to measure the volume absorbed by Schirmer’s strip per microliter. Different buffers (6) were used to compare the protein yield from the Schirmer’s strip in four different conditions. The tear proteins extracted using the highest protein yield buffer were analyzed by mass spectrometry.

Results:

A linear relationship between the tear volume and wetting length was observed (r = 0.0.997, n = 6). The highest yield was observed after incubation of the Schirmer’s strip in 100 mM ammonium bicarbonate (ABC) with 0.25% Nonidet P-40(NP-40) at 4°C for an hour (P < 0.00005). The in-solution digestion of tear eluted in the above condition 100 Mm ABC + 0.25% NP-40 with one-hour incubation yielded a total of 2119 proteins in HC, SJS, and DED. The unique protein observed in SJS and DED was 0.6% and 17.9%, respectively. The significantly expressed proteins are associated with innate immune response, proteolysis, wound healing, and defense response.

Conclusion:

A method for extraction of protein from Schirmer’s strip was optimized for increase in protein yield from the tear sample. SJS and DED tear samples have unique protein signature. The study will aid in better design of tear protein-based experimental study.
Management of cataract in dry eye disease: Preferred practice pattern guidelines
Authors: Donthineni Pragnya R , Deshmukh Rashmi , Ramamurthy Chitra , Sangwan Virender S , Mehta Jodhbir S , Basu Sayan
Published: April 2023

Cataract surgery is one of the most commonly performed ophthalmic surgeries in the world. Dry eye disease (DED) is found to coexist in most patients with cataracts due to the overlapping age groups of both these conditions. Preoperative evaluation for DED is important to improve outcomes. A pre-existing DED affecting the tear film is likely to affect biometry. Moreover, special intraoperative considerations are needed in eyes with DED to reduce complications and improve postoperative outcomes. Dry eye disease (DED) is known to occur following an uneventful cataract surgery or a pre-existing DED is likely to worsen following cataract surgery as well. In these situations, despite a good visual outcome, patient dissatisfaction is common owing to the distressing DED symptoms. This review aims to summarize the preoperative, intraoperative, and postoperative considerations when performing cataract surgery in the presence of a coexisting DED.
Aqueous-deficient dry eye disease: Preferred practice pattern guidelines on clinical approach, diagnosis, and management
Authors: Donthineni Pragnya R , Doctor Mariya B , Shanbhag Swapna , Kate Anahita , Galor Anat , Djalilian Ali R , Singh Swati , Basu Sayan
Published: April 2023

Dry eye disease (DED) is a broad term that includes a diverse group of clinical disorders. Aqueous-deficient dry eye (ADDE), a subtype of DED, is characterized by decreased tear production by the lacrimal gland. It can be seen in up to one-third of individuals with DED and can be comorbid with a systemic autoimmune process or occur secondary to an environmental insult. Since ADDE can be a source of long-term suffering and severe visual impairment, early identification and adequate treatment are imperative. Multiple etiologies can underlie ADDE, and it is critical to identify the underlying cause to not only improve the ocular health but also to improve the overall quality of life and well-being of affected individuals. This review discusses the various etiologies of ADDE, highlights a pathophysiology-based approach for evaluating underlying contributors, outlines various diagnostic tests, and reviews treatment options. We present the current standards and discuss ongoing research in this field. Through this review, we propose a treatment algorithm that would be useful for an ophthalmologist in diagnosing and managing individuals with ADDE.
Evaluation of the ocular surface in asymptomatic glaucoma patients on topical medications and following trabeculectomy - A cross-sectional study
Authors: Pathak Ray Vanita , Paidimarri Suharsha , Konda Nagaraju , Malhotra Varun
Published: April 2023

Purpose:

This present prospective, cross-sectional study aims to comprehensively evaluate the ocular surface in asymptomatic patients with diffuse blebs after trabeculectomy versus chronic anti-glaucoma medication use and compare it with the age-matched normal population.

Methods:

Objective clinical evaluation was done by tear film break-up time (TBUT) and Schirmer’s test (ST) in the three groups–trabeculectomy >6 months with a diffuse bleb (Wurzburg bleb classification score ≧10), chronic anti-glaucoma medication (AGM >6 months) group, and normal population. In all groups, tear film osmolarity was checked with the TearLab® device (TearLab Corp., CA, USA), and subjective evaluation was performed by administering Ocular Surface Disease Index (OSDI) questionnaire. Patients already on chronic lubricants or any other drug for the treatment of dry eyes (viz. steroids, cyclosporin) or having symptoms suggestive of an abnormal ocular surface, who had undergone refractive or intraocular surgery, and contact lens users were excluded.

Results:

In total, 104 subjects/eyes were recruited over 6 weeks. Thirty-six eyes recruited in the trab group were compared with 33 eyes studied in the AGM group, and both these groups were compared to 35 normal eyes. When compared to normals, TBUT and ST were significantly lower (P = 0.003 and 0.014) and osmolarity and OSDI were statistically significantly higher (P = 0.007 and 0.003) in the AGM group, whereas only TBUT was statistically significantly different (P = 0.009) when the trab group was compared to normals. Also, when the trab group was compared to the AGM group, ST was found to be higher (P = 0.003) and osmolarity was lower (P = 0.034).

Conclusion:

To conclude, ocular surface is affected even in asymptomatic patients on AGM but near normalcy is possible following trabeculectomy when blebs are diffuse.
Tear film microbiome in Sjogren’s and non-Sjogren’s aqueous deficiency dry eye
Authors: Pal Spandita , Vani Gorati , Donthineni Pragnya Rao , Basu Sayan , Arunasri Kotakonda
Published: April 2023

Purpose:

To understand the bacterial microbiome changes associated with Sjogren’s syndrome (SS) and non-Sjogren’s syndrome (NSS) aqueous-deficient dry eyes compared to healthy eyes.

Methods:

Bacterial microbiome was generated from the deoxyribonucleic acid of tear film samples in healthy (n = 33), SS (n = 17), and NSS (n = 28) individuals. Sequencing of the V3-V4 region of the 16S rRNA gene was performed on the Illumina HiSeq2500 platform. Quantitative Insights Into Microbial Ecology (QIIME) pipeline was used to assign taxa to sequences. Statistical analysis was performed in R to assess the alpha diversity and beta diversity indices. Significant changes between the healthy, SS, and NSS cohorts were depicted by principal coordinate analysis (PCoA), differential abundance, and network analysis.

Results:

Tear microbiome was generated in healthy, SS, and NSS samples. Phyla Actinobacteria, Firmicutes, and Bacteroidetes showed significant changes in SS and NSS compared to healthy. Genera Lactobacillus and Bacillus were predominantly present in all samples. PCoA and heat map analysis showed distinct clusters for SS and NSS from the healthy cohort. Genera Prevotella, Coriobacteriaceae UCG-003, Enterococcus, Streptomyces, Rhodobacter, Ezakiella, and Microbacterium significantly increased in abundance in SS and NSS compared to a healthy cohort. Bacteria–bacteria interaction in SS, NSS, and healthy cohorts was predicted by CoNet network analysis. This analysis predicted a major hub of interaction for the pro-inflammatory bacterium Prevotella in the SS and NSS cohorts.

Conclusion:

The results of the study indicate significant changes in the phyla and genera in SS and NSS compared to healthy. Both discriminative analysis and network analysis indicated a possible association of predominant pro-inflammatory bacteria with SS and NSS.
Evaporative dry eye disease due to meibomian gland dysfunction: Preferred practice pattern guidelines for diagnosis and treatment
Authors: Narang Purvasha , Donthineni Pragnya Rao , D’Souza Sharon , Basu Sayan
Published: April 2023

Evaporative dry eye (EDE) due to meibomian gland dysfunction (MGD) is one of the common clinical problems encountered in ophthalmology. It is a major cause of dry eye disease (DED) and of ocular morbidity. In EDE, inadequate quantity or quality of lipids produced by the meibomian glands leads to faster evaporation of the preocular tear film and symptoms and signs of DED. Although the diagnosis is made using a combination of clinical features and special diagnostic test results, the management of the disease might be challenging as it is often difficult to distinguish EDE from other subtypes of DED. This is critical because the approach to the treatment of DED is guided by identifying the underlying subtype and cause. The traditional treatment of MGD consists of warm compresses, lid massage, and improving lid hygiene, all measures aimed at relieving glandular obstruction and facilitating meibum outflow. In recent years, newer diagnostic imaging modalities and therapies for EDE like vectored thermal pulsation and intense pulsed light therapy have emerged. However, the multitude of management options may confuse the treating ophthalmologist, and a customized rather than a generalized approach is necessary for these patients. This review aims to provide a simplified approach to diagnose EDE due to MGD and to individualize treatment for each patient. The review also emphasizes the role of lifestyle modifications and appropriate counseling so that patients can have realistic expectations and enjoy a better quality of life.
Modulation of mucin secretion using combined polyethylene glycol–propylene glycol topical formulation in a hyperosmotic stress-based explant model
Authors: Panigrahi Trailokyanath , James Edwin , Khamar Pooja , Gorimapalli Bhavya , D’Souza Sharon
Published: April 2023

Purpose:

Ocular surface discomfort and dry eye disease are caused by a dysfunctional tear film. The efficacy of lubricating eye drops on the human eye is known, but the compositions may show differential effects on rescuing the tear film. Mucins form a critical layer of the tear film, a reduction of which may be causative for ocular surface conditions. Therefore, it is essential to develop relevant human-derived models to test mucin production.

Methods:

Human corneoscleral rims were obtained from a healthy donor (n = 8) post-corneal keratoplasty and cultured in DMEM/F12 media. Hyperosmolar stress mimicking dry eye disease was induced by exposing the corneoscleral rim tissues to +200 mOsml NaCl-containing media. The corneoscleral rims were treated with polyethylene glycol–propylene glycol (PEG–PG)-based topical formulation. Gene expression analysis was performed for NFAT5, MUC5AC, and MUC16. Secreted mucins were measured by enzyme-linked immunosorbent assay (ELISA) (Elabscience, Houston, TX, USA) for MUC5AC and MUC16.

Results:

The corneoscleral rims responded to hyperosmolar stress by upregulating NFAT5, a marker for increased osmolarity, as observed in the case of dry eye disease. The expression of MUC5AC and MUC16 was reduced upon an increase in hyperosmotic stress. The corneoscleral rim tissues showed induction of MUC5AC and MUC16 expression upon treatment with PEG–PG topical formulation but did not show significant changes in the presence of hyperosmolar treatments.

Conclusion:

Our findings showed that PEG–PG-based topical formulation slightly alleviated hyperosmolar stress-induced decrease in MUC5AC and MUC16 gene expression that is encountered in DED.
Hormones and dry eye disease
Authors: Gorimanipalli Bhavya , Khamar Pooja , Sethu Swaminathan , Shetty Rohit
Published: April 2023

The endocrine system influences all tissues and cells in the human body. The ocular surface is constantly exposed to circulating hormones and expresses their specific receptors. Dry eye disease (DED) is a disorder with multifactorial etiology, and endocrine anomalies are one of the inciting factors. The endocrine anomalies that cause DED include physiological conditions such as menopause, menstrual cycle variations, pathologies such as polycystic ovarian syndrome, androgen resistance, iatrogenic conditions such as contraceptive use, and antiandrogen treatment. This review highlights the status of these hormones in DED along with the mechanism of action of different hormones on the ocular surface structures and the clinical implications of these effects. The influence of androgens, estrogens, and progesterone on the ocular surface tissues, and the implications of androgen-deficient states in DED are also discussed. The physiological and pathological effects of menopause and sex hormone replacement therapy are discussed. The effects of insulin and insulin resistance on the ocular surface and DED, and the growing potential of topical insulin therapeutics for DED are mentioned. Thyroid-associated ophthalmopathy, its impact on the ocular surface, and the tissue effects of thyroid hormone in the context of DED are reviewed. Finally, the potential role of hormonal therapeutics in the management of DED has also been discussed. The compelling evidence suggests that it would be clinically beneficial to consider the possibility of hormonal imbalances and their impact while treating patients with DED.
Ocular surface immune cell diversity in dry eye disease
Authors: Nair Archana Padmanabhan , D’Souza Sharon , Khamar Pooja , Nuijts Rudy M M A , Sethu Swaminathan , Shetty Rohit
Published: April 2023

Dry eye disease (DED) is a multifactorial chronic ocular surface inflammatory condition. Disease severity has been directly related to the immuno-inflammatory status of the ocular surface. Any perturbation in the orchestrated functional harmony between the ocular surface structural cells and immune cells, both resident and trafficking ones, can adversely affect ocular surface health. The diversity and contribution of ocular surface immune cells in DED have been of interest for over a couple of decades. As is true with any mucosal tissue, the ocular surface harbors a variety of immune cells of the innate-adaptive continuum and some of which are altered in DED. The current review curates and organizes the knowledge related to the ocular surface immune cell diversity in DED. Ten different major immune cell types and 21 immune cell subsets have been studied in the context of DED in human subjects and in animal models. The most pertinent observations are increased ocular surface proportions of neutrophils, dendritic cells, macrophages, and T cell subsets (CD4+; CD8+; Th17) along with a decrease in T regulatory cells. Some of these cells have demonstrated disease-causal association with ocular surface health parameters such as OSDI score, Schirmer’s test-1, tear break-up time, and corneal staining. The review also summarizes various interventional strategies studied to modulate specific immune cell subsets and reduce DED severity. Further advancements would enable the use of ocular surface immune cell diversity, in patient stratification, i.e. DED-immunotypes, disease monitoring, and selective targeting to resolve the morbidity related to DED.
Efficacy of intense pulsed light therapy on signs and symptoms of dry eye disease: A meta-analysis and systematic review
Authors: Qin Guanghao , Chen Jiayan , Li Liangzhe , Zhang Qing , Xu Ling , Yu Sile , He Wei , He Xingru , Pazo Emmanuel Eric
Published: April 2023

This study reviewed the efficacy and safety of intense pulsed light (IPL) for the treatment of dry eye disease (DED). The PubMed database was used to conduct the literature search, which used the keywords “intense pulsed light” and “dry eye disease”. After the authors evaluated the articles for relevancy, 49 articles were reviewed. In general, all treatment modalities were proven to be clinically effective in reducing dry eye (DE) signs and symptoms; however, the level of improvement and persistence of outcomes differed amongst them. Meta-analysis indicated significant improvement in the Ocular Surface Disease Index (OSDI) scores post-treatment with a standardized mean difference (SMD) = −1.63; confidence interval (CI): −2.42 to −0.84. Moreover, a meta-analysis indicated a significant improvement in tear break-up time (TBUT) test values with SMD = 1.77; CI: 0.49 to 3.05. Research suggests that additive therapies, such as meibomian gland expression (MGX), sodium hyaluronate eye drops, heated eye mask, warm compress, lid hygiene, lid margin scrub, eyelid massage, antibiotic drops, cyclosporine drops, omega-3 supplements, steroid drops, and warm compresses along with IPL, have been found to work in tandem for greater effectiveness; however, in clinical practice, its feasibility and cost-effectiveness have to be taken into consideration. Current findings suggest that IPL therapy is suitable when lifestyle modifications such as reducing or eliminating the use of contact lenses, lubricating eye drops/gels, and warm compresses/eye masks fail to improve signs and symptoms of DE. Moreover, patients with compliance issues have been shown to benefit well as the effects of IPL therapy is sustained for over several months. DED is a multifactorial disorder, and IPL therapy has been found to be safe and efficient in reducing its signs and symptoms of meibomian gland dysfunction (MGD)-related DE. Although the treatment protocol varies among authors, current findings suggest that IPL has a positive effect on the signs and symptoms of MGD-related DE. However, patients in the early stages can benefit more from IPL therapy. Moreover, IPL has a better maintenance impact when used in conjunction with other traditional therapies. Further research is needed to assess cost-utility analysis for IPL.
Systemic investigations in dry eye disease
Authors: D’Souza Sharon , James Edwin , Jois Ramesh , Mahendradas Padmamalini , Koul Ameeta , Pradhan Aditya
Published: April 2023

The incidence of dry eye disease has increased manifold in the past few years with more patients presenting with these complaints to our clinics every day. In the more severe forms of disease, it is important to evaluate for any systemic association which could be driving the disease such as in Sjogren’s syndrome. Understanding the possible varied etiopathogenesis and knowing when to evaluate, form an important part of treating this condition effectively. In addition, it is sometimes confusing as to which investigations to order and how to prognosticate the disease in these situations. This article simplifies this into an algorithmic approach with insights from the ocular and systemic point of view.
Vitamin D and eye: Current evidence and practice guidelines
Authors: Gorimanipalli Bhavya , Shetty Rohit , Sethu Swaminathan , Khamar Pooja
Published: April 2023

Vitamin D is a steroid hormone that has widespread role in human physiology, not only in the maintenance of calcium homeostasis but also in immunomodulation, cellular differentiation, and proliferation. The immunomodulatory effects of vitamin D are well known and are applicable to the ocular surface immune cells and structural cells. The role of vitamin D in ocular surface conditions such as dry eye disease (DED), keratoconus (KC), and post-surgical outcomes has received widespread and well-deserved attention. Vitamin D supplementation is shown to improve DED clinically as well as in experimental models. The anti-inflammatory properties may be crucial in the treatment of ocular surface conditions such as DED and KC. Vitamin D plays a multifaceted role in corneal wound healing with its anti-inflammatory and extracellular matrix remodeling properties. In this review, we discuss how to approach patients with DED and those undergoing refractive surgery with the available basic and clinical knowledge on the role of vitamin D in these conditions. We aim to highlight the importance of clinically harnessing vitamin D-mediated natural immuno-inflammatory modulation in combination with currently available standard of care strategies to reduce the morbidity and disease duration associated with ocular surface diseases.
Study of dry eye syndrome: Focus on causative factors, treatment modalities, quality of life, and preservatives used in eye drops
Authors: Raval Pratham M , Patel Harsh H , Purohit Dipali M , Raval Reema M , Sood Shikha V
Published: April 2023

Purpose:

Dry eye syndrome (DES) is a global issue occurring due to tear deficiency or excessive tear evaporation. It is associated with a variety of symptoms causing ocular discomfort. The purpose of the study was to evaluate causative factors, treatment modalities, quality of life, and preservatives used in eye drops.

Methods:

This prospective, follow-up study was conducted in the ophthalmology outpatient department of a tertiary care teaching hospital. Patients older than 18 years of age of either sex diagnosed with DES and willing to give written informed consent were included. The patients were subjected to the Ocular surface disease index Questionnaire (OSDI Questionnaire) twice; at the time of the first visit and at 15 days follow-up.

Results:

A male preponderance was observed with a 1.86:1 male-to-female ratio. The mean age of the study population was 29.15 ± 10.07 years. The most common presenting complaints were symptoms related to dryness of the eyes followed by refractive error. Exposure to TV/computer screen for more than 6 hours is the most common causative factor. There was a statistically significant improvement in overall quality of life (QoL) in patients of DES on treatment. However, no significant difference was seen in the improvement of quality of life in comparison with different preservatives used in prescribed eye drops for the treatment of DES.

Conclusion:

DES can adversely affect the quality of life of patients. Prompt treatment of this condition can significantly improve the patient’s QoL. Physicians should be encouraged to perform quality of life evaluations for patients with DES to guide them in treatment with more individual-specific treatment options.
Patient stratification using point of care biomarkers in dry eye disease
Authors: Shetty Rohit , Khamar Pooja , Shirodkar Sailie , Sethu Swaminathan , Nair Archana P , Ghosh Arkasubhra
Published: April 2023

With changes in lifestyle, such as the increasing use of digital screens and rising demand for refractive surgery, dry eye disease has become increasingly prevalent in recent times. While we are equipped with a number of diagnostic modalities and a myriad of treatment forms, ranging from topical medication to procedural therapies, the condition remains an enigma in terms of varied patient satisfaction. An understanding of the molecular basis of a disease may open up new avenues in the customization of its treatment. We attempt to simplify this in the form of a stepwise protocol to incorporate biomarker assays in dry eye management.
Early Retention in Services as a Predictor of Tobacco Cessation: A Medical Record-based Longitudinal Tele-Follow-Up Study at a Tertiary Care Center in Eastern India
Authors: Basu Aniruddha , Rina Kumari , Guin Aparajita , Haokip Hoineiting Rebecca
Published: April 2023

Introduction:

The aim was to evaluate the outcome of tobacco cessation services. The primary objective was to find the association of early retention in services with tobacco cessation outcomes. Secondarily, it tried to find other sociodemographic, clinical, and treatment-related predictors of tobacco cessation.

Methodology:

The outcome would be evaluated through a retrospective–prospective design. The retrospective design was recorded based, while the prospective design was done telephonically by calling the patients and enquiring about their status after at least 6 months since their first visit. Patients with “No tobacco usage in last 1 month” were considered “abstinent.” Those who “reduced their usage in last 1 month” by about 50% were considered to have “reduced” usage, whereas others who “continued their usage in same previous manner” were considered “same” user.

Results:

Out of 356 patients registered between June 1, 2021 and February 28, 2022, 81 (22.75%) could not be contacted, 221 (62.08%) had “reduced usage” after a tele-follow-up of at least 6 months, 50 (14.04%) patients have retained similar amount of usage and 4 patients expired. Of the 221 who reduced usage, 53 were abstinent (14.48%). “Initial retention in services” that is a single physical follow-up was significantly associated with “reduced usage” (P = 0.003) in the tele-follow-up with a median duration of 13 months. With regard to “abstinence,” none could stand the test of significance after correction in the logistic model except “types of tobacco usage” which predicted a statistically significant effect with an odds ratio of 3.15 (P = 0.01).

Conclusion:

This study reveals important information regarding “type of tobacco” as a predictor of abstinence and “initial physical retention” as a predictor of “reduction in tobacco usage.” Such studies need further clarification in future, more robust face-to-face studies with biochemical verification.
Psychosocial Correlates of Recovery Capital in Alcohol and Opioid-Dependent Patients: A Cross-sectional Comparative Study
Authors: Kaur Apinderjit , Lal Rakesh , Sen Mahadev Singh , Sarkar Siddharth
Published: April 2023

Introduction:

All the resources that catalyze this recovery are known as recovery capital. This study aims at finding out the correlates which help increase the recovery capital of an individual and the extent to which it can affect them.

Methodology:

Along with sociodemographic and clinical variables, we assessed recovery capital (Assessment of Recovery Capital [ARC] Scale), religiosity (Duke University Religion Index), spirituality (Daily Spiritual Experience Scale), Coping (Coping Strategies Inventory-short form), social support (Social Support Questionnaire), subjective happiness (Subjective Happiness Scale) of patients diagnosed with Alcohol dependence syndrome (ADS group), and Opioid dependence syndrome (ODS group) who were currently not having withdrawal symptoms.

Results:

A total of 111 individuals were screened, of which 49 in the ODS group and 30 in the ADS group met the selection criteria. The majority of the individuals in both groups were married, belonged to urban areas, practiced Hinduism, and lived in nuclear families. There was a significant difference between the educational status, the religion practiced, the age of onset of dependence, the severity of dependence, and the duration of abstinence between the ADS and ODS groups. Better social support (P = 0.029), higher emotion-focused coping (P < 0.001), and higher engagement (P = 0.001) in ADS, while the pattern of disengagement (P = 0.003) was found higher in the ODS group. Other correlates were comparable in both groups. Recovery (ARC) has a moderate correlation with social support in both groups (ODS-rho = 0.424, P = 0.002 and ADS rho = 0.695, P < 0.001). Furthermore, in the ADS group, a moderate correlation was seen between emotion-focused engagement, problem-focused engagement, and coping skills. While in ODS individuals, a weak correlation of recovery capital was observed with organizational religious activity and emotion-focused engagement, emotion-focused disengagement coping skills.

Discussion and Conclusions:

The results of our study reveal that social support emerged as the important factor common in both groups, which suggests that it should be the key area of psychosocial interventions in both disorders. A focus on enhancing coping styles and increasing other lifestyle factors can help sustain this path for longer.
A Cross-Sectional Questionnaire-Based Study to Assess Anxiety among Healthcare Professionals in India during COVID-19 Pandemic
Authors: Arushi  , Agarwal Mudit , Patel Lajjaben , Agrawal Samprati , Kaur Snimarjot , Dhingra Lovedeep Singh , Boparai Gurasis Singh , Sarkar Siddharth , Ranjan Piyush , Khakha Deepika , Sharan Pratap
Published: April 2023

Background and Aims:

Coronavirus has resulted in unique challenges to the healthcare professionals. The pandemic has affected the mental health of healthcare professionals, which may impact their ability to provide care to patients. We aimed to assess anxiety among healthcare professionals, and its relation to selected parameters.

Methods:

This online questionnaire-based study recruited Indian healthcare workers through convenience sampling. Anxiety was measured using the Generalized Anxiety Disorder 7 scale. The reasons of emotional distress were also ascertained.

Results:

The sample comprised of 677 healthcare professionals including resident doctors, consultants, interns, nursing personnel, and others. Moderate/severe anxiety was present in 24.4% of the respondents. Moderate/severe anxiety was more likely to occur among those who had a friend or family member affected by COVID-19 (odds ratio [OR] 2.74, 95% confidence intervals [CI] 1.61–4.69), or who themselves had a psychiatric disorder in the past (OR 2.44, 95% CI 1.36–4.38). Those who reported long working hours and inadequate sleep, fear of being infected by the virus, concerns about transmitting the virus to a family member, mob violence against doctors, and shortage of personal protective equipment had significantly higher odds of moderate/severe anxiety.

Conclusion:

A considerable proportion of healthcare professionals suffering from anxiety suggests the need for addressing their mental health concerns.
COVID-19 and Women’s Mental Health during a Pandemic – A Scoping Review
Authors: Das Nileswar , Kathiresan Preethy , Shakya Pooja , Sarkar Siddharth
Published: April 2023

The novel coronavirus disease (COVID-19) has infected more than 10 million people globally, and it caused more than 500 thousand deaths. Researchers have highlighted the need for early detection and intervention for psychological ill effect of the pandemic on various population subgroups. Women may be more vulnerable in such a crisis phase. This review addresses the mental health needs of women and the kind of interventions needed to cater to their various psychological issues. All existing literature was searched using PubMed, Google Scholar, and Medline databases for articles published on mental health aspects of women during COVID-19 pandemic. Only English language articles published till June 15, 2020, were considered for the review. Data were extracted by the authors from the selected articles, and the findings were synthesized in a narrative format. From the available literature, following themes were identified for further discussion: sexual health and contraception, pregnancy, lactation, domestic abuse, female healthcare workers, women with pre-existing mental illness, women with substance use disorders, homeless women, refugees, and professional sex workers. Studies have reported a higher burden of mental health issues in females than male counterparts and an increase in domestic violence and crises for those at-risk (such as refugees and women with pre-existing illnesses). Women mental health is compromised in many aspects due to COVID-19 pandemic. Findings stress upon the increased need for early detection and prompt intervention for women in the community to alleviate the long-term psychological consequences of this pandemic.
Person-Centered Medicine and Psychiatry – Emerging Perspectives
Authors: Kallivayalil Roy Abraham , Enara Arun
Published: April 2023

Person-centered medicine is dedicated to the promotion of health as a state of physical, mental, socio-cultural and spiritual wellbeing as well as to the reduction of disease, and founded on mutual respect for the dignity and responsibility of each individual person. The concept of person centered care has evolved over the years and the main focus has been on moving further away from biological reductionism that has plagued western medicine. In the recent years, a critical evaluation of the current practices in psychiatry and the emerging lived experience research has helped garner momentum to the narratives around person centered care. In times of psycho-social adversity, and especially when health resources are inadequate, Person Centered Medicine offers a ray of hope. The article will look into some of the emerging perspectives in person centered care.
Upper Limb Deep-Vein Thrombosis Following Vaccination with Janssen Vaccine
Authors: Karmacharya Robin Man , Vaidya Satish , Lamsal Anukram , Sharma Grishma , Joshi Sahasra , Maharjan Sophiya
Published: April 2023

Deep-vein thrombosis (DVT) is a vascular condition that commonly presents in the lower limb(s). Although reported, its occurrence in the upper limbs is rare. Furthermore, problems with the risk of serious adverse effects in response to vaccination against COVID-19 are relatively rare, despite the unprecedented speed of vaccine production using advanced modern technology. Although infrequent, administration of certain mRNA-based and certain viral vector vaccines have been associated with vaccine-induced thrombotic thrombocytopenia cases in an otherwise healthy patient: most commonly in the central venous sinus or abdominal splanchnic veins or lower limb. Here, we present an unusual case of post Janssen vaccination upper limb DVT, with an average platelet count.
Evaluation of Peripheral Arterial Disease Using Noncontrast Magnetic Resonance Angiography
Authors: Gulhane Ämol Vijay , Mandapal T , Murali Belman , Burli Pradeep , Gupta P C
Published: April 2023

Introduction:

Peripheral arterial disease is common in older age group. PAD is evaluated using Doppler, contrast CT and MR angiography. Many PAD patients have comorbidities like diabetes, hypertension and renal dysfunction. CT and MR contrast administration is considered risky in patients with impaired renal function. CT contrast agents are nephrotoxic. Gadolinium-based MRI contrast are associated with nephrogenic systemic fibrosis in patients with severe renal dysfunction.

Aims:

The aim of our study was to evaluate the usefulness of non contrast enhanced MR angiography in imaging of peripheral arteries in patients with impaired renal function.

Materials and Method:

This prospective study was done using ECG-triggered 2D TOF MR Angiograpgy on 1.5 Tesla MR unit in PAD patients having renal dysfunction. We studied various arterial segments of lower limb for the degree of narrowing on MRA and compared the findings in all patients with duplex scan and in some patients with DSA. We determined accuracy, sensitivity, specificity, PPV and NPV of MRA compared to duplex scan for assessment of arterial luminal narrowing.

Results:

Our study results have demonstrated that in patients with high grade blockage (>50% diameter reduction or arterial occlusion) NC MRA had almost 100 % accuracy, sensitivity, specificity, PPV and NPV when compared to duplex scan in iliac, femoro-popliteal and tibioperoneal segment. In patients with low grade blockage (<50% diameter reduction) NC MRA had low sensitivity with high specificity and NPV.

Conclusion:

ECG-triggered non contrast-enhanced MR angiography (NCMRA) is safe and highly accurate in PAD patients having renal dysfunction.
An Unusual Case of Cervical Rib Tumor Presenting as Thoracic Outlet Syndrome
Authors: Singh Devender , Aryala Shalini
Published: April 2023

Thoracic outlet syndrome (TOS) is a complex clinical entity with a group of diverse disorders caused by multiple factors that compress the brachial plexus, subclavian artery, and subclavian vein. Among all the causes, a tumor in that region causing TOS is a very rare cause. Here, we present the case of a 21-year-old girl with right cervical rib osteoblastoma (OB) presenting as TOS, with direct compression of the brachial plexus and subclavian artery. OBs are rare primary bone tumors and origin from cervical bone is unheard. To our knowledge, this is the first case of a cervical rib OB mimicking as NTOS, and we share our experiences and challenges in managing this case more so due to the rarity of case and paucity of data in the literature.
Carotid Body Tumor Presentation, Management, and Outcome an Institutional Experience – 12-Year Experience
Authors: Prabhu B Venkatesh , Duraichi B Vella , Sritharan N , Jeyachander K , Ilayakumar P , Kumar S Prathap , Babu R Ranjith , Ramya M , Sujith P Jan
Published: April 2023

Objective:

This study aimed to analyze the presentation and treatment modalities of carotid body tumor (CBT) and evaluate the outcomes and complications of surgical treatment of CBT.

Methodology:

Twenty-seven CBT patients treated surgically from January 2012 to August 2022 were included in the study. Patient presentation, diagnostic modalities, surgical and radiological interventions, outcomes, and complications were analyzed.

Results:

(1) A total of 27 patients were studied, with an age ranging from 13 to 65 years (median age - 45 years), in which male preponderance was found (male: female = 2.5:1), (2) Local swelling was the most common symptom (n = 27), with other symptoms being hoarseness of voice, dysphagia, and ear/neck pain, (3) Left laterality was found in 76.2% of patients, whereas 17.3% of them were right sided with 6.5% of bilateral cases, (4) 15 patients (55.5%) out of the 27 total patients, were classified in Shamblin’s type II, 8 patients (29.6%) in Shamblin’s type I, and the remaining 4 patients (14.8%) as Shamblin’s type III CBTs, (5) Thirteen (48.1%) patients underwent preoperative angioembolization. All (100%) patients underwent complete excision (6) Operative site hematoma was the most common postoperative complication encountered. All patients are asymptomatic with the minimum of 6-month follow-up.

Conclusion:

Careful preoperative evaluation, which included appropriate modality for diagnosis, preoperative angioembolization for large tumors, meticulous dissection, and good postoperative care, resulted in complete excision of all the tumors and with less complications postoperatively. Shamblin III had a high risk of postoperative neurovascular complications. Therefore, early detection and prompt surgical resection of CBTs will decrease surgical morbidity.
Fatal Spontaneous Pneumomediastinum Complicating SARS-COV2 Pneumonia in a Pregnant Women
Authors: Motiaa Youssef , Rachidi Siham Alaoui , Labib Smael , Sbai Hicham
Published: April 2023

Pneumomediastinum was reported as a complication of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pneumonia in the general population. Data concerning the association of this complication with pregnancy are rare. We report a case of a parturient who presented with SARS-CoV-2 pneumonia complicated with pneumomediastinum. The management of Acute respiratory distress syndrome (ARDS) and obstetric approach are also discussed.
Anaesthesia for Caesarean Section in a Parturient with Sjogren Syndrome and Scoping Review
Authors: Mahajan Shalvi , Sharma Aakriti , Kumar Sanjay , Gandhi Komal
Published: April 2023

Sjogren syndrome is a slowly progressive autoimmune disease with lymphocytic infiltration of exocrine glands, peri-epithelial and extra-epithelial tissues. In light of better diagnostic modalities and improved treatment options, patients with Sjogren syndrome are now commonly encountered by anaesthetist for various surgeries. Here, we would like to describe an anaesthetic management of a parturient with bad obstetric history who was diagnosed with Sjogren syndrome and was planned for caesarean delivery. This article also reviewed anaesthetic problems faced due to inherent disease pathology and concurrent alterations in treatment modalities.
Evaluation of Non-Modifiable Factors Associated with Post-Dural Puncture Headache Following Subarachnoid Block Utilising 26 G Quincke Spinal Needle: Prospective, Observational Study
Authors: Negi Chander Mohan , Bhandari Shyam , Kumar Ravinder , Rana Shelly , Sharma Radhika , Kaushal Nishita
Published: April 2023

Background and Aims:

Post-dural puncture headache (PDPH) is one of the complications of the subarachnoid block (SAB), and the incidence of PDPH is influenced by various factors related to either patients or the type of spinal needle used. This study observed the incidence and severity of PDPH in relation to non-modifiable factors in the patients scheduled for surgeries under SAB.

Methods:

The study enrolled 302 obstetric and non-obstetric patients, aged 20–60 years, American Society of Anesthesiologists (ASA) I/II having body mass index (BMI) 18.5–29.9 kg.m-2 scheduled for surgeries under SAB utilizing 26 G Quincke spinal needle. Primary outcome was the incidence of PDPH in obstetric and non-obstetric patients. The secondary outcomes included onset, severity of PDPH, and association of age, BMI, and gender to PDPH.

Results:

The total incidence of PDPH was 5.6%, eight (7%) patients in obstetric and nine (4.8%) patients in non-obstetric group (P = 0.597). The onset of PDPH was comparable in obstetric 17.25 ± 3.69 and non-obstetric patients 18.0 ± 6.02 h (P = 0.663). None of the patient had severe PDPH. The BMI of the patients was not associated with the incidence of PDPH. The female patients among non-obstetric group had higher incidence of PDPH (P = 0.0002). The six patients having PDPH in non-obstetric group belonged to age-group of 31–40 yrs as compared to two above 40 years (P = 0.0173).

Conclusion:

Obstetric population had comparable incidence of PDPH to non-obstetric population. In the subgroup analysis of non-obstetric patients, the higher incidence of PDPH was observed in the female and younger patients.
Evaluation of High Flow Nasal Oxygenation as a Technique for Preoxygenation in Full Term Pregnant Women
Authors: Ajeetha P.G , Kachru Nisha , Saraswat Namita
Published: April 2023

Background and Aims:

Obstetric airway guidelines recommend preoxygenation before the induction of general anesthesia to achieve an end tidal oxygen concentration of ≥90%. Recently, high flow nasal oxygenation (HFNO) has been evaluated as a technique for delivering a high concentration of oxygen using high flow rates to patients. We evaluated the use of HFNO as a technique for preoxygenation in full-term pregnant women.

Methods:

A cross-sectional observational study was conducted on 100 term pregnant women. They underwent preoxygenation using HFNO for 4 minutes (30 L/min for 30 secs followed by 50 L/min for 210 secs) and end tidal oxygen concentration (ETO2) was measured at the end of preoxygenation. The primary outcome was the percentage of women who achieved an expired oxygen concentration of ≥90% for the first expired breath. The secondary outcome was the acceptability and comfort of HFNO as compared to facemask preoxygenation using a 4-point Likert scale.

Results:

The percentage of women who achieved expired oxygen concentration of ≥90% after 4 minutes of HFNO preoxygenation was 32% [95% confidence interval (CI):22.7-41.3%] with the mean end tidal oxygen (SD) being 86.67 (3.4). 71% [mean (SD): 2.94 (0.92)] found nasal cannula and 56% [mean (SD): 2.67 (1.21)] found facemask comfortable and acceptable for preoxygenation (P value, 0.05).

Conclusion:

Although HFNO is a comfortable technique, when used for preoxygenation for 4 minutes, it did not achieve an acceptable level of preoxygenation (ETO2 ≥90% in 95% of individuals). Therefore, it is an inadequate technique for preoxygenation in term pregnant women.
Walking Epidural in Labor Analgesia: A Comparative Study of Ropivacaine with Fentanyl and Without Fentanyl
Authors: Thacker Avni , Kheskani Divya , Panchal Divyesh , Chhanwal Heena
Published: April 2023

Background:

Labor pain and child birth entail a number of physiological consequences that may lead to deleterious effects on the mother and fetus. Implication of a neuraxial technique is being appreciated in labor. Fetal prognosis and maternal consent and its satisfaction are key to labor analgesia.

Method:

The primary objectives were to determine the visual analog scale (VAS), total duration of labor analgesia, patient-controlled analgesia demand, sensory and motor block, and hemodynamics. The secondary objectives were to determine obstetrics parameters such as maternal satisfaction, cervical dilation, membrane, APGAR score, and complications such as hypotension, bradycardia, and vomiting. A randomized prospective comparative, interventional study including 50 parturients was conducted, where they were divided into two equal groups of 25 each, and epidural analgesia was given by 0.2% ropivacaine with 2 mcg/ml fentanyl and 0.2% ropivacaine without fentanyl.

Observation and Results:

Analgesia was more in the RF group compared to the R group. The maternal satisfaction was more in the RF group than in the R group. Clinical hemodyamics, VAS score, Bromage score, and APGAR score were appreciable in the RF group as compared to the R group.

Conclusion:

We concluded that 0.2% ropivacine with fentanyl gives more analgesia and maternal satisfaction than ropivacine alone.
Anesthetic Management of An Emergency Cesarean Section in a Parturient with Inoperable Paraganglioma: A Challenging Case Report
Authors: AlJubairy Samahir , Alwatban Sara J. , AlRaffa Abdullah
Published: April 2023

Paraganglioma is a neuroendocrine tumor characterized by small organs comprising neuroendocrine cells that can produce catecholamines. Because of the nature of such tumors, hemodynamic instability can pose a management challenge. This condition can influence the provision of medical care across different clinical settings. The aim of this case report is to highlight anesthesia management in parturient patients with abdominopelvic paraganglioma, particularly during an emergency cesarean section. At 34 weeks of gestation, the 33-year-old female patient with three pregnancies and two past deliveries had a known case of inoperable large pelvic and lower abdominal retroperitoneal paraganglioma and poor radiotherapy response. The 15.5 × 4.2 × 22 cm tumor encased the aorta, inferior vena cava, and bilateral iliac vessels, compressing the lumbar vertebrae. The patient had an uneventful and successful cesarean delivery with a multidisciplinary team effort. Paragangliomas are rarely reported in a parturient and its optimization course. Despite being interrupted by an emergency cesarean section, which was handled safely and effectively, both mother and fetus had a safe delivery and postoperative recovery without complications.