bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Hyperparathyroidism in Young and Adolescents: Alike or Unlike Adult Hyperparathyroidism? - A Series from South India
Authors: Sadacharan Dhalapathy , Rao Smitha S. , Mahadevan Shriraam , Shanmugasundar G. , Murthy S , Chandrashekaran Shruti , Reddy Vijay Bhaskar , Ramji Bharath
Published: February 2024

Background:

Primary hyperparathyroidism (PHPT) is a common endocrine condition but rare in the pediatric and adolescent populations. The presentations can be unique, accounting for significant morbidity in the case of untimely detection.

Aim:

To study surgically treated pediatric PHPT retrospectively.

Methods:

Surgically treated children of PHPT up to 20 years of age between 2010 to 2022 were analyzed. All of them were operated on by an endocrine surgeon and team.

Results:

There was a total of 712 parathyroidectomies over 12 years, out of which there were 52 children (7.3%) had PHPT at less than 20 years of age. This group included 32 male children. The mean age was 16.1 years, including 7 cases of neonatal severe HPT. Multiple Endocrine Neoplasia type 1 was confirmed in 12 children. Presentations were more severe like bone pain (35.13%), renal stones (27.02%), incidental asymptomatic detection (18.9%), failure to thrive (10.8%), and pancreatitis (8.1%) as compared to adults. Mean serum calcium was 12.9 mg/dl (highest-14.1, N-8.8-10.8 mg/dl), mean parathormone levels were 386.91 pg/ml (N-10-65) and vitamin D levels ranged from 2.9-22.8 ng/ml. Localization was done with ultrasound and 99mTc- SESTAMIBI scans. Mean serum calcium levels in NSPHPT were 28.6 mg/dl (N-8.8-10.8 mg/dl). There were a total of 45 cases (6.32%) of PHPT less than 20 years of age, excluding the cases of NSPHPT. All children underwent parathyroidectomy, with 14 cases having an additional thymectomy, 2 cases with thyroidectomy, and a single case of hemithyroidectomy. The cure rate was 97.3%, while one baby with NSPHPT had persistent disease (postop PTH-110 pg/ml). The uniglandular disease was seen in 54.05% and the rest had a multiglandular disease. Adults accounted for 559/660 cases with 80% uniglandular disease. All cases had a postoperative histopathological confirmation with an average follow-up of 1 year.

Conclusion:

Childhood PHPT has a few features same as the adult population. Symptomatic presentations like adults, though pancreatitis and fatigue were more commonly seen as compared to bone pain. Calcium, phosphorus, and parathormone levels were comparable. Uniglandular involvement was seen just like the adult population. There are a few others that make them a distinct subtype like their symptoms of bone pain and being more common among boys. One-fourth of them had MEN1. Fewer cases in this age group make them unique.
SGLT2 Inhibitors: Paradigm Shift from Diabetes Care to Metabolic Care—An Indian Perspective
Authors: Kumar K M Prasanna , Unnikrishnan A G , Jariwala Pankaj , Mehta Ashwani , Chaturvedi Richa , Panchal Sagar , Lakhani Preet , Acharya Rachana , Dixit Jitendra
Published: February 2024

The prevalence and burden of diabetes are on the rise in India, making it ‘the diabetes capital of the world’. Comorbidities such as obesity, cardiovascular (CV) complications, chronic kidney disease (CKD), non-alcoholic fatty liver disease (NAFLD), and neurodegenerative diseases are common in patients with diabetes. Recent breakthroughs in diabetes medications and continuous glucose monitoring have resulted in a paradigm shift in diabetes care. Hence, a review in the Indian context is warranted. This review focuses on the existing evidence (gathered by a systematic literature search utilising online databases such as PubMed) on the metabolic, cardio-renoprotective, and hepatoprotective effects of sodium-glucose co-transporter 2 (SGLT2) inhibition, particularly in the Indian setting. The study revealed that the SGLT2 inhibitors (SGLT2i), with their numerous pleiotropic benefits, have received considerable attention recently as a novel class of antihyperglycaemic agents (AHAs) for the management of diabetes. SGLT2i play a crucial role in the transition from glycaemic control to metabolic care, particularly in the context of obesity, CV disease and renal disease. In addition to improving glycaemic control, SGLT2i have been shown to promote weight loss, reduce blood pressure and improve lipid profiles, which are key components of metabolic health. Moreover, SGLT2i have demonstrated renal protective effects, including a reduction in albuminuria and a slower decline in the estimated glomerular filtration rate (eGFR), suggesting a potential role in the management of renal dysfunction.
Serum Irisin in Polycystic Ovary Syndrome and its Alteration with Metformin Intervention
Authors: Telagareddy Radhakrishna , Kumar Padala Ravi , Pattanaik Sudhi Ranjan , Dash Deepak Kumar , Patro Debasish , Sahoo Bijay K. , Sahu Mahija
Published: February 2024

Introduction:

Studies investigating the alterations of serum irisin and its change with metformin therapy in patients with polycystic ovary syndrome (PCOS) are conflicting. Our aim is to study serum irisin in PCOS patients and the change of irisin levels with metformin therapy over 6 months.

Methods:

This is a randomized control study conducted in 187 PCOS cases and 94 age-matched controls aged 18–40 years. Detailed evaluation of anthropometric, biochemical, and hormonal parameters was performed. A subset of 99 overweight/obese patients with body mass index (BMI) ≥23 kg/m2 were stratified into a metformin group (n = 67) receiving 500 mg thrice daily and a lifestyle intervention-only group (n = 32). The effect of metformin therapy on serum irisin levels was measured at the end of 6 months. Statistical analyses were performed with SPSS version 26.0 Software.

Results:

Serum irisin was higher in PCOS patients than in controls [12.47 (8.1–17.7) vs 8.3 (7.0–9.6) ng/ml, P < 0.001], independent of BMI. Serum irisin showed a significant positive association with BMI (β =0.168), waist-to-hip ratio (β =0.166), leutinizing hormone (β =0.225), TG (β =0.305), FAI (β =0.151), and testosterone (β =0.135). Serum irisin showed a significant positive association with homeostatic model assessment of insulin resistance (HOMA-IR) (β =0.14, P = 0.04) in overweight/obese PCOS patients only (n = 146) but not in the whole PCOS cohort (n = 187). Metformin reduced the median serum irisin levels significantly (13.9 to 12.1 ng/ml, P < 0.001), and the delta change in irisin levels was associated with HOMA-IR in the metformin group.

Conclusion:

Serum irisin is increased in PCOS patients independent of BMI. Metformin therapy reduced serum irisin levels in overweight/obese PCOS patients by improving insulin resistance.
Evaluation of Effect of Montelukast in the Model of Streptozotocin Induced Diabetic Nephropathy in Rats
Authors: Kokate Dhananjay , Marathe Padmaja
Published: February 2024

Background:

Diabetic nephropathy is a progressive condition and a leading cause of end-stage renal disease. Oxidative stress and inflammation play an important role in its pathogenesis. In pre-clinical studies, Montelukast had shown renoprotective and anti-oxidant properties, hence the study was planned to evaluate the effect of Montelukast in a Streptozotocin (STZ) induced model of diabetic nephropathy.

Methods:

40 Wistar rats of either sex were randomly divided into four groups viz. 1. Vehicle control group, 2. Enalapril (5 mg/kg), 3. Montelukast low-dose (10 mg/kg) and 4. High-dose (20 mg/kg) group. On day 1, diabetes was induced using a single dose of STZ (60 mg/kg) intraperitoneally. Diabetes induction was verified based on fasting blood glucose (FBG) levels on day 7 and from day 8 to day 42, rats were given study drugs. FBG, serum creatinine, blood urea nitrogen (BUN) and urine microalbumin levels were assessed pre-study and post-study. Assessments of kidney malondialdehyde (MDA), reduced glutathione (GSH) and renal histopathology were carried out at the end of the study.

Results:

Montelukast 10 mg/kg group showed significantly lower urine microalbumin levels compared to the vehicle control group (p < 0.05). Montelukast 20 mg/kg group showed significantly lower levels of FBG, serum creatinine, BUN and urine microalbumin compared to the vehicle control group (p < 0.05). In addition, Montelukast 20 mg/kg group also showed better effects on kidney MDA and GSH levels (p < 0.05) and histopathological scores compared to the vehicle control group.

Conclusion:

Montelukast showed a protective effect in the model of diabetic nephropathy because of its antioxidant effect.
Role of Genetic Testing in the Management of Indeterminate Thyroid Nodules in the Indian Setting
Authors: Riju Jeyashanth , Thomas Nihal , Paul Thomas V. , Abraham Deepak Thomas , Pai Rekha , Prabhu Anne J. , Jacob Paul Mazhuvanchary , Rajan Remya , Michael Rajiv C. , Tirkey Amit Jiwan , Ramalingam Natarajan , Asha Hesarghatta S. , Kapoor Nitin
Published: February 2024

The increased detection of thyroid nodules in the human population has led to an increase in the number of thyroid surgeries without an improvement in survival outcomes. Though the choice for surgery is straightforward in malignant thyroid nodules, the decision is far more complex in those nodules that get categorized into indeterminate thyroid nodules (ITN) by fine needle aspiration. Therefore, there is a pressing need to develop a tool that will aid in decision-making among the ITN. In this context, the development of various molecular testing (MT) panels has helped to confirm or rule out malignancy, reducing unnecessary surgeries and potentially guiding the extent of surgery as well. Currently, such tests are widely used among the Western population but these MT panels are not used by the South Asian population because of non-availability of validated panels and the high cost involved. There is a need to develop a suitable panel which is population-specific and validate the same. In this review, we would focus on current trends in the management of ITN among the South Asian population and how to develop a novel MT panel which is cost-effective, with high diagnostic accuracy obviating the need for expensive panels that already exist.
Utility of Colour Flow Doppler Ultrasonography to Differentiate Gestational Transient Thyrotoxicosis and Graves Disease in Pregnancy
Authors: Danda Vijay Sheker Reddy , Lodha Piyush , Paidipally Srinivas Rao , Devireddy Sandeep Reddy
Published: February 2024

Introduction:

Accurate diagnosis of the etiology of thyrotoxicosis in pregnancy is important to guide appropriate treatment. The role of thyroid blood flow velocities by color Doppler to differentiate between Graves’ disease (GD) in pregnancy and gestational transient thyrotoxicosis (GTT) is not well explored. This study evaluated inferior thyroid artery (ITA)-peak systolic velocity (PSV) as a marker for differential diagnosis of thyrotoxicosis in pregnancy.

Methods:

Fifty-six pregnant patients with thyrotoxicosis (30 with GTT and 26 with GD) along with 30 age-matched healthy euthyroid pregnant subjects were enrolled. Thyroid ultrasound examinations and color Doppler was performed by an ultrasound scanner. The studies of the right and left ITAs were performed with Doppler, and the PSV and End diastolic velocity (EDV) values were obtained from the right and left ITA.

Results:

The mean total T4 value in GD and GTT were almost similar (25.04 ± 2.43 vs 23.25 ± 2.81, P value = 0.14). Beta HCG levels were significantly higher in cases of GTT as compared to GD (152946 ± 26694 vs 120608 ± 21244 mIU/ml, P < 0.0001). The ITA-PSV and EDV in patients with GTT were significantly lower than those of pregnant patients with GD (right: 22.5 ± 6.8 and 8.3 ± 2.3; left: 22.97 ± 6.3 and 8.13 ± 2.01; P < 0.001). receiver-operating-characteristic (ROC) curve demonstrated an optimal cutoff value of mean right ITA-PSV of 35 cm/sec to differentiate GTT from GD during pregnancy, with 84.6% and 93.3% sensitivity and specificity.

Conclusion:

Thyroid artery velocities can help to differentiate between GD and GTT. The cutoff point of mean ITA-PSV at 35 cm/s had an excellent value in differentiating between the two, with good sensitivity and specificity.
Insulin Sensitivity, Islet Cell Function, and Incretin Axis in Pregnant Women With and Without Gestational Diabetes Mellitus
Authors: Narayanan Niya , Sahoo Jayaprakash , Kamalanathan Sadishkumar , Sagili Haritha , Zachariah Bobby , Naik Dukhabandhu , Roy Ayan , Merugu Chandhana
Published: February 2024

Introduction:

The aim of this study was to compare insulin sensitivity, islet cell function, and incretin axes in pregnant subjects with GDM and normal healthy controls.

Methods:

Pregnant women at 24 to 28 weeks of gestation were subjected to a 75 g oral glucose tolerance test (OGTT). Samples for glucose, insulin, glucagon, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were collected at 0, 30, 60, and 120 min during the OGTT. The Matsuda index (MI) and insulin secretion and sensitivity index-2 (ISSI-2) were assessed. The glucagon suppression index (GSI) was calculated along with the area under the curve (AUC) for glucose, insulin, glucagon, GLP-1, and GIP.

Results:

A total of 48 pregnant women (25 GDM and 23 controls) were finally analysed. The MI and ISSI-2 were low in the GDM group [4.31 vs. 5.42; P = 0.04], [1.99 vs. 3.18, P ≤ 0.01] respectively). Total AUCglucagon was higher in the GDM group (7411.7 vs. 6320.1, P = 0.02). GSI30 was significantly lower in the GDM group (-62.6 vs. -24.7, P = 0.03). Fasting GLP-1 levels were low in GDM women (17.3 vs. 22.2, P = 0.04). The total AUCGLP-1 positively correlated with total GSI in the GDM group.

Conclusion:

Asian-Indian GDM women have high insulin insensitivity, islet cell dysfunction, and low fasting GLP-1. Incretin axis dysfunction plays a potential role in their islet cell dysfunction.
Efficacy of Pistacia lentiscus Plant (Rumi Mastagi) in Comparison to Levosulpiride in Patients with Diabetic Gastroparesis: A Double-Blind Non-Inferior Randomised Control Trial Study
Authors: Singh Ajaypal , Kant Ravi , Raina Rohit , Dhingra Vandana , Nema Rajeev , Bairwa Mukesh Chand , Kanwar Varsha , Mukherjee Rifika l Sukhes , Mirza Anissa Atif , Agarwal Mayank
Published: February 2024

Introduction:

Gastrointestinal neuropathies are frequently found in diabetic patients. The pathogenesis of diabetic gastroparesis (DG) is multifactorial. The usual treatment for DG includes dietary modifications, prokinetic and antiemetic agents. There is increasing demand for more effective medicines to treat DG. The current study was conducted on the Pistacia lentiscus stem extract to add to the armamentarium of DG treatment and to find the efficacy of P. lentiscus plant extract (mastic gum) in comparison to levosulpiride in DG for improvement in gastroparesis symptoms and gastric emptying scintigraphy (GES) in a single centric double-blind non-inferiority randomised control trial.

Methods:

Thirty-eight individuals were recruited and equally randomised into two study groups based on Gastroparesis Cardinal Symptom Index (GCSI) score and TC99 Radionuclide GES, mastic gum group and levosulpiride group. Both pre and post-intervention (8 weeks) GCSI scores were calculated, GES was performed to quantify the improvement in gastric emptying. Power analysis was performed using G*POWER software version 3.1.9.7 and data analysis using SPSS 23.0, variables measured in mean ± standard deviation (SD). Various statistical tests were used such as independent t-test, Chi-square test or Fisher’s exact test, Wilcox Mann–Whitney test, analysis of variance (ANOVA) test, and posthoc pairwise tests.

Results:

The mastic gum is found effective in the improvement of 4 h gastric emptying percentage from the mean (SD) 76.60 (± 9.96) to mean (SD) 97.20 (2.17)% (P < 0.001). Mastic gum has the property of HbA1c reduction, which is more significant than that of levosulpiride (P = 0.044). Mastic gum also had significant Low density lipoprotein (LDL) (mg/dL) levels reduction, (P < 0.001), compared to levosupiride. An absolute increase was observed in haemoglobin (HB) level in mastic gum at a 2-month mean (SD) of 1.03 (0.77) (g/dL) (P-value <0.001).

Conclusions:

To our knowledge, this is the first study to compare the effect of levosulpiride with mastic gum concerning improvement in diabetic gastroparesis (DG) using GES. In the study, mastic gum was found to have great properties to improve DG with many important pleiotropic effects.
Heterophilic Interference of Rheumatoid Factor in TSH Immunometric Assay: A Cross-Sectional Observational Study
Authors: Nayeemuddin Shaikh N. , Panigrahi Akash , Bhattacharjee Rana , Chowdhury Subhankar
Published: February 2024

Introduction:

Considering the inherent vulnerability of immunoassays for heterophilic interference and the potential of Rheumatoid Factor (RF) to act as a heterophile-like antibody, we conducted this study to investigate if RF leads to any such heterophilic interference in seropositive rheumatoid arthritis (RA) patients. The study was done on the TSH assay as it is a noncompetitive, double antibody sandwich assay, which is known to be vulnerable to heterophilic interference.

Methods:

In this cross-sectional observational study, eighty-four consecutive newly diagnosed RF-positive RA patients underwent TSH, Free T4, and anti-TPO estimation using the chemiluminescence technique (CLIA) on Siemens Immulite 1000 platform. The samples were screened for TSH interference using four methods: 1) analysis on a different platform, 2) assessment of linearity using doubling dilutions, 3) polyethylene glycol (PEG) precipitation, and 4) addition of a commercial blocker.

Results:

Ten samples had a loss of linearity on serial dilution, indicating potential interference. After heterophile blocker treatment, five cases exhibited interference. One patient had diagnostic interpretation discordance on the second platform. No sample on PEG precipitation suggested the influence of antibodies. It is worth noting that even in cases where interference was suspected, the clinical interpretation was largely unaffected by the correction of TSH values based on mean dilution or measurement after heterophile blocker treatment.

Conclusion:

RF can cause heterophilic interference in TSH immunoassays used commercially. However, in most cases, this interference does not affect clinical decision-making.
PreserfloTM MicroShunt implantation combined with OlogenTM in primary and secondary glaucoma patients in a clinical setting
Authors: Rojo-Arnao María , Martinez-de-la-Casa José María , Albis-Donado Oscar , Yañez-Castro Giovanni , Maroto-Cejudo Raquel , Téllez Jesús , Menoyo-Calatayud Ricardo
Published: February 2024

Purpose:

This study aims to assess the effectiveness and safety of combining the Preserflo™ MicroShunt implant (MicroShunt) with a simultaneous Ologen™ implant in patients with glaucoma.

Methods:

We conducted a retrospective study on consecutive patients with medically uncontrolled glaucoma who underwent MicroShunt + Ologen implantation as a standalone procedure or in combination with phacoemulsification (combined procedure). Success was defined as achieving an intraocular pressure (IOP) of 6–15 mmHg at 18 months post surgery, with a preoperative IOP reduction of at least 20%, and without (complete success) or with (qualified success) the need for antiglaucoma medications. The primary endpoint was the success rate.

Results:

Forty-eight eyes from 47 patients were included, with 28 eyes (58.3%) undergoing the standalone procedure and 20 eyes (41.7%) undergoing the combined procedure. Overall, there was a significant reduction in preoperative IOP from 19.7 ± 5.8 mmHg to 11.4 ± 2.6 mmHg at 18 months (P < 0.0001). In the standalone procedure group, preoperative IOP decreased from 21.5 ± 5.2 mmHg to 11.7 ± 2.5 mmHg (P < 0.0001), and in the combined procedure group, preoperative IOP decreased from 17.1 ± 5.8 mmHg to 10.9 ± 2.7 mmHg (P = 0.0002), with no significant difference between the two groups regarding final IOP. The mean number of antiglaucoma medications significantly decreased from 3.2 ± 1.1 to 0.3 ± 0.7 in the overall study population (P < 0.0001). At 18 months, 40 eyes (83.3%) were classified as successful. Regarding safety, out of the total number of eyes, two (4.2%) experienced choroidal detachment without visual impairment, two (4.2%) had transient hyphema, one (2.1%) showed reactivation of a corneal herpetic ulcer, one (2.1%) had diplopia, and one (2.1%) exhibited a shallow anterior chamber during the first week.

Conclusion:

The combination of Ologen™ and Preserflo™ MicroShunt, either alone or in conjunction with phacoemulsification, demonstrated a favorable profile in terms of IOP reduction and safety.
Effect of beta blockers on optical coherence tomography angiography in normal, suspect, and glaucomatous eyes: A prospective study
Authors: Philip Reni , Vijaya Lingam , Balekudaru Shantha , Panda Smita , Khurana Mona , David Rathini L , Asokan Rashima , George Ronnie
Published: February 2024

Purpose:

The study aimed to assess the effect of hypertension, and use of systemic beta blockers (BB) and other antihypertensives on ocular perfusion by optical coherence tomography angiography (OCTA) in normal, suspect, and glaucomatous eyes.

Methods:

Cross-sectional study in tertiary eye care center. Prospectively recruited consenting subjects between 18 and 90 years with or without glaucoma. Measured the optic nerve peripapillary perfusion and flux and macular vessel density (MVD: 6 × 6 and 3 × 3 mm) in the superficial retinal layer using OCTA.

Results:

Included 200 eyes (112 patients). Compared to nonhypertensives or those on non-BB antihypertensives (NBB), hypertensives on BB had lower peripapillary perfusion (43.45,43.40, 42.05%, P = 0.003), and MVD (6 × 6 mm: 16.65, 16.70,15.75 mm/mm2, P = 0.002; 3 × 3 mm: 18.70, 18.50, 18.00 mm/mm2, P = 0.025). Those on systemic BB with vasodilatory properties had similar perfusion parameters as nonhypertensives and NBB. Those on systemic BB without vasodilating properties had significantly lower peripapillary perfusion (42.05 vs 43.30%, P = 0.011) and MVD (6 × 6 mm: 15.15 vs 16.60 mm/mm2, P < 0.001; 3 × 3 mm: 17.40 vs 18.70 mm/mm2, P = 0.005) compared to nonhypertensives. On multivariate analysis, peripapillary perfusion increased with increase in diastolic blood pressure (β:0.051, p: 0.04) and increasing age was the only factor found to be significantly associated with decreased peripapillary and macular perfusion parameters.

Conclusion:

Systemic BB users have worse ocular perfusion parameters compared to those on other medications or nonhypertensives on univariate analysis but similar perfusion on multivariate analysis. Those on BB with vasodilation have better ocular perfusion parameters. All BB cannot be considered equally detrimental to ocular perfusion. Further well-controlled prospective studies are needed to reassess the effects of BB with or without vasodilation on ocular perfusion.
Performance of perimetric glaucoma staging systems and their preference patterns among the Indian eye care practitioners
Authors: Shirodker Suchana S Shet , Meethal Najiya Sundus K , Mazumdar Deepmala , Asokan Rashima
Published: February 2024

Context:

Various systems are available to stage glaucomatous field defects into different severity grades. Still, the preference for such systems among Indian eye care practitioners (ECPs) and the consensus between them are not explored.

Purpose:

To compare the clinical performance of perimetric glaucoma staging systems and to assess their preference patterns among Indian ECPs.

Setting and Design:

Retro-prospective cross-sectional study.

Methods:

Three investigators stratified 400 perimetry reports using four systems: Hodapp Anderson Parrish (HAP), enhanced Glaucoma Severity Staging (eGSS), Advanced Glaucoma Intervention Study (AGIS), and Collaborative Initial Glaucoma Treatment Study (CIGTS). Their performance was compared in terms of agreement and association. Following this, 30 ECPs from across the country segregated a subset of reports (n = 20) into different stages based on their system of choice, and their preferences/perceptions about the available perimetry staging systems were enquired and documented.

Statistical Analysis Used:

Descriptive statistics, Kruskal–Wallis, Cohen’s kappa, and Spearman’s correlation.

Results:

For the consolidated severity stages, substantial agreements (K ranging from 0.61 to 0.75) were found between all the systems, except for HAP–CIGTS (K = 0.58) and AGIS–CIGTS (K = 0.51). All ECPs were aware of perimetry staging systems, and a high preference was reported for HAP (97%) due to ease of implementation and interpretation.

Conclusion:

Among the four staging systems, the highest agreement was found between HAP and eGSS. A majority of ECPs proposed the need for a uniform classification system across the practices for clinical comparisons and patient education.
Selective laser trabeculoplasty: An updated narrative review
Authors: Narayanaswamy Arun , Sood Shana R , Thakur Sahil
Published: February 2024

Selective laser trabeculoplasty (SLT) has experienced a resurgence in interest, primarily driven by promising findings from the Laser in Glaucoma and Ocular Hypertension Trial. By offering SLT as an initial drug-free treatment option, we may be able to thwart issues such as adherence and persistence that plague our current medical management protocols. In this comprehensive narrative review, we delve into the current body of literature that explores the utility of SLT across a wide spectrum of scenarios and glaucoma subtypes. We present evidence that provides valuable insight into the efficacy and benefits of SLT, positioning it as a viable option in the management of glaucoma. Careful consideration of the associated risks and challenges is also necessary for successful adoption into clinical practice. Despite the ample evidence supporting SLT’s efficacy, some questions remain regarding its long-term effects and the potential need for retreatment. This review aims to shed light on these aspects to guide clinicians in making informed decisions and tailoring treatment plans to individual patient needs. This review also provides the readers with a bird’s eye view of the potential impact of SLT and adds clarity to the various therapeutic protocols that one can follow to ensure optimal clinical outcomes for our patients.
Association between Health Anxiety, Smartphone Addiction, and Cyberchondria
Authors: Neeraj M. S. , Nirmala Berigai Parthasarathy , Sharma Manoj Kumar
Published: February 2024

Introduction:

Online health information seeking is one of the single most popular platforms in which people gather health-related information. Many sources provide ambiguous and unauthorized health information, which is part of the digital era. Cyberchondria refers to prolonged and repetitive online health searches and negative emotional and physiological responses that occur due to online searches. Health anxiety due to COVID-19 also contributed to online health information seeking. This current study assesses the association between health anxiety and smartphone use with cyberchondria among young adults.

Methods:

The study sample consisted of 356 individuals aged 18–25 years. We used an online survey for study participants with the Cyberchondria severity scale-12 (CSS-12), Health Anxiety Questionnaire, and the Smartphone Addiction Scale-Short Version.

Results:

The mean age of participants was 22 years (standard deviation: 2.13). Sixty-two percent of participants used the information obtained by the online platform to diagnose themselves. Excessiveness was more among all other subscales of cyberchondria. The results of linear regression analysis indicated that health anxiety (P < 0.001) and smartphone addiction (P < 0.001) significantly contributed to cyberchondria.

Conclusion:

This study shows the association between health anxiety and smartphone addiction with cyberchondria. This finding implies the need for a community-level conscientization on cyberchondria. There is a need to carry out promotional and preventive programs regarding the health usage of technology.
Mental Illness Leading to Homelessness in Adolescents and Reintegration with Families: A Case Series of Three Adolescent Girls
Authors: Sharma Panna , Malhotra Niharika , Gupta Shivani , Nashine Aayushee , Kumar Deepak , Sen Mahadev Singh
Published: February 2024

Individuals with poor mental health often find themselves vulnerable to a myriad of factors such as poverty, social disadvantage, lower level of education, abuse, and personal vulnerability. For these reasons, they struggle to secure stable housing, which leads to a cycle of persistent poverty. In this background, we present a series of three adolescents who succumbed to homelessness due to their mental illnesses and subsequent social situations. The three adolescent girls were rescued by child welfare committees with the help of police and brought to the hospital. The challenges faced by the treating team included a lack of caregivers, difficulty in ruling out any sexual abuse, dealing with different jurisdictions, financial limitations of parents to travel long distances, COVID restrictions across states, and mental illness of patient impairing capacity. This also delayed their rehabilitation and prolonged hospital stay. We can conclude that clinicians should focus on stopping the vicious cycle at the earliest so that the long‐term consequences of mental illness, as well as homelessness, can be avoided. The current imperative is to establish a secure setting for children while also facilitating early detection and intervention for mental health issues, with a particular focus on homeless children.
Clinical profile and risk factors of symptomatic and asymptomatic hypoglycemia in neonates admitted to NICU in a tertiary care center: A cross-sectional study
Authors: Bhaisare Kiran Bhojraj , Mundada Shivprasad Kachrulal , Shah Nehal Bharat
Published: February 2024

Objective:

To investigate the clinical profile and risk factors of symptomatic and asymptomatic hypoglycemia in neonates admitted to a neonatal intensive care unit in a tertiary care center.

Methods:

The prospective observational study was conducted in a tertiary care center in the Specialty Department of Pediatric. 196 Newborn babies with blood glucose levels < 45 mg/dL were examined with a simple random sampling method between December 2019 and November 2021. Maternal and neonatal risk factors and clinical signs were recorded and compared between symptomatic and asymptomatic cases.

Results:

The proportion of symptomatic hypoglycemia neonates bom to gestational diabetes mellitus mothers was significantly higher (23.4% vs. 8.4%)(P<0.05). Small for gestational age, low birth weight, respiratory distress syndrome, hypothermia, and endocrine disorders were risk factors. The death rate in asymptomatic hypoglycemia neonates was significantly higher (58% vs. 39%) (P<0.05).

Conclusions:

The study indicates that maternal gestational diabetes mellitus is associated with symptomatic hypoglycemia and asymptomatic hypoglycemia is associated with neonatal mortality. It is important to take vigilance and timely interventions to address associated symptoms, particularly poor feeding, in the management of neonatal hypoglycemia.
A 10-year review and epidemiology of animal bite cases in Gerash city, south of Iran: A retrospective cross-sectional study
Authors: Bazrafshan Mohammad-Rafi , Kavi Esmaeil , Shahkarami Negar , Nowrouzi Mohammad , Jahangir Fereidoun , Haghshenas Hajar
Published: February 2024

Objective:

To determine the temporal trend and epidemiology of animal bite cases in Gerash City, Iran.

Methods:

This retrospective cross-sectional study analyzed 630 cases of people with animal bites between 2011 and 2021 in Gerash City. The collected data were analyzed using Chi-square test.

Results:

The mean age of victims was (30.9±17.5) years. 80.54% Of victims were male, 39.70% were self-employed, and 64.60% were adults (≥18 years). Most cases of bites occurred in 2019 (91 cases), 2020 (74 cases) and 2021 (87 cases), and most of the bites were related to the upper limbs (62.70%). Most of the wounds were superficial (78%), most of the biting animals were domestic animals (91.74%), and most of the victims had Iranian nationality (97.62%).

Conclusions:

Given the increasing trend of animal bites in Gerash City, health authorities should carry out basic measures such as education and awareness among the public, especially at-risk groups such as adult males. Additionally, since most cases of bites are due to dogs, it seems necessary to plan for vaccination of dogs, especially those with owners.
Relationship between nutritional therapy and beneficial bacteria ratio in severe disease
Authors: Nakayama Kento , Koami Hiroyuki , Sakamoto Yuichiro
Published: February 2024

Objective:

To evaluate relationship between changes in the beneficial bacteria in intensive care unit (ICU) patients and nutritional therapy type.

Methods:

Ten patients aged ≥18 years admitted to the ICU between January and December 2020, were included. Good enteral nutrition was defined as early achievement of target calorie intake through enteral feeding. The ratio of beneficial bacteria at the first and second bowel movements after each patient's admission was calculated and the patients were classified into the increase or decrease group. Among all patients, five each were in the increase and decrease groups. We investigated patient background, changes in sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scores, nutritional doses or methods, and clinical outcomes.

Results:

No relationship was found between changes in the ratio of beneficial bacteria and changes in SOFA/APACHE II scores at the time of admission. The rate of good enteral nutrition was significantly higher in the increase group than in the decrease group (4/5 vs. 0/5, P=0.01).

Conclusions:

An increase in beneficial bacteria may be significantly related to the early establishment of enteral nutrition. In the future, accumulating cases may make it possible to establish a new nutritional strategy for critically ill patients from an intestinal microbiota perspective.
Inflammation: Complexity and significance of cellular and molecular responses
Authors: Özdemir Serdar
Published: February 2024

Inflammation is a multifaceted cellular and molecular response triggered by injury, infection, or various pathological conditions. Serving as a protective defense mechanism, the inflammatory response involves clinical signs like redness, swelling, pain, and increased body temperature. Immune cells, notably neutrophils and macrophages, play key roles in orchestrating this response. The delicate balance between proinflammatory and anti-inflammatory mediators, including cytokines and chemokines, regulates the inflammatory cascade. While acute inflammation is crucial for tissue repair, chronic inflammation may indicate an imbalance, contributing to conditions like autoimmune diseases. Understanding these mechanisms is vital for developing therapeutic strategies and managing chronic diseases.
Acute coalescent mastoiditis in a 16-month-old child due to Streptococcus pneumoniae infection
Authors: Pszczołowska Magdalena , Morawska-Kochman Monika , Resler Katarzyna , Pękalska Katarzyna , Zatoński Tomasz
Published: February 2024

Rationale:

Acute otitis media is a common disease in early childhood, and is usually caused by Streptococcus pneumoniae (S. pneumoniae). Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone (acute coalescent mastoiditis). In addition, the infection can extend through the surrounding bones or the emissary veins beyond the mastoid's air cells, leading to subperiosteal abscesses.

Patient's Concern:

A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis (swelling and redness of the skin).

Diagnosis:

Bilateral acute coalescent mastoiditis caused by S. pneumoniae infection. The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides.

Interventions:

The patient underwent intravenous antibiotic therapy and surgical treatment.

Outcomes:

The patient was discharged 14 days after hospitalization with an improved condition.

Lessons:

Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications, sometimes serious and even life-threatening. Complications are prevalent in children under 2 years, in whom the disease progresses more rapidly and severely. The vaccination with a 13-valent vaccine may not result in sufficient immunity against S. pneumoniae, a predominant pathogen in children affected by acute coalescent mastoiditis.
Paradoxical systemic toxicity by inhaled paraquat poisoning: A case report
Authors: Garg Tulika , Kaur Jaspreet , Cheema Yuvraj Singh
Published: February 2024

Rationale:

Multi-organ failure is a symptom of paraquat poisoning, resulting in high mortality and morbidity rates. Though paraquat is widely available, poisoning through inhalation is rare.

Patient's Concern:

A 37-year-old male reported to the emergency department with complaints of vomiting after an alleged history of inhalation of paraquat while at work.

Diagnosis:

Paraquat poisoning.

Interventions:

Supportive management along with multiple sessions of hemodialysis.

Outcomes:

Renal complications caused by paraquat were improved after multiple sessions of hemodialysis. However, the patient developed respiratory complications and later due to persistent hypoxemia and non-responsive to supportive therapy, he succumbed to his illness.

Lessons:

Acute kidney injury is a complication of paraquat poisoning. However, kidney involvement with the inhalational mode is rare. It is caused by reduction and oxidation cycles, as well as the formation of reactive oxygen species, necessitating hemodialysis as the treatment. Without a clear history, a specific clinical trait, or a diagnostic test, diagnosis can be difficult. Our case thus highlights the inhaled paraquat poisoning, presenting with acute kidney injury with late respiratory impairment as a consequence.
Validity, reliability, and factor analysis of organoleptic tests of Dangke Deppamil as an alternative treatment of nutrition problems in pregnant women in Indonesia
Authors: Arifuddin Hidayanti , Wahyuni Rosa Dwi , Arifuddin Hikmayanti , Nur A Fahira , Arifuddin Adhar
Published: February 2024

BACKGROUND:

Dangke is a traditional food product sourced from high-quality cow’s milk from Enrekang Regency, South Sulawesi, Indonesia. The nutrients contained in Dangke are a source of calories needed by the body and can help meet the nutritional needs of pregnant women. The present study was conducted to validate the organoleptic instrument of Deppamil Dangke through validity, reliability, and factor analysis; the organoleptic test of Deppamil Dangke was carried out.

MATERIALS AND METHODS:

This type of research is a mix method with an explanatory sequential design approach. Qualitative analysis was done using Atlas Ti software.

RESULTS:

The results of the instrument validation showed a reliable level of instrument validity with Kaiser–Meyer–Olkin results (0.747), and the Cronbach’s coefficient alpha values of each of the two types of Deppamil Dangke were 0.84 and 0.91. Exploratory factor analysis identified two main factors using the varimax rotation and excluded items with a factor loading below 0.3, which included taste (2 items), color (2 items), aroma (2 items), and texture (2 items), which explains 52.7% of the general variance of the Deppamil Dangke organoleptic test. The confirmatory factor analysis results showed that the factor structure of the Deppamil Dangke organoleptic instrument matched the data (CFI = 0.948, TLI = 0.936, RMSEA = 0.069, and WRMSR = 0.891). The factor loading of the model ranged from 0.691 to 0.825 and was statistically significant. The organoleptic test results of the Deppamil Dangke on 30 panelists of pregnant women showed that pregnant women really liked the taste as much as 63.3%, texture as much as 53.3%, and color as much as 50%, and those who really liked the aroma were as much as 46.7%.

CONCLUSION:

Recommendation: Deppamil Dangke is liked by pregnant women and is very suitable to be used as an additional food product for pregnant women. It is necessary to make changes and innovations from the Dangke Deppamil product in terms of both texture and appearance and especially in the variety of flavors so that pregnant women can choose flavors according to their wishes and needs.
Educational intervention of parents and teachers for children with attention deficit hyperactivity disorder
Authors: Hosseinnia Maede , Mazaheri Maryam Amidi , Heydari Zahra
Published: February 2024

BACKGROUND:

Educating parents and teachers is very important in managing child behavior, so the present study investigates the effect of parent-teacher educational intervention on reducing ADHD symptoms in children.

MATERIALS AND METHOD:

This quasi-experimental study with a randomized control group before and after. The multi-stage cluster sampling method was used in this study. Seventy-two children and their parents and teachers participated in this study. They were selected using the multistage cluster sampling method and randomly divided into two groups of test and control. Data collected by CSI-4 questionnaire and researcher-made questionnaires (knowledge, attitude, practice) of parents and teachers. Parents and teacher in test group participated in training sessions. Student’s ADHD symptoms were assessed before and after the educational intervention.

RESULTS:

In this study, the mean (SD) age of the parents was 37.28 (6.24) and the age of the teacher was 45.50 (6/45). Covariance test show that, two months after the intervention, based on parent and teacher report, the mean total score of attention was increase significantly only in test group students. Also, the mean total of hyperactivity score was decreased significantly only in test group students (P < 0.001). Also, the score of knowledge, attitude, and practice of parents as well as teachers 2 months after the intervention was significantly higher than the control group (P < 0.001).

CONCLUSION:

Parents and teachers training and developing appropriate strategies to increase their awareness, attitude, and practice can diminish ADHD symptoms in all three aspects including inattention and reduce the side effects of ADHD. Planning in educating parents and teacher is essential to prevent impulsive and hyperactive behaviors.
Factors associated with dietary and exercise compliance among elderly with chronic conditions of hypertension and type 2 diabetes mellitus residing in rural areas of coastal Karnataka: A community-based cross-sectional study
Authors: Jeyalakshmi K. , Devi Elsa S. , Rao Mahadev , Shashidhara Y. N. , Thunga Girish
Published: February 2024

BACKGROUND:

Compliance with diet, exercise regimen, and medication is vital to maintain an acceptable range of blood pressure and glycemic level among elderly with hypertension and diabetes mellitus. However, these are considered to be more challenging tasks among elderly. The aim of this study is to identify dietary and exercise compliance among elderly with hypertension and type 2 diabetes mellitus and to find its influencing factors.

MATERIALS AND METHODS:

The community-based survey was done in rural areas of five randomly selected clusters of primary health centers (PHC) using PPS sampling technique. After ethical clearance, a total of 360 consented participants residing in selected clusters were interviewed using pre-designed rating scale and questionnaire on dietary and exercise compliance, respectively. In this study, compliance refers to practicing prescribed diet and exercise regimen regularly by the elderly with HTN and T2DM. The data were analyzed using SPSS version 16.0.

RESULTS:

Eighty percent (n = 287) of study participants had moderate adherence to diet and only, 37.8% (n = 136) of them practice physical exercise. A Chi-square test report confirmed that there is a significant association (P < 0.05) between dietary compliance and level of education, occupation, family income, procurement of insurance, poor memory, multiple functional impairments, duration of hypertensive, and diabetes illness. Exercise compliance is influenced by factors such as gender, level of education, family income, and procurement of insurance (P < 0.05).

CONCLUSION:

Adherence to diet and exercise among elderly with chronic conditions are influenced by various socio-demographic or environmental, poor health or physiological and cognition or psychological factors.
Investigating the effect of selenium nanoparticles on mineral trioxide aggregates as a promising novel dental material
Authors: Shehab Njwan F , Hasan Nadia H , Ismail Hana K
Published: February 2024

Abstract

Aim:

To enhance mineral trioxide aggregate high plasticity (MTA HP), a commonly used dental calcium silicate cement, by incorporating selenium nanoparticles (SeNPs) known for their antioxidant and anti-inflammatory properties. The objectives included investigating the impact of SeNPs on the setting time and chemical properties of MTA HP.

Materials and Methods:

We performed a comprehensive study to formulate and profile SeNPs integrated into MTA HP. Diverse concentrations of SeNPs were introduced into MTA HP, and the commencement and culmination of the setting process were gauged employing a Gillmore needle cabinet. The chemical composition was validated using Fourier transform infrared spectroscopy with attenuated total reflectance and X-ray diffraction analysis.

Results:

The incorporation of SeNPs led to remarkable improvements. Notably, SeNPs positively affected the setting time of MTA HP, with faster setting times corresponding to higher SeNPs concentrations. Chemical analyses confirmed the successful integration of SeNPs with MTA HP. These enhancements make the material may be suitable for dental applications, especially due to its accelerated setting time.

Conclusions:

MTA HP incorporated with SeNPs represents a significant advancement in dental materials. Its faster setting time, combined with the antioxidant and anti-inflammatory properties of selenium, provides dental professionals with an efficient and time-saving option for complex treatments. This novel nanomaterial holds promise for improving dental procedures and patient outcomes.