bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Serum Vitamin D Level with Acute Myocardial Infarction
Authors: Chowdhury Rubyat Hasan , Nessa Azimun , Mohibullah A. K. M.
Published: November 2023

Context:

Numerous recent studies have found high rates of cardiovascular diseases among patients with lower levels of Vitamin D. This study seeks the pattern of Vitamin D level in patients with acute myocardial infarction (MI).

Aims:

This study aims to assess the association between serum Vitamin D level and Acute MI (AMI).

Subjects and Methods:

This was a cross-sectional analytical study, conducted for 6 months from January to June 2022 in the Department of Cardiology of BIRDEM. Fifty patients with evidence of AMI, both male and female, age ≥18-year, biomarker evidence of myocardial injury (elevated troponin I) enrolled in case group. Fifty attendants of the patients admitted in other specialties of the hospital and having no ischemic heart disease enrolled in the control group.

Statistical Analysis Used:

t test, odd ratio.

Results:

The mean plasma Vitamin D level in case group was 15.62 ± 8.56 and that of control group was 19.50 ± 7.04. The difference between the two groups was statistically significant (P < 0.05). Severely deficient Vitamin D subjects were more likely to develop AMI than subjects who had normal/insufficient Vitamin D level in blood (odds ratio [OR] 2.70, 95% confidence interval for OR 1.03–7.03) (P < 0.05). Vitamin D insufficiency and deficiency were evident in diabetic patient compared to nondiabetic patient with a significant difference (P < 0.05).

Conclusions:

From the study result, it is revealed that subjects with AMI in comparison to the control group had a significantly low Serum 25 (OH) Vitamin D level which may be a risk factor for developing AMI.
Parkin Enhances Sensitivity of Paclitaxel to Nasopharyngeal Carcinoma by Activating BNIP3/NIX-Mediated Mitochondrial Autophagy
Authors: Ni Haifeng , Liu Renhui , Zhou Zhen , Jiang Bo , Wang Bin
Published: November 2023

As a malignant head and neck cancer, nasopharyngeal carcinoma (NPC) has high morbidity. Parkin expression has been reported to be reduced in NPC tissues and its upregulation could enhance paclitaxel-resistant cell cycle arrest. This study was performed to explore the possible mechanism of Parkin related to B-cell lymphoma-2 (Bcl-2)/adenovirus E1B 19 kDa interacting protein 3 (BNIP3)/BNIP3-like (NIX)-mediated mitochondrial autophagy in NPC cells. Initially, after Parkin overexpression or silencing, cell viability and proliferation were evaluated by lactate dehydrogenase and colony formation assays. JC-1 staining was used to assess the mitochondrial membrane potential. In addition, the levels of cellular reactive oxygen species (ROS) and mitochondrial ROS were detected using DCFH-DA staining and mitochondrial ROS (MitoSOX) red staining. The expression of proteins was measured using Western blot. Results showed that Parkin overexpression inhibited, whereas Parkin knockdown promoted the proliferation of paclitaxel-treated NPC cells. Besides, Parkin overexpression induced, whereas Parkin knockdown inhibited mitochondrial apoptosis in paclitaxel-treated NPC cells, as evidenced by the changes of Cytochrome C (mitochondria), Cytochrome C (cytoplasm), BAK, and Bcl-2 expression. Moreover, the levels of ROS, mitochondrial membrane potential, and LC3II/LC3I in paclitaxel-treated C666-1 cells were hugely elevated by Parkin overexpression and were all declined by Parkin knockdown in CNE-3 cells. Furthermore, Parkin upregulation activated, whereas Parkin downregulation inactivated BNIP3/NIX signaling. Further, BNIP3 silencing or overexpression reversed the impacts of Parkin upregulation or downregulation on the proliferation and mitochondrial apoptosis of paclitaxel-treated NPC cells. Particularly, Mdivi-1 (mitophagy inhibitor) or rapamycin (an activator of autophagy) exerted the same effects on NPC cells as BNIP3 silencing or overexpression, respectively. Collectively, Parkin overexpression activated BNIP3/NIX-mediated mitochondrial autophagy to enhance sensitivity to paclitaxel in NPC.
Correlation of Hemolysis by Plasma Hemoglobin with Biochemical Markers during Storage of Blood under Standard Conditions in the Blood Bank of a Tertiary Health-care Center
Authors: Gaur Parisha , Bhardwaj Aparna , Raturi Gaurav , Ahmed Saqib , Usmani Rana
Published: November 2023

Background and Objectives:

Stored blood undergoes many metabolic, biochemical, and molecular changes known as storage lesions which are responsible for negative posttransfusion effects in recipients. This study aims to detect serial in vitro qualitative changes that occur during processing and blood storage including changes in plasma hemoglobin (Hb), plasma lactate dehydrogenase (LDH), and potassium levels and changes (fall) in pH of packed red blood cell at serial intervals under a standard condition of storage in the blood bank. This is a two year prospective study.

Methods:

Fifty donors were selected and blood units were collected and stored under blood bank conditions. Mean plasma Hb of stored blood was estimated by measuring the transmittance and absorbance of modified azide-methemoglobin and percentage hemolysis was calculated on days 0, 1, 7, 21, 28, 35, and 42 days. Similarly, plasma LDH and plasma potassium levels were also assessed during storage.

Results:

It was noted that free Hb level and percentage hemolysis progressively increased with storage along with the level of LDH and potassium. However, the extent of hemolysis did not exceed the permissible limit of up to 42 days of storage.

Conclusion:

It was concluded that quantitative estimation of Hb is superior to the visual method for the determination of hemolysis. Hemolysis can be further reduced by additive solution saline, adenine, glucose, and mannitol and using di-2-ethyl hexyl pHthalate as s plasticizer in blood bags for storage.
Spectrum of Hemolytic Transfusion Reactions from Tertiary Cancer Center Over a 1-year Period
Authors: Fathima Valathuparambil Jalaludheen , Murugesan Mohandoss , Anju Radhakrishna Kurup
Published: November 2023

Background and Objectives:

Acute hemolytic transfusion reactions (HTRs) one of the serious adverse events manifesting within 24 h of blood transfusion. To review the adverse transfusion reactions in our cancer center over a 1-year period, especially HTR and its causation to find the ways of mitigating the same.

Methods:

This was a retrospective analysis of HTR in tertiary care cancer center from South India. Patients who developed HTR in 2022 were included for discussion.

Results:

A total of six HTRs observed in five patients during 1 year. Case 1 was an acute presentation of HTR due to Anti Jka antibody. Case 2 was a nonimmune HTR associated with leukodepleted irradiated packed red blood cells transfusion. Case 3 was an incidental finding of passive hemolysis due to ABO incompatible platelet transfusion in patient clinically manifesting febrile and transfusion-associated dyspnea. Case 4 presented as an HTR with inconclusive evidence suggestive of HTR, with an impression of hemolysis as a part of the underlying disease.

Conclusion:

While the incidence of HTR due to ABO-incompatible transfusion reactions has been minimized, the other potential causes for acute HTR are still a concern. An effective hemovigiliance and strict adherence to standards in blood component practice may help to mitigate any form of transfusion reaction.
An Overview of Blood Transfusion Services in Palestine
Authors: Seir Rania Abu , Nazzal Lana , Yasin Dorgam , Manasrah Lina , Najjar Osama
Published: November 2023

Blood transfusion is a vital component of the health-care system, especially considering the ongoing violent Palestinian-Israeli conflict that increases the need to maintain sufficient availability of safe blood for medical emergencies. We assessed the elements of blood transfusion services (BTS) against the guidelines of the World Health Organization guidelines to identify the achievements and gaps of the Palestinian BTS. Before the provision of the Palestinian Authority in 1994, BTS was provided by one blood bank and lacked any legislative or regulatory framework. Currently, BTS is overseen by the Palestinian Ministry of Health (MoH). There are 32 functional blood banks in the West Bank. Fourteen functional blood banks are overseen by MoH including the Central Blood Bank, which takes the role of a reference blood bank and 13 hospital-based blood banks. BTS in Palestine still lacks some of the major components required for a good national effective and safe BTS such as legislative and regulatory frameworks that are integrated within the national health system, defined standards and national guidelines on the clinical use of blood components, a national comprehensive quality assurance program for BTS, and a hemovigilance system to capture data on adverse events. In addition, there are no national blood donor programs or educational programs for staff in place.
Necessity of Implementing Ferritin Testing for Regular Blood Donors – A Cross-sectional Analysis of Serum Ferritin Levels in Individuals Donating Blood at Various Frequencies in a Year at a Regional Blood Transfusion Center
Authors: Hameed Yameena , Shaiji P. S. , Meena D.
Published: November 2023

Background and Objectives:

The virtuous act of blood donations should be encouraged and promoted by all means while safeguarding the well-being of the donor. If regular blood donations lead to iron store depletion in any individual, it may be identified and preventive measures should be taken. The current practice of hemoglobin (Hb) testing alone before donation may not detect the depletion of iron stores. Yet, a policy to introduce tests for iron stores and iron supplementation in regular donors requires extensive research in this area because of the cost and feasibility concerns. The objectives were to study the prevalence of subclinical anemia among voluntary blood donors using serum ferritin levels attending the blood transfusion center and to compare the average Hb and serum ferritin levels of donors across different age groups, gender, and donation frequencies.

Methods:

A cross-sectional study was done on 300 consecutively enrolled voluntary whole-blood donors (December 2018–November 2019) who fulfilled eligibility criteria. Donors were further divided into four groups, depending on their number of donations. Their samples were tested for Hb and serum ferritin to check for reduced body iron stores. The data obtained were analyzed using SPSS version 23.

Results:

A total of 300 regular voluntary donors were included in the study. 57.7% of donors were in the age group of 20–29 years, of which 83.33% were males. The total prevalence of subclinical anemia was 16%, in whom 54.2% were males and 45.8% were females. Out of the total female donors in our study (50), 44% suffered from subclinical anemia. Out of the total male donors in the study (250), 10.4% suffered from subclinical anemia. There was a significant association between frequency of donation and subclinical anemia (odds ratio [OR] =6.36, P < 0.001). There was a significant association between subclinical anemia across gender (high for females; OR = 6.76, P < 0.001). There was a significant correlation between the frequency of donation and serum ferritin (Spearman correlation coefficient: −0.299), but there was no correlation observed between the frequency of donation and Hb levels.

Conclusion:

The study demonstrates the depletion of iron store with increasing donation frequency. This calls for continual supervision of body iron stores rather than Hb alone to ensure the continuous supply of healthy blood donors.
Successful Management of Steroid-refractory Morvan's Syndrome 3 Months after Onset with Therapeutic Plasma Exchange
Authors: Kumatagi Shivanand Hemant , Amod R. , Sukumaran Sajith , Gupta Debasish
Published: November 2023

A 52-year-old man presented with behavioral and cognitive symptoms and involuntary movements. Serum CASPR-2 antibodies were strongly positive, and the nerve conduction study showed hyperexcitability. Thus, it was diagnosed as a case of Morvan's syndrome, detected after 3 months. The failed therapy with steroids led to the initiation of the therapeutic plasma exchange (TPE). Five cycles of TPE were completed to improve dramatically the cognitive and behavioral issues as well as the involuntary movements. He was initiated on rituximab for long-term maintenance therapy. In conclusion, TPE can be initiated even after 3 months of onset to achieve significant recovery. Although it is challenging, it is still a tolerated procedure with good outcomes.
The Incidence of Evanescent Antibodies to Red Blood Cell Antigens in a Tertiary Care Hospital in Northern India
Authors: Chowdhury Sourav , Chowdhry Mohit
Published: November 2023

Background and Objectives:

The anti-A and anti-B are naturally occurring antibodies in the human body but alloantibodies may be formed in individuals who lacks that corresponding red cell antigen after any sensitising event like blood transfusion or pregnancy. The aim of this study was to find the incidence of evanescenct RBC alloantibodies that may not be detectable at the time of pre-transfusion screening.

Methods:

This was a retrospective observational study from January 2017 to May 2019 in a tertiary care centre from North India. The data on antibody screening and identification retrieved from the departmental records. The patients were screened for red blood cell antibody and those with a positive screening test were further investigated for antibody identification. Antibody screening was performed by solid phase method using Immucor Capture-R Ready Screen (4 cell). Confirmed positive samples were investigated with advance methods of Antibody ID using Reagent panel Red Blood Cells Capture-R Ready ID (16 Cell) in Automated Analyzer Iris or Neo (Immucor Inc. Nocross, GA, USA). As and when required other advance techniques of adsorption and elution, etc were also performed too.

Results:

The total number of patient screened during this period were 8071. Amongst them 312 were positive for antibody screening (3.8%), of those 216 (62.9%) cases had alloantibodies and 96 (30.7%) cases had autoantibodies. Among the 216 cases of alloantibody, 147 (68.1%) cases had single alloantibody and 69 (31.9%) cases had multiple alloantibodies. Amongst the patients having single alloantibody, the prevalence was highest for Anti-D 54 (36.7%), followed by Anti-E 27 (18.3%), Anti-C 8 (5.4%), Anti-c 7 (4.7%), Anti-K 9 (6.1%), Anti-Fyb 11 (7.4%), Anti-M 18 (12.2%), Anti-N 4 (2.7%), Anti-Fyb 3 (2%), Anti-Lea 3 (2%), Anti-Cw 2 (1.3%) and Anti-Mia 1 (0.6%). Of the 96 patients with autoantibody 72 had warm autoantibody, 10 had cold autoantibody and there were 8 cases of mixed warm and cold autoantibodies. There were 6 patients with warm autoantibody with underlying alloantibody.

Conclusion:

In conclusion, the high prevalence of Anti-Rh (Anti-D, E), Anti-M, Anti-Fyb antibodies in patient requiring transfusion reiterates the importance of stringent antibody screening and identification as an essential step in preventing delayed hemolytic transfusion reaction.
Monitoring Blood Transfusion Policies and Implementation of Maximum Surgical Blood Ordering Schedule
Authors: Moshfegh Fereshteh , Farahbakhsh Negar , Bahraini Mehran , Kardan-Yamchi Jalil , Fazeli Alieh , Boluki Ebrahim
Published: November 2023

Background and Objectives:

The procedure of blood ordering is a major issue in hospitals. Hence, maximum surgical blood ordering schedule is recommended to manage the blood application process properly. The aim of this study was to evaluate the demand and rate of blood consumption in different wards of a pediatric hospital.

Methods:

This is a cross-sectional on patients ≤18 years old who underwent major surgical procedures from 2015 to 2019. Data included type of department, number of total blood bags requested as well as cross-matched and transfused units. Furthermore, indices such as cross-matched to transfusion (Cross-matched to Transfused (C/T) ratio) in various hospital departments and months were calculated.

Results:

This study revealed that the utilization rate was 77.29% of blood units among a total of 97356 cases done. The emergency department consumed only 28.08% of its requests. C/T ratio for all departments of the hospital was 1.34. The most and lowest numbers of requests were for surgery 2 department and newborn intensive care unit, respectively. Furthermore, we have observed the lowest rate of C/T ratio in December.

Conclusions:

Our data showed that in the majority of elective pediatric surgical procedures, a large number of blood units tested for antibody screening were consumed, reducing the consumption of cord blood bags as well as the financial burden for the hospital and the patients. Furthermore, our findings revealed that based on the calculated C/T ratio, the hospital used the correct procedure for blood requests in period of 1 year. In addition, the time for preparation of blood was decreased dramatically.
Utility of Dithiothreitol in a Case of Spontaneous Autoagglutination Due to Mixed Autoimmune Hemolytic Anemia in a Child – A Rare Scenario
Authors: Subramaniyan Rajeswari
Published: November 2023

Mixed autoimmune hemolytic anemia (AIHA) represents <5% of pediatric AIHA cases. Spontaneous agglutination is known in patients with cold agglutinins reacting at room temperature. They often interfere with serological tests; generally, they can be dispersed by simple warming techniques. Rarely, in severe cases, as seen in the index case, dithiothreitol treatment of the red cells is needed to eliminate autoagglutination.
Ultrasonographic evaluation of diaphragmatic excursion changes after major laparoscopic surgeries in the Trendelenburg position under general anaesthesia: A prospective observational study
Authors: Rustagi Preeti Sachin , Yadav Akshay , Nellore Shalaka Sandeep
Published: November 2023

Background and Aims:

Laparoscopic surgeries result in increased intra abdominal pressure and cephalad displacement of the diaphragm. The Trendelenburg position can augment these respiratory changes. The primary objective of this study was to compare diaphragmatic excursions before and after a major laparoscopic pelvic surgery under general anaesthesia in the Trendelenburg position using ultrasonography (USG).

Methods:

This prospective observational study included 90 patients of either gender, aged 20–60 years, with American Society of Anesthesiologists physical status I/II. M-mode USG was used to assess diaphragm inspiratory amplitude (DIA) before induction of anaesthesia and 10 minutes after tracheal extubation. Factors such as age, gender, body mass index, positive end-expiratory pressure (PEEP), pain, peak airway pressures, duration of pneumoperitoneum, duration and degree of Trendelenburg position and duration of anaesthesia were recorded. Pearson’s correlation and multiple linear regression were used to analyse the factors affecting change in DIA (ΔDIA).

Results:

The mean difference (95% confidence interval (CI)) of measured DIA was 0.70 (0.598–0.809), P < 0.001. ΔDIA had a weak positive significant correlation with age, anaesthesia duration, pneumoperitoneum, and visual analogue scale (VAS) score 10 minutes after extubation. Multiple linear regression analysis showed 14.86% of the variance in DIA. Age (β = 0.008, P = 0.049), duration of anaesthesia (β = 0.002, P = 0.02) and VAS score 10 minutes after extubation (β = 0.128, P = 0.001) were significant independent predictors.

Conclusion:

DIA decreased significantly after pelvic laparoscopic surgeries performed in the Trendelenburg position. Age, duration of anaesthesia and pain after the procedure were significant independent predictors.
Validation of Hindi version of the obstetric quality of recovery score-11 (ObsQoR-11 H) following elective caesarean section
Authors: Gupta Sunanda , Choudhary Savita , Choudhary Vidhu , Jain Kajal , Bhatia Nidhi , Gupta Apoorva
Published: November 2023

Background and Aims:

Obstetric quality of recovery score-11 (ObsQoR-11) was developed in English to evaluate the quality of recovery in the caesarean section. We aimed to validate the Hindi version of ObsQoR-11 (ObsQoR-11H) for Hindi-speaking patients to evaluate the quality of recovery following the elective caesarean section.

Methods:

The ObsQoR-11 was translated into Hindi and assessed for validity, acceptability and feasibility. The questionnaire was administered postoperatively at 24 and 48 hours, and the Global Health Numeric Rating Scale (NRS) was used to evaluate recovery.

Results:

The mean (standard deviation [SD]) (95% confidence interval [CI]) ObsQoR-11 H was 75.94 (4.09)(95% CI 75.1, 76.7) and 80.25 (4.08)(95% CI 79.5, 81) at 24 and 48 hours, respectively. The mean (SD) (95%CI) Global Health NRS scores were 71.22 (5.97)(95% CI 70, 72.4) and 77.37 (5.79)(95% CI 76.2, 78.5) at 24 and 48 hours, respectively. Convergent validity showed a strong correlation between ObsQoR-11H and Global Health NRS (Spearman’s correlation coefficient [rs] >0.8 and 0.78) scores at 24 and 48 hours, respectively. Discriminant validity was significant in appreciating the difference between good and poor recovery (P < 0.001). Split-half coefficient of 0.69 and 0.65 and Cronbach’s alpha (α) of 0.91 and 0.82 at 24 and 48 hours suggested good score reliability. The acceptability and feasibility of the score were also good.

Conclusion:

The ObsQoR-11H discriminated well between ‘good’ and ‘poor’ recovery and correlated strongly with Global Health NRS scores. It was found to be a valid, reliable, acceptable and feasible tool for psychometric recovery evaluation after elective caesarean section in Hindi-speaking women.
Short-axis versus long-axis approach for ultrasound-guided vascular access: An updated systematic review and meta-analysis of randomised controlled trials
Authors: Mishra Aparna , Kumar Mohan , Kumar Niraj , Goyal Keshav , Soni Kapil Dev , Yadav Anuradha
Published: November 2023

Background and Aims:

There are two approaches for ultrasound (US)-guided vessel cannulation: the short axis (SA) approach and the long axis (LA) approach. However, it remains to be seen which approach is better. Therefore, we performed the present updated systematic review and meta-analysis to assess the effectiveness and safety of US-guided vascular cannulation between the SA and LA techniques.

Methods:

We performed a comprehensive electronic database search in PubMed, Embase, Cochrane Library and Web of Science for the relevant studies from inception to June 2022. Randomised controlled trials comparing the SA approach and the LA approach for US-guided vascular access were incorporated in this updated meta-analysis. The first-attempt success rate was the primary outcome. The secondary outcomes were the overall success rate, cannulation time, number of attempts and the incidence of complications. The statistical analysis was conducted using RevMan software (version 5.4; the Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, Denmark). The Cochrane risk of bias tool was used to evaluate each study’s potential risk for bias.

Results:

In total, 16 studies consisting of 1885 participants were incorporated in this updated meta-analysis. No statistically significant difference was found between the SA and LA vascular access techniques for first-pass success rate (risk ratio = 1.07, 95% confidence interval: 0.94–1.22). The overall cannulation success rate, complication rate, average cannulation time and average number of attempts were not significantly different between the SA and LA groups.

Conclusion:

This updated meta-analysis demonstrated that the SA and LA approaches of US-guided vessel cannulation are similar regarding first-pass success, overall cannulation success rate, total complication rate, cannulation time and the number of attempts.
A randomised, double-blind, comparative study of preoperative magnesium sulphate versus zinc sulphate gargle for prevention of postoperative sore throat following endotracheal intubation
Authors: Mondal Amit Kumar , Maiti Asim Kumar , Chattopadhyay Suman , Bhar Debasish
Published: November 2023

Background and Aims:

Magnesium sulphate and zinc sulphate have been reported to attenuate postoperative sore throat (POST). The study aims to compare the effect of preoperative magnesium sulphate and zinc sulphate gargle on the incidence and severity of POST following endotracheal intubation within 24 h.

Methods:

After ethics committee approval, 132 patients were randomly allocated to three groups (M, Z and D). Fifteen minutes before laryngoscopy and tracheal intubation, patients assigned to groups M and Z received a solution for gargle containing magnesium sulphate 20 mg/kg and zinc sulphate containing 40 mg of elemental zinc dissolved in 20 ml of 5% dextrose solution, respectively. Group D received 20 ml of 5% dextrose solution. Incidence and severity of POST (4-point score: Grade 0- no sore throat, Grade 1- mild sore throat, Grade 2- moderate sore throat, Grade 3- severe sore throat) was assessed for 24 h after extubation. Statistica, Version 8.0 (StatSoft, Inc., Tulsa, Oklahoma, USA) was used for analysing the data.

Results:

The lowest incidence of POST in group M was 13.6% (95% confidence interval [CI] 3.5–23.7) compared to 0% in group Z, whereas the highest incidence recorded in group M was 25% (95% CI 12.2–37.7) in contrast to 13.6% (95% CI 3.5–23.7) in group Z during the first 24 h after operation. It was observed that the incidence of mild POST (POST score 1) was significantly lower (P < 0.05) in group Z compared to group M in the first 4 h postoperatively.

Conclusion:

Zinc sulphate gargle before laryngoscopy and tracheal intubation is more effective for reducing the incidence of POST than magnesium sulphate gargle.
Early prediction of pre-eclampsia using circulating placental exosomes: Newer insights
Authors: Rao Aishwarya , Shinde Uma , Das Dhanjit Kumar , Balasinor Nafisa , Madan Taruna
Published: November 2023

Pre-eclampsia (PE), a multifactorial de novo hypertensive pregnancy disorder, is one of the leading causes of foeto-maternal morbidity and mortality. Currently, antihypertensive drugs are the first-line therapy for PE and evidence suggests that low-dose aspirin initiated early in high risk pregnancies may reduce the risk of development or severity of PE. However, an early prediction of this disorder remains an unmet clinical challenge. Several potential serum biomarkers associated with maternal immunoregulation and placental angiogenesis have been evaluated but are ineffective and inconsistent for early prediction. Although placental biomarkers would be more specific and sensitive in predicting the risk of PE, accessing the placenta during pregnancy is not feasible. Circulating placental exosomes (pEXO), originating from foeto-maternal interface, are being evaluated as the placenta’s surrogate and the best source of non-invasive placental biomarkers. pEXO appear in the maternal circulation starting from six weeks of gestation and its dynamic biological cargo across pregnancy is associated with successful pregnancy outcomes. Therefore, monitoring changes in pEXO expression profiles could provide new insights into the prediction, diagnosis and treatment of PE. This narrative review comprehensively summarizes the available literature on the candidate predictive circulating biomarkers evaluated for PE to date. In particular, the review elucidates the current knowledge of distinct molecular signatures emanating from pEXO in pre-eclamptic women to support the discovery of novel early predictive biomarkers for effective intervention and management of the disease.
Understanding barriers, recommended solutions, and future prospects for the diagnosis and management of Pythium insidiosum keratitis
Authors: Gurnani Bharat , Kaur Kirandeep
Published: November 2023

Pythium insidiosum keratitis (PIK) is a devastating corneal infection resulting in blindness in a large number of cases. Clinically and morphologically, it closely mimics fungal keratitis, and hence is also labeled as “parafungus.” Although many clinical studies have documented evidence regarding the virulence of microorganism, and anatomical and functional outcomes, it remains a clinical challenge and diagnostic dilemma for most clinicians. Till today, PIK is being diagnosed and treated with certainty at only limited centers across the globe. But the question is why this is so? Taking this as the research question, this section on current ophthalmology aims to highlight the understanding of barriers to diagnosing and treating PIK, the suggestions to improve diagnosis and treatment, and the future prospects.
Knowledge, attitude, and practice patterns of Indian ophthalmologists regarding medicolegal issues
Authors: Agrawal Deepanshu , Heda Aarti , Ghosh Sayantan , Kalia Sonal , Bhatia Karan , Kumar Nilesh , Tripathy Koushik
Published: November 2023

Purpose:

To assess the knowledge, attitude, and practice patterns (KAPP) of Indian ophthalmologists regarding medicolegal issues using an initial survey.

Methods:

An online form was circulated among Indian ophthalmologists of all ages over social media and email by the Young Ophthalmologists Society of India (YOSI) and its medicolegal working group. Anonymous responses were obtained and analyzed for each question. The questionnaire comprised questions about demographic details, KAPP of medicolegal issues including how to deal with medicolegal issues (if faced), medical indemnity insurance, deviation from the recommended minimum sum assured (Rs. 1 crore for Indian ophthalmologists), and legal service providers.

Results:

A total of 109 responses were obtained. The majority of the respondents were male (60, 55%). More than 50% of respondents (58, 53.2%) were younger than 35 years. More than one-fourth of the respondents were private practitioners (29, 27%), and the majority were of senior consultant designation (45, 41%). Around 80% of respondents (89, 81.6%) were aware of professional indemnity insurance; however, only 54% (n = 59) bought the insurance cover. A majority of the respondents (38, 64.4%) had an indemnity cover of a maximum of Rs. 50 lacs. Only 20% of respondents were aware of the expert body at the state/national level that deals with medicolegal cases. Thirty percent of respondents recommended the ideal cover amount to be more than Rs. 1 crore.

Conclusion:

The current survey highlights the dismally low rate of awareness of medicolegal issues among ophthalmologists. Specifically, a majority of Indian ophthalmologists surveyed did not have recommended minimum insured cover for professional indemnity insurance. Larger studies are needed to further explore KAPP of Indian ophthalmologists in various medicolegal issues.
Impact of COVID-19 on cataract surgical competency of ophthalmology residents
Authors: Ghiasian Leila , Aghili SeyyedSaeed , Abdolalizadeh Parya
Published: November 2023

Context:

Coronavirus disease 2019 (COVID-19) pandemic led to a decrease in elective surgeries.

Purpose:

To compare the performance of postgraduate year 4 prepandemic (2018–2019) and pandemic (2021–2022) ophthalmology residents.

Settings and Design:

This was an observational comparative study conducted at a university-based hospital.

Methods:

Ophthalmology residents of postgraduate year 4 during prepandemic (2018–2019) and pandemic (2021–2022) time periods were included. The performances of residents in phacoemulsification were scored by a single faculty assessor using the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric for phacoemulsification (ICO-OSCAR: phaco). The scores were compared between the two groups.

Statistical Analysis Used:

The comparisons between the pre- and post-pandemic groups were performed using the Chi-square and Mann–Whitney U test.

Results:

Seventy-one surgeries were rated in each group. All task-specific and global scores of the pandemic group were lower than those of the prepandemic group (all P values < 0.001). The maximum intergroup difference was in capsulorrhexis circular completion (difference of 1.21 score, P < 0.001) and tissue handling (difference of 1.21 score, P < 0.001) among task-specific and global scores, respectively. The residents of the two groups had the highest similarity in irrigation and aspiration (difference of 0.61 score, P < 0.001) from task-specific scores and central eye position from global scores (difference of 0.93 score, P < 0.001).

Conclusion:

The COVID-19 pandemic has negatively affected the surgical competency of ophthalmology residents in phacoemulsification.
Prognostic factors of open-globe injuries: A review
Authors: Tan Sze Ing , Hoskin Annette K , Khatri Anadi , Dave Vivek P , Bhalerao Sushank , Romero Jose , Agrawal Rupesh
Published: November 2023

Open-globe injuries (OGI) can lead to significant visual impairment. The Ocular Trauma Score (OTS) is the most widely recognized tool for predicting visual outcomes. This review aimed to identify prognostic factors and assess the effectiveness of the OTS in predicting visual outcomes. Twenty-one articles published on PubMed and Google Scholar were analyzed. Initial visual acuity and the zone of injury were found to be the most significant prognostic factors for OGI. Other significant prognostic factors include retinal detachment/involvement, relative afferent pupillary defect, vitreous hemorrhage, vitreous prolapse, type of injury, hyphema, lens involvement, and duration from incidence of OGI to vitrectomy. Of the 21 studies evaluated, 11 investigated the effectiveness of OTS. Four studies concluded that OTS was effective overall, while six studies suggested that it was only useful in certain OGI categories. Thus, there is a need for further research to develop an optimized ocular trauma prognosticating system.
Study of rhino-orbital-cerebral mucormycosis and its correlates during COVID-19 pandemic in a tertiary eye care institute of central India
Authors: Verma Vidhya , Sarkar Deepayan , Moharana Bruttendu , Singh Priti , Noyadu Richa , Sharma Bhavana
Published: November 2023

Purpose:

To evaluate factors associated with the occurrence of ROCM in COVID-19 patients and to compare its related parameters and outcomes between active and recovered COVID-19 groups.

Methods:

A total of 35 patients of ROCM associated with COVID-19 (active and post-COVID-19) were included. This is an ambispective study with retrospective medical records review for COVID-19 analysis and prospective assessments of ROCM-associated COVID-19 during the second wave of the COVID-19 pandemic. The demographic data, clinical parameters, and outcome were recorded on MS excel sheet, and various parameters were compared between active and recovered COVID-19 groups.

Results:

ROCM in recovered COVID-19 group was higher (57.1%) as compared to active COVID-19 (42.9%) (P = 1.00). High occurrence of ROCM was seen in those who had a history of hospitalization due to severity of COVID-19 (n 33, 94.28%), oxygen support (77.14), and received systemic steroids (82.9%). The most common comorbidity was diabetes mellitus (82.9%), and new-onset hyperglycemia was noticed in 17.1% of patients. Exenteration (28.6%) was performed in severe cases who had stage IV ROCM, bilateral, and CNS involvement (RR = 7.2, 95% CI: 2.91 to 18.00). The risk of globe exenteration was 1.35 (0.7-2.29) times higher in recovered COVID-19 group, and mortality was 1.76 (0.72-3.36) times higher in active COVID-19 group.

Conclusion:

Monitored use of systemic steroids and the prompt management of hyperglycemia in COVID-19 patients are important factors for favorable outcomes with reference to globe salvage and life-saving in ROCM associated with COVID-19. Even recovered COVID-19 patients should be observed for persistent hyperglycemia and occurrence of ROCM.
ChatGPT in academic writing: Maximizing its benefits and minimizing the risks
Authors: Mondal Himel , Mondal Shaikat
Published: November 2023

This review article explores the use of ChatGPT in academic writing and provides insights on how to utilize it judiciously. With the increasing popularity of AI-powered language models, ChatGPT has emerged as a potential tool for assisting writers in the research and writing process. We have provided a list of potential uses of ChatGPT by a novice researcher for getting help during research proposal preparation and manuscript writing. However, there are concerns regarding its reliability and potential risks associated with its use. The review highlights the importance of maintaining human judgment in the writing process and using ChatGPT as a complementary tool rather than a replacement for human effort. The article concludes with recommendations for researchers and writers to ensure responsible and effective use of ChatGPT in academic writing.
Retrieval of deep corneal stromal wooden foreign body using vitreoretinal foreign body forceps as scoop: An innovative technique
Authors: Sharma Ashok , Sharma Rajan
Published: November 2023

A 55-year-old woman presented with a stromal wooden foreign body (FB) in the left cornea. The deep corneal stroma wooden FB was removed using vitreoretinal FB forceps as a scoop. In this innovative technique, a 26-gauge needle was used to open the track of the wooden FB. The FB was trapped in the concavity of one limb of the vitreoretinal FB forceps. The vitreoretinal forceps were gradually withdrawn and the FB was removed. The patient was treated with gatifloxacin and voriconazole six times, and atropine 1% three times daily. The patient did not develop infiltrate or hypopyon in 2 weeks. After 2 weeks, gatifloxacin and voriconazole were reduced to four times a day; and atropine to two times a day. After 6 weeks topical medication was stopped. The patient achieved a best-corrected visual acuity (OS) of 6/9 at 8 weeks and maintained it through 7 months of follow-up.
Assessment of risk of obstructive sleep apnea with thyroid eye disease and its activity
Authors: Kumari Namita , Arora Nitish , Das Sima , Tiple Sweety , Singh Harshdeep , Patidar Narendra , Mishra Mihir , Majumdar Atanu
Published: November 2023

Purpose:

To evaluate the association between obstructive sleep apnea (OSA) and thyroid eye disease (TED) and its effect on disease activity.

Methods:

A prospective case–control study was conducted from January 2020 to March 2022. All TED patients (group A) were clinically evaluated. The activity of thyroid eye disease was calculated based on the clinical activity score (CAS), and grading of severity was done according to the EUGOGO classification. All TED patients (group A) were screened for OSA using the Snoring Tired Observed Pressure (STOP)-Bang survey. Age- and gender-matched control group patients (group B) without TED were screened for OSA.

Results:

One hundred TED patients and 138 control patients without TED were included in the respective groups. Sixty-two (62%) patients in group A and 48 (34.78%) patients in group B were having high risk of OSA, and this difference was statistically significant (P = 0.001). Further, in group A patients, on univariate analysis, TED activity was significantly associated with a high risk of OSA (P = 0.009). On multivariate logistic regression analysis, OSA also showed significant association with TED activity (odds ratio [OR]: 4.14, 95% confidence interval [CI]: 1.11-18.85 at 10% level; P = 0.05).

Conclusion:

Our study showed that OSA is significantly associated with TED disease and its activity. However, no significant association was found between OSA and severity of the disease.
Health Drink Poisoning – An Unusual Case of Bottle Gourd Toxicity
Authors: Varun H. S. , Pandya Kushal , Muniraju M.
Published: November 2023

Bottle gourd, popularly known as “Lauki” is a commonly used vegetable throughout the world including India. Its juice is considered a “health tonic” for chronic ailments by practitioners of alternate therapy and nutritionist. It is essential for emergency physicians to be aware of this toxicity, especially in tropical countries like India, where alternate therapy practices are prevalent. We present the case of a 35-year-old man who consumed concentrated bottle gourd juice and subsequently experienced multiple episodes of vomiting, bloody diarrhea, and giddiness. The patient was resuscitated and stabilized with crystalloid fluids, proton.pump inhibitors, and antiemetics, and admitted to the critical care unit. The patient was discharged in stable condition after 4 days of hospitalization. Bottle gourd toxicity treatment is symptomatic, and there is no specific antidote for this toxicity. It is important to early diagnose bottle gourd toxicity, especially in countries where it is commonly used as a health tonic.
Impact of eHealth education to reduce anemia among school-going adolescent girls in rural Bangladesh: Study protocol of a randomized controlled trial
Authors: Rahman Md Jiaur , Rahman Md Moshiur , Kakehashi Masayuki , Matsuyama Ryota , Sarker Mohammad Habibur Rahman , Ali Mohammad , Promitee Sumaita Kabir , Prihanto Junaidi Budi , Ahmed Ashir , Shimpuku Yoko
Published: November 2023

Adolescent girls are highly vulnerable to developing anemia due to reproductive immaturity, poor personal hygiene, and lack of nutritional intake and health education in rural Bangladesh. Digital health technology is a promising tool to overcome barriers and provide appropriate health guidelines. We aim to evaluate eHealth education's impact and changes in adolescent girls' knowledge, attitude, and practice regarding anemia. A 1:1 parallel randomized control trial was conducted among school-going adolescent girls in rural Bangladesh. A total of 138 anemic (mild and moderate) participants were enrolled. We randomized schools to reduce the health education bias through a simple coin toss technique, then allocated participants to the intervention group (n = 69) and control group (n = 69) by stratified random sampling technique. The intervention group received two online counseling sessions and 8-month eHealth education through mobile phone calls and short message service regarding anemia. The control group received the usual care. The primary endpoint changes the anemic level through changing knowledge, healthy lifestyle behavior, and an iron-rich food dietary plan. Per-protocol analysis will utilize to compare the control and intervention groups using SPSS software. Descriptive statistics (frequencies, percentages, mean, SD) will be employed, and continuous variables will be compared using the t-test/Mann–Whitney test. Two-way analysis of variance will assess outcome variables at baseline, 4 months, and 8 months. The 8-month intervention is designed from May 2022 to February 2023. Participants' age range of 10-14 years was 60.9% in the intervention group and 56.5% in the control group. Among the participants, 89.9% and 88.4% were mild anemic; 11.11 (SD ± 0.80) and 11.06 (SD ± 0.96) were mean hemoglobin in the intervention and control groups, respectively. eHealth education is expected to be an effective way to increase knowledge and healthy behavioral change, which can reduce the anemia burden among adolescent girls.
Serum levels of sclerostin in prediabetes and its correlation with bone mineral density
Authors: Chauhan Ajay , Bhakhar Manoj Kumar , Goyal Parul
Published: November 2023

Background:

Diabetes is a major burden globally, more commonly so in developing countries, as its complications are detected relatively late due to underdeveloped healthcare systems. These complications, when detected, are more or less irreversible, thereby leading to increased morbidity and mortality. Among these, complications related to bones (mainly osteoporosis) start fairly early (even in the prediabetes stage) but are less emphasized, nonetheless are major contributors to morbidity in diabetics due to increased fracture risk. One of the novel bone markers recently discovered is sclerostin, which helps in the assessment of the effect of hyperglycemia on bone homeostasis. Bone mineral density (BMD) by DXA scan is a good tool to assess the status of bone health but requires modern expensive radiological equipment. In this study, we wanted to see the correlation of serum levels of sclerostin to BMD so that by a simple serum investigation, early detection of poor bone quality in treatment-naive prediabetics can be done.

Objective:

The aim of the study was to measure serum levels of sclerostin in prediabetics, compare them with normoglycemic controls, and find the correlation of serum levels of sclerostin with BMD.

Methods:

50 prediabetic patients and 50 age, sex, blood pressure, and BMI-matched controls were recruited in the study. In both the groups, serum levels of fasting blood glucose and postprandial glucose, glycated hemoglobin (HbA1c), Vitamin D, fasting insulin, and serum sclerostin levels were measured in both groups using ELISA. The obtained values were compared between the two groups. Bone mineral density is measured by DXA scan in cases and a correlation between BMD and serum levels of sclerostin was observed.

Results:

Serum sclerostin was significantly higher in the cases [18.22 (19.42) ng/ml] compared to the control group [11.08 (4.73) ng/ml] with a P value of 0.013. The mean of BMD in prediabetes is 1.06 g/cm2, T score is − 1.02, and Z score is − 0.59. There was a significant negative correlation between serum sclerostin levels and BMD in prediabetes (r = −0.404, P < 0.001).

Conclusion:

Serum levels of sclerostin are increased in prediabetes and correlate well with low BMD in prediabetes, and can therefore be used for early recognition of osteoporosis and fractures in diabetes.
Association of physical activity and stress reactivity with depression in elderly hypertensive population: A cross-sectional study from Eastern India
Authors: Banerjee Arijita , Kumar Sumit , Dasgupta Shirin
Published: November 2023

Objective:

Depressive disorder poses an increased risk for sudden cardiac death in elderly population with existing comorbidities. Also, few international studies suggest the association of decreased stress reactivity with symptoms of depression in old age. Our cross-sectional study has attempted to explore the relationship of daily exercise and stress reactivity with depression in elderly individuals with hypertension.

Methods:

Depression was assessed using Hamilton depression rating scale or HAM-D. The physical activity was assessed using the global physical activity questionnaire (GPAQ), developed by WHO. Stress reactivity is calculated from various cardiovascular parameters. The relationship of physical activity and stress reactivity scores on depression was explored using regression analysis.

Results:

The prevalence rate of depressive symptoms in elderly hypertension population was around 40.2%. Significantly lower reactivity scores (P = 0.032) to deep breathing were evident in elderly hypertension population. After proper adjustment of the confounding factors, regression analysis depicted that decreased physical activity (Odds ratio = 4.48; 95% Confidence interval = 2.32–7.69) resulted in heavy risk of developing depressive symptoms besides old age and low educational status.

Conclusion:

Our ﬁndings suggest that low physical activity leads to the development of depressive symptoms and decreased stress reactivity among elderly hypertensive patients.