bluuebunny/crossref_metadata_2025 huggingface dataset:
Navigating Digital Payments in Ghana's Public Sector
Authors: Ahiabenu Kwami
Published: February 2024

The adoption of digital payments presents new opportunities for enhancing public sector service delivery. However, little coherent literature exists on the diffusion of public-sector digital payments, including deployment challenges and successes. This chapter reviews the evidence on the evolution of digital payments in Ghana's public sector. It draws upon stakeholder theory to analyze the diffusion of digital payments for public service delivery in Ghana. This chapter gathered qualitative evidence through expert interviews to map the evolution of public sector digital payments. The findings of this chapter reveal that Ghana's public sector finances are digititalized, leading to a significant reduction in the use of physical cash. Government entities are empowered to access public finance data in real time, supporting better revenue collection, disbursement, and judicious utilization of financial resources. This chapter highlights the need to improve stakeholder engagement as a prerequisite to ensuring increased usage of public sector digital payments.
Corrosion and Microstructure on the Casting Product Propeller Shaft Model of Al6063 Aluminum Alloy Base Materials
Authors: Joni Joni , Bhiftime Eka Irianto , Ranteallo Obet , Dewa Rando Tungga , Permata Ariyo N.S. , Nayaka Muhammad Daffa , Zulhazmi Ali , Priyono Ilhamul Akbar
Published: February 2024

Aluminum materials are used in a wide field for household appliances, aircraft, cars, ships, and construction. This research aims to obtain a new material based on aluminum magnesium silicon (AlMgSi) alloy as an alternative material to replace the steel base material in the shaft propeller product. In this paper, we will use the die-casting method to investigate corrosion resistance and the microstructure of the propeller shaft with AlMgSi aluminum alloy base material. The main base material used is 6063 aluminum alloy, with variations in the addition of Si (1, 2, 4 wt%). Alloy Al6063 is heated to a temperature of 720°C to reach a complete liquid state. Then the temperature is lowered to 645°C, then the Si element is inserted into the heating furnace and stirred. Then the temperature is lowered to 615°C, then the Mg element is added, then stirred thoroughly by a mechanical stirrer. The rotational speed of the stirrer is 70 rpm and the stirring time is 240 seconds. They were then heated to a pouring temperature of 680°C. The mold is heated to a temperature of 265°C. Then poured into the mold and pressed 7 MPa. The cast is cooled at room temperature. Then the casting products were heat treated with a solution treatment temperature of 485°C for 3600 seconds and quenched. After that, the casting products were treated with artificial aging. The results of this study show corrosion resistance increases along with the addition of variations of Silicon. The highest corrosion rate was obtained by adding Si as much as 4 wt% of 511.28 mm/y. With the addition of variations of Silicon 0 wt%, 1 wt% and 2 wt% showed the corrosion rate of 173.35 mm/y, 201.60 mm/y, 233.49 mm/y. The microstructure shows differences in grain structure. materials with variations of si 0 wt% and materials with variations of si 0 wt%, 1 wt%, 2 wt% and 4 wt% have different grain sizes. The intermediate phase (Mg2Si) was mostly formed at Si 4% wt variation. So this study proves that adding silicon elements can increase grain sizes and refiner the propeller shaft.
Fatigue Resistance Assessment of WAAM Carbon Steel
Authors: Hietala Mikko , Rautio Timo , Jaskari Matias , Keskitalo Markku , Järvenpää Antti
Published: February 2024

This study presents a comprehensive exploration of the fatigue resistance of wire arc additive manufacturing (WAAM) carbon steel for lattice structures. Microstructural analysis unveils substantial grain dimensions characterized by a distinctive crystallographic configuration. These grains exhibit equiaxed characteristics, demonstrating uniform dimensions in all directions. The prevailing microstructure is dominated by ferrite grains. In tandem with the microstructural insights, hardness evaluations were conducted in correspondence with the part's deposition direction. The analysis of these measurements unveiled a consistent base material hardness of approximately 159 HV. The uniform distribution of hardness profiles supports the deduction that WAAM carbon steel uniformly embodies strength attributes. This congruence aligns harmoniously with the uniform microstructure evident in microscopic analyses. The yield strength of the WAAM carbon steel exhibits higher values in the build direction, peaking at 392 MPa. The bending fatigue tests revealed a fatigue limit approximating 180 MPa for WAAM carbon steel, evident in both the build and deposition directions. Fatigue strength of WAAM carbon steel mirrors that observed for reference material S355MC steel sheet.
The Effect of Cetyl Trimethylammonium Bromide Addition as Surfactant in Multiwalled Carbon Nanotube-Based Nanofluid for Quench Medium in Steel Heat Treatment Application
Authors: Putra Wahyuaji Narottama , Ariati Myrna , Suharno Bambang
Published: February 2024

Nanoparticle addition into a fluid can increase the thermal conductivity. Such fluid is commonly called a nanofluid. Due to its improved heat transfer characteristic, nanofluid is widely used as coolant in engine or electronic equipment. In the steel heat treatment industry, nanofluid can be utilized as a quench medium. By controlling the amount of nanoparticle added in the nanofluid quench medium, the cooling rate can be adjusted. To preserve the heat transfer effectivity, the stability of the nanoparticle become very important. Hence, surfactant is quite essential to improve the particle stability and avoid particle agglomeration and sedimentation. In this study, a multiwalled carbon nanotube (MWCNT) was used as the nanoparticle in the distilled water. The concentration of the MWCNT was varied at 0.1, 0.3, and 0.5 % w/v. For the surfactant, Cetyl Trimethylammonium Bromide (CTAB) was chosen to disperse the particle better. In each of the three MWCNT variations, CTAB was added from 3 – 30% w/v. The maximum thermal conductivity obtained was in the nanofluid with 0.3% MWCNT and 5% CTAB at 0.72 W/mK. For the steel hardness, the value was roughly stable at 33 – 35 HRC in the nanofluid with no CTAB and 3 – 5% CTAB addition. Excessive surfactant addition at 30% CTAB decrease the hardness significantly up to 17 HRC.
Towards Smart Additive Manufacturing: Cost and Component Complexity
Authors: Tarlochan Faris , Alsendibad Shehadeh
Published: February 2024

The global market size for Additive Manufacturing is predicted to be around USD 20 billion by 2025. The question arises whether conventional machining such as Computer Numerical Control (CNC) should be replaced by Additive Manufacturing (AM). The results presented in this paper are the outcome of an ongoing study. The overall objective of this study is a decision tool to decide which manufacturing route to adopt from a sustainability perspective. This paper will discuss the first phase of this study looking at the mechanical performance, cost and complexity of parts produced from AM and CNC. The results show that small parts are cheaper to fabricate by AM regardless of part complexity, whereas large, simple parts are cheaper to fabricate by CNC machining. These results might help in identifying manufacturing limitations of AM process in terms of mechanical performance and cost. These results will serve as inputs into a decision-making framework to decide on the most effective manufacturing route based on desired application such as in the spare parts in oil and gas industry.
Astaxanthin Inhibits STING Carbonylation and Enhances Antiviral Responses
Authors: Li Qizhao , Jia Mutian , Song Hui , Peng Jun , Zhao Wei , Zhang Weifang
Published: February 2024

STING-mediated DNA sensing pathway plays a crucial role in the innate antiviral immune responses. Clarifying its regulatory mechanism and searching STING agonists has potential clinical implications. Although multiple STING agonists have been developed to target cancer, there are few for the treatment of infectious diseases. Astaxanthin, a natural and powerful antioxidant, serves many biological functions and as a potential candidate drug for many diseases. However, how astaxanthin combats viruses and whether astaxanthin regulates the cyclic GMP-AMP synthase–STING pathway remains unclear. In this study, we showed that astaxanthin markedly inhibited HSV-1–induced lipid peroxidation and inflammatory responses and enhanced the induction of type I IFN in C57BL/6J mice and mouse primary peritoneal macrophages. Mechanistically, astaxanthin inhibited HSV-1 infection and oxidative stress-induced STING carbonylation and consequently promoted STING translocation to the Golgi apparatus and oligomerization, which activated STING-dependent host defenses. Thus, our study reveals that astaxanthin displays a strong antiviral activity by targeting STING, suggesting that astaxanthin might be a promising STING agonist and a therapeutic target for viral infectious diseases.
IDO1 Inhibition Promotes Activation of Tumor-intrinsic STAT3 Pathway and Induces Adverse Tumor-protective Effects
Authors: Yu Longbo , Xu Lingyan , Chen Yunjie , Rong Yicheng , Zou Yi , Ge Shushan , Wu Tiancong , Lai Yisheng , Xu Qiang , Guo Wenjie , Liu Wen
Published: February 2024

Pharmacological inhibition of IDO1 exhibits great promise as a strategy in cancer therapy. However, the failure of phase III clinical trials has raised the pressing need to understand the underlying reasons for this outcome. To gain comprehensive insights into the reasons behind the clinical failure of IDO1 inhibitors, it is essential to investigate the entire tumor microenvironment rather than focusing solely on individual cells or relying on knockout techniques. In this study, we conducted single-cell RNA sequencing to determine the overall response to apo-IDO1 inhibitor administration. Interestingly, although apo-IDO1 inhibitors were found to significantly activate intratumoral immune cells (mouse colon cancer cell CT26 transplanted in BALB/C mice), such as T cells, macrophages, and NK cells, they also stimulated the infiltration of M2 macrophages. Moreover, these inhibitors prompted monocytes and macrophages to secrete elevated levels of IL-6, which in turn activated the JAK2/STAT3 signaling pathway in tumor cells. Consequently, this activation enables tumor cells to survive even in the face of heightened immune activity. These findings underscore the unforeseen adverse effects of apo-IDO1 inhibitors on tumor cells and highlight the potential of combining IL-6/JAK2/STAT3 inhibitors with apo-IDO1 inhibitors to improve their clinical efficacy.
Liquid-based Cytology as a Superior Tool Compared to Conventional Pap Smear in Detecting Cervical Cancer in Suspected Cases: A Comparative Study
Authors: Das Subhashish , Kalyani R , Sheela SR , Kamala K
Published: February 2024

Introduction:

Screening programs has conventional cytology such as Conventional Pap Smear (CPS) have successfully reduced cervical cancer, but newer tests like Manual Liquid-based cytology (MLBC) and Human Papillomavirus testing might enhance screening.

Materials and Methods:

This was a cross sectional study conducted on 175 samples was processed for CPS and MLBC. Cytobrush was used for LBC which was suspended and detached in the preservative fluid and processed by manual method. Histopathological correlation and HPV DNA testing was also done.

Results:

MLBC showed higher specimen adequately, cellularity, clean background and uniform distribution of cells than CPS.

Conclusion:

MLBC showed improved specimen adequately, better cytomorphological features and higher detection of epithelial cell abnormality.
Publication Guideline Check! What do the Academician, Clinician and Post-graduate Student Think? A Cross-sectional Study
Authors: Modak Jayaditya , Agarwal Srishti , Chakraborty Richik , Manohar Balaji , Bhuvaneshwari S
Published: February 2024

Introduction:

Several journals are launched every month. The authors need to stay updated regarding selecting and publishing their research work in the right journal, considering the number of predatory journals present now.

Materials and Methods:

A cross-sectional study was conducted amongst academicians, clinicians and post-graduate students from the speciality of periodontology in India by using a valid questionnaire to understand the knowledge regarding the choice, publisher details, peer review system, indexing, archiving and publication fee guidelines. Inferential statistics and descriptive statistics were performed for the analysis.

Results:

The survey included academicians (n = 1832), clinicians (n = 370) and post-graduate students (n = 969) who consented to take part in the survey. Overall, the results showed that the post-graduate students had better knowledge regarding the selection and publication of articles in journals.

Conclusion:

The present findings suggest that the participants have an understanding of publication in niche speciality journals with a little ambiguity in the names of the journals.
Evaluation of the anti-arthritic activity of Rhuflex-F – A proprietary Ayurvedic herbomineral formulation in albino rats
Authors: Gupta Veerendra , Panigrahi Balaji , De Subrata , Nariya Mukeshkumar B.
Published: February 2024

Background:

Rhuflex-F is a proprietary Ayurvedic herbo-mineral formulation clinically used to combat and relieve stiffness in joints and muscles, reduce edema, restore mobility, and also effective in relieving the symptoms of other autoimmune illnesses that lead to rheumatism.

Aims:

The aim and objective of the research study is to evaluate the efficacy of Rhuflex-F against in vitro protein denaturation and in vivo Freund’s adjuvant-induced arthritis in albino rats.

Materials and methods:

In vitro inhibition of protein denaturation activity was carried out using bovine serum albumin. For in vivo activity, arthritis was induced by complete Freund’s adjuvant in albino rats. Rhuflex-F (135–270 mg/kg, po) was administered for 30th days in arthritic rats, and effects were assessed on primary and secondary paw edema, on pain response, hematological, serum biochemical parameters (serum transaminases, alkaline phosphatase, urea, uric acid, and orosomucoid), and serum anti-oxidant parameters and adrenal ascorbic acid.

Results:

Aqueous extract of Rhuflex-F showed in vitro protein denaturation inhibitory activity in a dose-dependent manner. Rhuflex-F showed nonsignificant decrease in primary and secondary paw edema with reduced pain response, some reversal effects on hematological parameters such as white blood cell and red blood cell related parameters and serum orosomucoid and adrenal ascorbic acid in comparison to Fruend’s adjuvant control group. Further, Rhuflex-F reversed Freund’s adjuvant-induced adverse effects on oxidant status in the serum of albino rats.

Conclusion:

Result of the present study suggested that Rhuflex-F formulation has anti-inflammatory activity, may be due to the inhibition of protein denaturation in vitro and in vivo anti-arthritic activity against complete Freund’s adjuvant-induced arthritis in albino rats.
Comparative Pharmacognostic study of market samples of Tagara collected from five different markets of Kerala with the official source plant Valeriana jatamansi Jones ex Roxb
Authors: Iqbal P. Mohammed , Harinarayanan C. M. , Palengara Vivek
Published: February 2024

Background:

Tagara is a very popular Ayurveda herb used in the treatment insomnia, epilepsy, neurosis, hepatoprotective, anticancerous, and analgesic. Characteristic smell is the typical feature of it. As per the Ayurvedic Pharmacopoeia of India and many other classical texts, rhizomes of Valeriana jatamansi of the family Valerianceae is the accepted source of the drug. From some of the reports from early 1980s, it was found that roots of some aquatic plants such as Nymphoides macrospermum, Nymphoides hydrophylla, Nymphoides indica, and Limnanthemum cristatum were said to be used as Tagara instead of V. jatamansi in the South Indian markets.

Aim:

This study proposed to assess the present status of Tagara available in herbal raw drug markets of Kerala.

Materials and methods:

Five market samples of Tagara were collected from selected markets of Kerala, and some of the reported aquatic plants, collected from natural habitats nearby. Macroscopic, microscopic, histochemical, and powder microscopic characterization of all these samples were done as per the standard procedure mentioned in Ayurvedic Pharmacopoeia of India and characters observed were compared with official source plant and pharmacopoeial standard.

Results:

Morphological characters of market samples of Tagara collected from the various markets of Kerala were not matching with the rhizomes of genuine drug V. jatamansi and that of Uttarakhand sample. The microscopic and histochemical examination also gave the same result. However, these samples showed similarities with the roots of Nymphoides macrospermam. Sample collected from Uttarakhand was the rhizome of V. jatamansi.

Conclusion:

The collected market samples of Tagara from various Kerala markets were not the rhizomes of V. jatamansi but the roots of N. macrospermam.
Safety and Efficacy of Semaglutide Use in Diabetes during Ramadan Fasting: A Real-world Experience from Bangladesh
Authors: Pathan Md Faruque , Akter Nazma , Selim Shahjada , Amin Md Feroz , Afsana Faria , Saifuddin M. , Kamrul-Hasan A. B. M. , Mustari Marufa , Chakraborty Ashish Kumar , Hossain Riad M. M.
Published: February 2024

Aims:

The study has been conducted to observe the efficacy and safety of once-weekly subcutaneous semaglutide during Ramadan fasting among patients with type 2 diabetes mellitus (T2DM) from Bangladesh who intended to fast during Ramadan 2022.

Methods:

This was an open-label, single-center, two-arm parallel-group study. In this prospective observational study, patients were enrolled in two groups depending on treated with or without semaglutide for at least 3 months prior Ramadan. Initially, total 200 patients were enrolled at the first visit (4 weeks before Ramadan); among them, 58 subjects were in the semaglutide group (Group A) and 142 in other than the semaglutide group (Group B). At the end of the second visit (within 4 weeks after Ramadan) after data editing and cleaning, a total of 130 patients (55 subjects in Group A and 75 subjects in Group B) were included in the final statistical analysis. All of them were followed up for a total of 24 weeks including 12 weeks of screening period. The primary objectives were to assess the efficacy and safety of semaglutide in terms of glycosylated hemoglobin (HbA1c) (%), weight loss (kg), hypoglycemia (number of events), and episodes of gastrointestinal (GI) upset (number of events) during Ramadan fasting.

Results:

Patients in the semaglutide group had better glycemic control after fasting of Ramadan compared to the control group (mean decrease in HbA1c level: 0.61% vs. 0.19%; P < 0.001). In addition, more than 18% of the patients in the semaglutide group achieved good glycemic control (HbA1c <7%), while the rate was 13.3% in the control group. Patients treated with semaglutide achieved a better weight loss than the nonsemaglutide group (2.97 vs. 1.38 kg; P < 0.001). Although there was no significant difference in terms of hypoglycemic events in both the groups (P = 0.13), but the GI symptoms were more common in the semaglutide group than the control group (P < 0.05). Among other secondary endpoints, the serum levels of total cholesterol, low-density lipoprotein, and triglyceride were significantly decreased in the semaglutide group compared to the control group (P < 0.05).

Conclusions:

Semaglutide showed better efficacy in glycemic control, weight loss, and dyslipidemia compared to other hypoglycemic drugs in patients with T2DM during Ramadan. Although patients receiving semaglutide reported fewer hypoglycemic episodes and GI upset events, they might be subjected to other medications or prolonged fasting. Semaglutide might be considered a suitable therapy during Ramadan fasting based on judicial judgment.
Ocular surface changes in patients who have undergone head and neck radiation therapy
Authors: Sujithra H , Shah Kannisha N , Anoop R , Ullattil Pushpaja K , Pillai Gopal S , Ravindran Greeshma C , Vazirani Jayesh
Published: February 2024

Purpose:

Dry eye syndrome (DES) is a familiar sequelae of radiation therapy (RT) for head and neck cancers (HNC). Ocular surface changes such as DES occur due to injury to the conjunctival epithelium, goblet cells, corneal surface, lacrimal glands, and meibomian glands. This study aimed at the evaluation and early detection of changes in ocular surface parameters in patients receiving RT for extraocular HNC.

Methods:

Forty-two eyes of 21 patients undergoing HNC RT were evaluated. Radiation technique and dose of radiation to the lens and eye were recorded. Subjects were evaluated for meibomian gland changes by meiboscore grading, ocular surface disease index (OSDI) questionnaire, Schirmer’s test, tear film break-up time (TBUT), and slit-lamp examination before RT, immediately post RT, and 6 weeks post RT. A comparison of the ipsilateral eye on the irradiated side to the contralateral eye was done.

Results:

A significant reduction in TBUT was seen immediately post RT and 6 weeks post RT (P < 0.001 and 0.008, respectively), with an increase in meiboscore at both visits (P < 0.001). An OSDI score of >13 was seen in 23.80% of patients post RT, with a significant difference from baseline (P < 0.001). On comparing ipsilateral and contralateral eye groups, a significant difference from baseline was seen in TBUT (P < 0.001 and 0.033, respectively) and meiboscore (P < 0.001 for both eyes). A significant change of >1 second in TBUT and >1.7 in meiboscore was seen with a mean dose of around 8 Gy to the lens.

Conclusion:

All patients undergoing HNC RT should be followed up for ocular surface and meibomian gland changes. The contralateral eye should also be evaluated. Patients receiving lower doses to the ocular structures should also be kept under follow-up.
Current concepts in the management of cataract with keratoconus
Authors: Nicholson Maneck , Singh Vivek M , Murthy Somasheila , Gatinel Damien , Pereira Savio , Pradhan Aditya , Vasavada Shail , Dandekar Prajakta , Naik Mekhla , Sharma Supriya
Published: February 2024

This review analyzed all pertinent articles on keratoconus (KCN) and cataract surgery. It covers preoperative planning, intraoperative considerations, and postoperative management, with the aim of providing a simplified overview of treating such patients. Preoperatively, the use of corneal cross-linking, intrastromal corneal ring segments, and topo-guided corneal treatments can help stabilize the cornea and improve the accuracy of biometric measurements. It is important to consider the advantages and disadvantages of traditional techniques such as penetrating keratoplasty and deep anterior lamellar keratoplasty, as well as newer stromal augmentation techniques, to choose the most appropriate surgical approach. Obtaining reliable measurements can be difficult, especially in the advanced stages of the disease. The choice between toric and monofocal intraocular lenses (IOLs) should be carefully evaluated. Monofocal IOLs are a better choice in patients with advanced disease, and toric lenses can be used in mild and stable KCN. Intraoperatively, the use of a rigid gas permeable (RGP) lens can overcome the challenge of image distortion and loss of visual perspective. Postoperatively, patients may need updated RGP or scleral lenses to correct the corneal irregular astigmatism. A thorough preoperative planning is crucial for good surgical outcomes, and patients need to be informed regarding potential postoperative surprises. In conclusion, managing cataracts in KCN patients presents a range of challenges, and a comprehensive approach is essential to achieve favorable surgical outcomes.
Predictive accuracy of Barrett TK toric calculator compared to measured posterior corneal astigmatism using Pentacam in toric IOL power calculation
Authors: Tamilarasi S , Joseph Ashalyne James , Dandapani Ramamurthy
Published: February 2024

Purpose:

To compare the predictive accuracy of Barrett total keratometry (Barrett TK) toric calculator with the measured posterior corneal astigmatism (PCA) by using Pentacam in toric intraocular lens (IOL) power calculation.

Methods:

A prospective analysis was done on 118 eyes requiring toric IOL power implantation. The absolute prediction error of the Barrett TK toric calculator and the measured PCA in the online toric calculator were assessed and compared to the standard Alcon toric calculator (with Barrett toric calculator incorporated).

Results:

The mean absolute prediction error of the online toric calculator (0.32 D) (with Barrett toric calculator incorporated), Barrett TK Toric (0.34 D), and measured PCA of Pentacam in Barrett toric calculator (0.33 D) were found to be similar with no statistically significant difference. Subanalysis in eyes with with-the-rule astigmatism, against-the-rule astigmatism, and oblique astigmatism showed similar results. Alpins analysis showed that all three methods overcorrected corneal astigmatism.

Conclusion:

The Barrett TK toric calculator and the measured PCA of Pentacam in the Barrett toric calculator have similar predictive accuracy to the online toric calculator (with Barrett toric calculator incorporated).
Vision on wheels: Technician-assisted retinopathy of prematurity screening in rural Tamil Nadu and Andhra Pradesh: 2018–2021 Project Report
Authors: Vedantham Vasumathy , Ratnagiri Praveen Krishna
Published: February 2024

Aim:

To analyze the incidence of sight-threatening retinopathy of prematurity (ROP) in premature infants in rural Tamil Nadu and Andhra Pradesh from 2018 to 2021, and to analyze its association with birthweight (BW), gestational age (GA), and postconceptional age (PCA).

Methods:

Project Vision on Wheels is a free ROP screening and treatment program initiated by a tertiary eye care center in South India in June 2018 to screen preterm infants in rural areas in 11 centers in Tamil Nadu and Andhra Pradesh by trained technicians. Infants with sight-threatening ROP were immediately shifted for vision-preserving laser.

Results:

Of the 18,117 infants screened from 2018 to 2021, 1046 infants underwent laser, with the majority being bigger and more mature when compared to Western data. There was a yearly increase in the number of infants with sight-threatening ROP in the lower BW, GA, and PCA categories. The timely detection of the condition by committed screening led to salvage of vision by timely laser in 100% of the treated babies in all the years. The incidence of sight-threatening ROP had a yearly decrease in higher BW, GA, and PCA categories. These trends were statistically significant (P = 0.001 for ROP and BW, P = 0.037 for ROP and GA, and P = 0.001 for ROP and PCA).

Conclusion:

The statistically significant trend of decreasing sight-threatening ROP in babies with higher BW, GA, and PCA and increasing treatable ROP in younger and smaller babies (with lower BWs, GAs, and PCAs) in rural India, over time, is a hitherto unreported finding. This is the first such study in rural Tamil Nadu and Andhra Pradesh combined, with the largest data to date (as per MEDLINE search) to document this healthier trend.
Outcome of real-time telescreening for retinopathy of prematurity using videoconferencing in a community setting in Eastern India
Authors: Padhi Tapas R , Bhunia Souvik , Das Taraprasad , Nayak Sameer , Jalan Manav , Rath Suryasnata , Barik Biswajeet , Ali Hasnat , Rani Padmaja Kumari , Routray Dipanwita , Jalali Subhadra
Published: February 2024

Purpose:

To evaluate the feasibility and outcome of a real-time retinopathy of prematurity (ROP) telescreening strategy using videoconferencing in a community setting in India.

Method:

In a prospective study, trained allied ophthalmic personnel obtained the fundus images in the presence of the parents and local childcare providers. Analysis of images and parental counseling were done in real time by an ROP specialist located at a tertiary center using videoconferencing software. A subset of babies was also examined using bedside indirect ophthalmoscopy by an ROP care-trained ophthalmologist. The data were analyzed using descriptive statistics, sensitivity, specificity, positive and negative predictive values, and correlation coefficient.

Results:

Over 9 months, we examined 576 babies (1152 eyes) in six rural districts of India. The parents accepted the model as they recognized that a remotely located specialist was evaluating all images in real time. The strategy saved the travel time for ROP specialists by 477 h (47.7 working days) and for parents (47,406 h or 1975.25 days), along with the associated travel cost. In a subgroup analysis (100 babies, 200 eyes), the technology had a high sensitivity (97.2%) and negative predictivity value (92.7%). It showed substantial agreement (k = 0.708) with the bedside indirect ophthalmoscopy by ROP specialists with respect to the detection of treatment warranting ROP. Also, the strategy helped train the participants.

Conclusion:

Real-time ROP telescreening using videoconferencing is sensitive enough to detect treatment warranting ROPs and saves skilled workforce and time. The real-time audiovisual connection allows optimal supervision of imaging, provides excellent training opportunities, and connects ophthalmologists directly with the parents.
Outcomes of intravitreal anti-VEGF injections and panretinal photocoagulation in preretinal hemorrhage secondary to proliferative diabetic retinopathy involving the fovea
Authors: Brar Manpreet , Sharma Mansi , Grewal Satinder Pal Singh , Dogra Mangat
Published: February 2024

Purpose:

To evaluate the outcome of intravitreal anti-vascular endothelial growth factor (VEGF) injections and panretinal photocoagulation (PRP) in fovea involving preretinal hemorrhage (PRH) secondary to proliferative diabetic retinopathy (PDR).

Methods:

Retrospective non-comparative cross-sectional series of patients diagnosed with fovea involving PRH secondary to PDR at our institute from March 2019 to October 2021 who were treated with combination treatments of intravitreal anti-VEGF and PRP and have completed a minimum 6-month follow-up. The primary outcome measure was serial changes in the visual acuity (VA) and PRH regression from the fovea. Secondary outcome measures were the quantitative assessment of the size of PRH, its association with VA improvement and time to regression, and the proportion of patients who underwent surgery for poor response.

Results:

In total, 22 eyes of 21 patients showed regression of PRH from the foveal center at 33.6 days, and complete regression was seen at 140.7 days. The average number of anti-VEGF injections required for clearance of PRH from the fovea was 1.6. Mean LogMAR visual acuity improved from 0.54 at baseline to 0.32 at 4 weeks and 0.18 at 6 months (P < 0.01). Three eyes (13.6%) required vitrectomy surgery during follow-up. The mean area of PRH as measured by Image J analysis was 14.78 mm2 at baseline, 8.97 mm2 at 4 weeks, and 1.25 mm2 at 3 months (P < 0.01). No statistically significant difference was seen between the size of PRH and PRH clearance time and VA improvement. No systemic side effects were observed following the intravitreal injections during follow-up.

Conclusion:

Intravitreal anti-VEGF injections and PRP were found to be effective and safe treatment methods for fovea involving PRH secondary to PDR. Long-term studies are warranted to assess the long-term efficacy.
Safety and efficacy of McCarey-Kaufman medium supplemented with colistin (polymyxin E) and amphotericin B in inhibiting the multidrug-resistant Pseudomonas aeruginosa using an ex vivo donor corneal infection model
Authors: Sushmasri Kukutam , Mishra Priyasha , Roy Sanhita , Joseph Joveeta , Ramachandran Charanya , Srinivas Kandibanda , Chaurasia Sunita
Published: February 2024

Purpose:

This study aimed to evaluate the efficacy and safety of McCarey-Kaufman (MK) medium supplemented with colistin and amphotericin B in inhibiting the growth of multidrug-resistant Pseudomonas (P.) aeruginosa, using an ex vivo experimental model with human donor corneas.

Methods:

Cadaveric human corneas deemed unsuitable for corneal transplantation were obtained, and MK media were supplemented with colistin and amphotericin B. Multidrug-resistant P. aeruginosa was cultured and used to infect the human donor corneas ex vivo. Infected corneas were placed in the MK media with additional antibiotics (colistin and amphotericin B) and the standard MK media, which served as the control arm for comparison. Corneal opacity due to infiltration and quantitative analysis of colony-forming units (CFUs) were assessed. The viability of the corneal endothelium was assessed using trypan blue staining.

Results:

Corneas incubated in MK media supplemented with additional antibiotics showed less corneal opacification compared with those in standard MK media at both 48- and 96-hour (hr) time points. Quantitative analysis revealed a lower bacterial load and a significant reduction in CFU in the corneas incubated in MK media with additional antibiotics compared with the control group. At 48 hrs, there was 84% (P value = 0.024) reduction in bacterial load, and at 96 hr, a 53% (P value = 0.016) reduction was observed in comparison with those placed in standard MK media. The trypan blue staining tests revealed that the extent of endothelial cell loss in corneas incubated in supplemented MK media was comparable to the ones in standard MK media.

Conclusion:

The addition of colistin and amphotericin B to MK media demonstrated efficacy in inhibiting the growth of multidrug-resistant P. aeruginosa in an ex vivo cornea infection model. The supplemented media had no detrimental effect on the corneal endothelium. The findings suggest that supplementing the MK media with these broad-spectrum antimicrobial agents may help mitigate the risk of postoperative donor-related infection in the recipients by reducing and containing the load of microbial contamination in donor corneas.
Public Health Student Evaluation of Teaching Qualitative Research Using Interactive Methods
Authors: Livingstone Anitha , Bhadoria Ajeet Singh , Pontin David , Saxena Vartika , Thomas Michelle , Mehta Aprajita , Wallace Carolyn
Published: February 2024

Background:

Interactive teaching methods aid post graduate students in learning qualitative research. Four academic researchers from the United Kingdom had an opportunity to teach qualitative research methods, specifically consensus methods, to the Master of Public Health students (MPH) during a visit to India. This teaching formed part of a work package with All India Institute of Medical Sciences Rishikesh, India exploring the concept of family resilience among families with children under 6 years.

Aims:

To use the experiences of the MPH students to gain knowledge and create meaning about using the consensus methods.

Participants:

The participants were the MPH students.

Methods:

We used the workshop method to introduce the concept of family resilience by using the question, ‘What will be the three top public health priorities in India to support family resilience in the 21st century?’ as a central theme for all the workshops. Furthermore, we introduced qualitative research methods and hands on experience of consensus methods to the students. The students were introduced to Delphi and Group Concept Mapping (GCM) methods during workshop 1. Workshop 2 introduced Nominal Group Technique (NGT) through a short presentation followed by a practical hands on session using GCM data from workshop 1. The last workshop (3) focused on the World Café method.

Results:

The students evaluated the workshops highly and asked for online sessions on GCM, NGT, and World Café which will be planned in the future.

Conclusion:

We concluded that the post graduate curriculum for master’s in public health studies would benefit from teaching using interactive research methods which will enhance their critical thinking and autonomy. Second, although the MPH curriculum had quantitative methods in place, introducing qualitative consensus methods will open new avenues into future research. Finally, teaching using practical demonstration gives students a voice and makes learning effective and enjoyable.
Application of the International System for Reporting Serous Fluid Cytopathology: An Experience at a Tertiary Care Centre in India
Authors: Singh Shashikant , Gupta Prajwala , Kannappan Anukrishnaa
Published: February 2024

Background:

The cytological analysis of body fluids is the preliminary investigation performed for the diagnostic evaluation of body fluids, helping the physician make the diagnosis and plan proper treatment. The International System for Reporting Serous Fluid Cytology (ISFRSFC) was created using best international practises, current literature and expert consensus to make a uniform reporting system for serous fluids.

Aims:

The present study was conducted with the aim of recategorising the effusion fluids as per the guidelines prescribed by ISRFRC, knowing the distribution of cases into various categories and assessing their feasibility in day-to-day reporting.

Patients and Methods:

This study was performed on serous fluids (ascitic, pleural, peritoneal and pericardial) received over a period of 5 years, from January 2017 to April 2022, in the cytology unit of the Department of Pathology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi. Wherever possible, clinicoradiological and histopathological data were obtained and correlated with cytological findings. Serous fluids were categorised into reporting formats as prescribed by ISRFRC and its feasibility was assessed in day-to-day reporting.

Results:

A total of 1115 cases of serous effusion fluid were examined. The male-to-female ratio was 1:1.12. Pleural fluid constituted the majority of the sample (436, 39.10%). Overall, 56 (5.02%) cases were non-diagnostic (ND), 1013 (90.85%) cases were negative for malignancy, 8 (0.72%) were atypia of undetermined significance, 11 (0.99%) were suspicious of malignancy and 27 (2.42%) were malignant (MAL).

Conclusion:

The current study emphasises the significance of cytological analysis of serous fluid as a comprehensive diagnostic investigation that also aids in determining the cause and monitoring the disease process. With the introduction of ISFRSFC, serous fluid reporting is now uniform and more comprehensive, both for cytopathologists and clinicians.
Ileo-dermoid Fistula: A Rare Presentation of Ovarian Dermoid
Authors: Agrawal Neha , Gothwal Meenakshi , Yadav Garima , Singh Pratibha , Varshney Vaibhav , Yadav Taruna , Khera Sudeep
Published: February 2024

ABSTRACT

Mature cystic teratoma is a benign ovarian tumor that usually presents in reproductive-age females. This tumor usually presents with pain abdomen, bloating, and a lump. Hereby, we describe a case of an ovarian dermoid presented with features of intestinal obstruction secondary to ileo-dermoid fistula formation. A 55-year-old postmenopausal female presented with lower abdominal pain, nausea, vomiting, and the feeling of a lump in the abdomen. On evaluation and imaging, it was diagnosed as a large ovarian dermoid (with malignant transformation) with multiple fistulous communications with ileal loops. The patient was managed by laparotomy, total abdominal hysterectomy with bilateral salpingo-oophorectomy, bowel resection, and anastomosis. The patient was discharged in good condition. The rupture of malignant ovarian dermoid followed by enterodermoid fistula formation and intestinal obstruction is rare. Complete cytoreduction and bowel repair should be considered for optimal results.
Development and Validation of India-specific Hindi Version of Osteoporosis Knowledge Assessment Tool
Authors: Barik Sitanshu , Raj Vikash , Munshi Boudhayan Das , Rajput Ojasvi , Prajapati Shivji , Prasad Sant Guru , Kumar Ashish
Published: February 2024

ABSTRACT

Purpose:

Patient education is one of the important components of reducing the morbidity of osteoporosis. The aim of this study is to validate the Hindi version of the Osteoporosis Knowledge Assessment Tool (OKAT-H) among a hospital-based sample in the age group of 18–44 years of age.

Methods:

The study was conducted in two phases – translation and adaption of the OKAT in Hindi followed by its validation. The translated tool was analyzed by Flesch reading ease, McNemar test, Cronbach alpha, difficulty index, discrimination index, and principal factor analysis.

Results:

Two hundred and sixty women with a mean age of 28.3 ± 17.2 years were enrolled in the study. The mean score of the OKAT-H tool obtained in the study was 11.3 ± 2.1. A significant difference was noted in the scores based on educational qualification or with any family history of either osteoporosis or fracture (P < 0.05). The Flesch score for the OKAT-H tool was 86. Inter-item correlation for all the items ranged between 0.15 and 0.5. The Cronbach’s alpha measured 0.892 suggesting high internal consistency. Items number 6, 7, 8, 9, 13, and 14 showed a significant difference on the McNemar test questioning its consistency on test-retest.

Conclusion:

A new shorter version of the tool may be developed since six items showed low consistency. The use of such an instrument in local language would help spread awareness about the disease as well as help the population in adopting osteoprotective strategies and also to seek help and advice regarding treatment.
Surgical Outcomes and Feasibility of Transvaginal Sacrospinous Ligament Fixation through Anterior Approach for Women with Pelvic Organ Prolapse
Authors: Agrawal Mohini , Kumari Rajesh , Sharma J. B. , Nisha N , Manasi Deoghare , Bhatla Neerja
Published: February 2024

ABSTRACT

Introduction:

Supporting vaginal vault or apex is a central component of primary therapy and to prevent recurrence of prolapse. This study aims to review the surgical outcomes and feasibility of the anterior approach following both sacrospinous fixation (SSF) and sacrospinous hysteropexy (SSHP) in a single center over a specific period. And also to review its impact on quality of life.

Materials and Methods:

This was a retrospective study that included all women who underwent unilateral SSF or SSHP through anterior approach for pelvic organ prolapse (POP) from May 2021 to May 2023 after institutional ethical approval for the study. The anterior approach was undertaken in 47 patients which were included in final review. A retrospective case note review to assess urinary symptoms was undertaken at baseline and 3 months by urinary distress inventory 6 score. The main outcome measure was recurrence of prolapse, predominant compartment for prolapse, presenting complaints, concomitant surgeries performed, and associated urinary complaints.

Results:

The mean age was 56.17 ± 11.95 years and the average body mass index was 26.12 ± 3.11 kg/m2. Except for 4 cases of SSHP, remaining women were postmenopausal at the time of surgery. Ten women presented with urinary complaints as their chief complaint. On examination, POP Quantification evaluation, 35 cases have Ba as leading point, 10 have Ap as their leading point and in two cases C was the leading point.

Conclusion:

Anterior unilateral sacrospinous ligament fixation is a safe, effective strategy to treat POP and other concomitant surgery can also be well combined with it.
Survival outcomes correlate with the level of cell-free circulating DNA in ST-elevation myocardial infarction
Authors: Chu Ai-Ai , Gao Han-Xiang , Wu Ting-Ting , Zhang Zheng
Published: February 2024

Background:

Myocardial infarction (MI) can lead to higher cellular damage, making cell-free DNA (cfDNA) a potential biomarker for assessing disease severity. The aim of this study is to evaluate survival predictions using cfDNA measurements and assess its correlation with MI.

Materials and Methods:

A direct fluorescence assay was employed to measure cfDNA content in the blood samples of participants. The inclusion criteria included patients who gave informed consent, suffering from ST-elevation myocardial infraction (STEMI) based on established diagnostic criteria (joint ESC/ACC guidelines), between the age of 18 and 80 years old, and had elevated troponin biomarker levels. The study included 150 patients diagnosed with STEMI and 50 healthy volunteers as controls. Serial monitoring of patients was conducted to track their postdisease status. The rate of change of cfDNA was calculated and daily measurements for 7 days were recorded.

Results:

Mean levels of cfDNA were found to be 5.93 times higher in patients with STEMI compared to healthy controls, providing clear evidence of a clinical correlation between cfDNA and STEMI. Patients were further categorized based on their survival status within a 90-day period. The study observed a strong predictive relationship between the rate of change of cfDNA during daily measurements and survival outcomes. To assess its predictive capability, a receiver operating characteristics (ROC) curve analysis was performed. The ROC analysis identified an optimal cutoff value of 2.50 for cfDNA, with a sensitivity of 81.5% and specificity of 74.0% in predicting disease outcomes.

Conclusion:

This study demonstrates a robust association between cfDNA and STEMI, indicating that cfDNA levels can be a valuable early prognostic factor for patients. Serial measurements of cfDNA during early disease onset hold promise as an effective approach for predicting survival outcomes in MI patients.
Latent class of depressive symptoms of and its determinants: A cross-sectional study among Iranian University students
Authors: Aleebrahim Forugh , Heidari Zahra , Yousefnejad Shahla , Kheirabadi Gholamreza , Tarrahi Mohammad Javad
Published: February 2024

Background:

According to the report of the World Health Organization, mental disorders are one of the 10 most important causes of disability in the world. This study was conducted with the aim of determining the number and frequency of latent classes of depression and its determinants in Isfahan university of medical students.

Materials and Methods:

A total of 1408 medical students from Isfahan University of Medical Sciences, Iran, were enrolled in the study in 2017. The symptoms and severity of depression were assessed using the standard Hospital Anxiety and Depression scale questionnaire. Latent class analysis was applied to seven symptoms of depression, all of which had four levels. Latent class subgroups were compared using the Chi-square test and analysis of variance test. The regression model was used to check the relationship between identified classes and related factors. Analyzes were done using SPSS-21 and Mplus7 software.

Results:

In this study, three latent classes were identified, that is, the group of healthy people, the group of borderline people, and the group of people suspected of depression. The prevalence of identified latent classes among medical students is 0.52, 0.32, and 0.16%, respectively. The regression results showed that compared to the healthy group, the factors affecting depression in the borderline and suspicious group were increasing age, female gender, interest in the field of study, physical activity, history of depression, and history of anxiety.

Conclusion:

The three classes that were identified based on the students’ answers to the depression symptoms questions differed only based on severity. The history of depression and anxiety were the strongest predictors of latent classes of depression.