bluuebunny/crossref_metadata_2025 huggingface dataset:
New Developments in Neonatology: Less Severe Retinopathy of Prematurity?
Authors: Termote Jacqueline , Schalij-Delfos Nicoline E , Brouwers Hens A A , Donders A Rogier T , Cats Bernard P
Published: April 2021

ABSTRACT

Purpose: To determine the effects of surfactant replacement therapy (SRT), high-frequency oscillatory ventilation (HFOV), and general improvements in quality of care on the incidence of severe retinopathy of prematurity (ROP).

Methods: Retrospective comparison of the incidence and severity of ROP in two groups of preterm infants admitted to our neonatal intensive care unit (NICU) in two consecutive 5-year periods (1986-1995) and screened for ROP. During the second study period, natural surfactant was introduced in the treatment of respiratory distress syndrome (RDS) and HFOV was used for treatment of respiratory insufficiency of any origin. The effects of these developments and general improvements on the incidence of severe ROP were analyzed with stepwise logistic regression.

Results: The overall incidence of ROP from 19861990 was not significantly different from the incidence of ROP from 1 991 -1 995. The incidence of severe ROP (ROP stage 3 or greater) was significantly lower in the second period (15.7% versus 6.4%, P=.015). For infants <1000 g, the incidence of overall ROP was increased significantly during the second study period (47.6% versus 60.1 %, P=.045), although the incidence of severe ROP remained unchanged. Only SRT was associated with a decreased risk for severe ROP; HFOV and general improvements in quality of care had no influence on the outcome. In patients with RDS, the incidence of severe ROP decreased significantly during the second period.

Conclusion: Of the recent new developments in neonatology, only SRT was associated with a decreased risk for severe ROP.

Journal of Pediatric Ophthalmology and Strabismus 2000;37:142-148.
Anterior Transposition of the Superior Oblique Tendon in the Treatment of Oculomotor Nerve Palsy and Its Influence on Postoperative Hypertropia
Authors: Young Terri L , Conahan Bridget M , Summers C Gail , Egbert James E
Published: April 2021

ABSTRACT

Purpose: To determine whether postoperative hypertropia after anterior transposition of the superior oblique tendon without trochleotomy could be avoided with a simplified surgical approach.

Methods: Eight patients with oculomotor nerve palsy (one patient was bilaterally affected) were retrospectively identified as having undergone anterior transposition of the superior oblique tendon without trochleotomy or vertical rectus muscle surgery between March 1992 and September 1998. The superior oblique tendon was cut at the medial border of the superior rectus muscle and placed 1 - 3.5 mm anterior to the medial insertion of the superior rectus muscle in each of these patients. Resection of the superior oblique tendon was not performed. The lateral rectus muscle was weakened, and no vertical rectus muscles were resected.

Results: Preoperative deviations with the uninvolved eye fixating in primary position ranged from 20-90 prism diopters (Δ) of exotropia (mean: 49.3 Δ) and from 0-20 Δ of hypotropia (mean: 11.25 Δ). Postoperative horizontal deviations in the primary gaze position ranged from 12 Δ of exotropia to 20 Δ of esotropia. Six cases were aligned within 10 Δ of exotropia or esotropia. Postoperative vertical deviations in the gaze position ranged from 2 Δ of hypertropia to 8 Δ of hypotropia. Six cases were aligned within 2 Δ of deviation. Significant postoperative restrictive hypertropia, or new postoperative paradoxical ocular movements, did not occur in any patient. Patients who underwent follow-up >4 months maintained stable eye alignment.

Conclusion: Transposition of the superior oblique tendon without simultaneous resection trochleotomy, or additional surgery to the vertical rectus muscle simplifies the surgical technique and eliminates subjective decision making regarding the amount of resection.

Journal of Pediatric Ophthalmology and Strabismus 2000;37:149-155.
Augmented Hummelsheim Procedure for Paralytic Strabismus
Authors: Brooks Steven E , Olitsky Scott E , Ribeiro Geraldo deB
Published: April 2021

Abstract

Purpose: To report a modification of the Hummelsheim procedure for use in the management of paralytic strabismus.

Methods: Eight patients with paralytic strabismus secondary to third nerve palsy (n=1 ), sixth nerve palsy (n=3), combined cranial nerve palsy <n=1), or extraocular muscle damage (n=3) were treated using a modification of the Hummelsheim transposition procedure. The procedure involves half-tendon transpositions of the adjacent rectus muscles to the insertion of the paralyzed muscle, coupled with resection of the transposed halves. Further augmentation was achieved by surgical or pharmacologic weakening of the ipsilateral (n=6) or contralateral (n=1) antagonist. One patient underwent the procedure bilaterally. All patients underwent at least 6 weeks of follow-up.

Results: The mean preoperative primary position deviation in the seven unilateral cases was 54 prism diopters (Δ) (range: 25-85 Δ). Preoperative forced ductions were positive in four cases. Resections varied from 4-8 mm. Ipsilateral antagonist recession varied from 0-14 mm. The mean change was 52 Δ (range: 25-85 Δ). Five cases were aligned within 1 5 Δ of orthotropia at 6 weeks. No cases of anterior segment ischemia or induced vertical deviation were noted.

Conclusion: The modified Hummelsheim procedure appears capable of correcting large angles of strabismus associated with muscle palsy of various etiologies. It is safe, amenable to adjustable sutures, and relatively tissue- and vessel-sparing. Additional study is required to understand more fully the procedure's component effects and its interaction with ocular rotation.

Journal of Pediatric Ophthalmology and Strabismus 2000;37:189-195.
Evaluation of Corneal Thickness and Endothelial Cells Before and After Excimer Laser Photorefractive Keratectomy
Authors: Cennamo Giovanni , Rosa Nicola , Guida Eugenia , Del Prete Antonio , Sebastiani Adolfo
Published: April 2021

ABSTRACT

BACKGROUND: The possible endothelial damage induced by photorefractive keratectomy was investigated in myopic eyes.

METHODS: A morphometric analysis of the endothelial cells was performed in 19 patients before and 2 months after photorefractive keratectomy for the correction of various degrees of myopia. Central ultrasonic pachometry was also recorded at the same examination times.

RESULTS: No significant changes (p = .816) of the endothelial cell density were found between preoperative and postoperative measurements. The pleomorphic index did not show any significant changes after treatment (p = .955). Central corneal thickness was reduced to a various extent (range from 50 µm to 250 µm) according to the amount of myopic correction intended.

CONCLUSIONS: Our preliminary data suggest that photorefractive keratectomy for the correction of myopia does not induce endothelial cell damage, at least in the short term. [J Refract Corneal Surg. 1994;10:137-141.]
Noncontact Laser Photothermal Keratoplasty III: Histological Study in Animal Eyes
Authors: Ren Qiushi , Simon Gabriel , Parel Jean-Marie
Published: April 2021

ABSTRACT

BACKGROUND: Laser photothermal keratoplasty has been studied as a potential refractive procedure. The purpose of this study is to investigate the histological response to various laser treatments including geometrical patterns, radiant exposure levels, and pulse numbers.

MATERIALS AND METHODS: A noncontact laser photothermal keratoplasty system was used in this study. Epithelial and endothelial response to the laser photothermal keratoplasty annulus treatment pattern were studied on an owl monkey model with a 5-millimeter annulus ring pattern, 8 J/cm
p 2
, 25 consecutive pulses at 1 Hz. Epithelial and endothelial response to the laser photothermal keratoplasty spot pattern were then studied and compared on cat and rabbit models for safety monitoring. One pulse and five consecutive pulses of eight different radiant exposures (5.00 J/cm
p 2
to 18.01 J/cm
p 2
) were applied on each cornea. A cadaver eye model was used to study the collagen shrinkage induced by the laser spot treatment following the same protocol as the cat and rabbit model. Finally, the biological healing response to the laser photothermal keratoplasty treatment with the optimal laser parameters obtained in our experiment was studied on the cat model. Five cats were treated by the laser photothermal keratoplasty procedure with eight spots on a 3-millimeter ring, 15.6 J/cm
p 2
, and 1 pulse.

RESULTS: Epithelial and endothelial damage were observed after annulus treatment on an owl monkey's cornea at 8 J/cm
p 2
, 25 pulses, and after spot treatment on cat and rabbit corneas at 18.01 J/cm
p 2
, five pulses. No endothelial damage was observed on cat corneas for the single pulse treatment at 18.01 J/cm
p 2
. For the tissue shrinkage study, no laser photothermal keratoplasty lesion could be detected for a radiant exposure setting below 10.26 J/cm
p 2
. Histological cross-sections showed that the fivepulse treatment reached the endothelial layer at a radiant exposure of 13.4 J/cm
p 2
, while no single pulse treatment reached the endothelium for the radiant exposure range (5 J/cm
p 2
to 18 J/cm
p 2
) studied. The cat model showed that the laser-induced mechanical octagonal stress-lines by collagen shrinkage were maintained after 3 months. The histological sections across the lesion showed a denser keratocyte population indicating scar formation.

CONCLUSION: The volume of collagen shrinkage, its location, and its geometrical shape can be accurately and precisely controlled by a 2.10-micrometer Ho:YAG laser coupled to an optical delivery system. [J Refract Corneal Surg. 1994;10:529-539.]

RESUME

INTRODUCTION: La kératoplastie photo-thermique a été étudiée comme possible chirurgie refractive. Nous avons étudié la réponse histologique de la cornée aux traitements de laser en variant les motifs géométriques des taches, la lumination radiante, et le nombre de pulsations.
Donor Scleral Graft Patching for Persistent Filtration Bleb Leak
Authors: Melamed Shlomo , Ashkenazi Isaac , Belcher Davis C , Blumenhal Michael
Published: April 2021

ABSTRACT

We report effective and efficient sealing of a persistent leak in a cystic filtration bleb by applying a full-thickness donor scleral patch.
Long-Term Placement of Silastic Nasolacrimal Tubes
Authors: Veloudios Angela , Harvey John T , Philippon Mark
Published: April 2021

ABSTRACT

We retrospectively reviewed the complication rate associated with silastic tube intubation in the treatment of congenital and acquired obstructions of the lacrimal system in 82 patients with a follow-up of 3 to 66 months. Complications included tube prolapse, extrusion or breakage, punctal erosion, conjunctival irritation, intranasal discomfort, and tube inspissation with mucoid debris ("dirty tubes"). The rate was highest in the first 3 months (41%); it decreased to less than 10% after 6 months. Based on these findings, we recommend that silastic nasolacrimal tubes be regarded as semi-permanent devices which may safely be left in place for years.
Techniques for Application of Tissue Adhesive for Corneal Perforations
Authors: Erdey Richard A , Lindahl Kenneth J , Temnycky George O , Aquavella James V
Published: April 2021

ABSTRACT

We describe a modified technique of using cyanoacrylate adhesive to seal corneal perforations. Easily performed at the slit lamp, its advantages over previously described methods include a smooth, contoured collagen surface overlying the adhesive, which is easily wet by the tear film. Even greater comfort and protection are provided by the addition of a hydrophilic bandage lens or collagen shield.
An Analysis of Fully Synchronous Pandemic Secondary Education
Authors: Ryan Mark Patrick
Published: April 2021

Twenty-one grades 6-12 students were interviewed to learn about their experiences participating in a fully synchronous virtual learning environment at a public charter school in California, USA. Students take seven 50-minute classes four days a week and seven 30-minute classes the fifth weekday using the Zoom platform and Google Classroom. One-third of participants were students with disabilities, one-third English language learners, and one-third possessed neither designation. This study identifies several themes regarding the benefits and drawbacks of an entirely synchronous learning experience for secondary students. The participants make recommendations for their general education, special education, and English language development teachers, including strategies to engage secondary students more effectively, assessment suggestions, curriculum design ideas, advice about organizing Google Classrooms in ways that are supportive of student needs, and exhortations about what teachers should not do when planning and implementing synchronous online learning.
Critical Autoethnography for Social Justice Research in Doctoral Education
Authors: Throne Robin
Published: April 2021

As autoethnography and other methods for self-as-subject research continue to increase in use across doctoral education, this guide proposes to inform the methods in this area specific to critical autoethnography for doctoral scholars desiring to conduct the many forms of social justice research. This includes indigenous research, contemporary feminist research, and arts-based research, which have also seen rise across dissertation research among many disciplines. While many works exist to describe critical autoethnography within specific contexts, few research guides examine critical autoethnography specific for use by the doctoral scholar and specific examples across research focused on societal change and/or disruption of existing power dynamics, lack of parity, or historical trauma from acculturation and/or dispossession. Thus, this chapter offers a concise research methods resource for doctoral scholars and their research supervisors to facilitate use of critical autoethnography across disciplines and among diverse research problems of inquiry.
User Identity Hiding Method of Android
Authors: Zhang Yi
Published: April 2021

With an 86.1% global market share, Android takes the top spot smartphone operating system. Due to its open environment, Android suffers from various kinds of attacks, which cause a serious privacy leakage problem. To protect users' privacy information, this article proposes a user identity hiding method of Android. The method constructs a hidden user identity in Android based on the multi-user mechanism. In particular, by hiding information related to hidden user, the method makes it invisible to normal user. The method can quickly switch the identity of normal user and hidden user by passwords. Thus, the method can deal with privacy information under hidden user identity while processing regular information under normal user identity. Compared with traditional security methods of Android, this method significantly improves the security of android devices without arousing any suspicion. Experimental results show the effectiveness of the method that it not only achieves ideal hiding effect on user identity, but also implements quick switch without sacrificing the performance of system.
Biometric Systems in Mobile Devices
Authors: Singh Sukhdev , Kant Chander
Published: April 2021

Growth of mobile devices uses has favored the user experience with different digital platforms, from basic activities such as sending messages, phone calls, taking pictures for social networks, email, bank account management, and commerce. These are some examples of daily tasks performed from mobile devices, which makes it essential to provide security of information. Therefore, privacy of stored information has become a main point in the development of mobile devices. This article presents research about the impact that mobile devices have in people's lives and the presence of biometric systems in this kind of device. Papers related with biometrics on mobile devices were examined to find which devices have integrated biometric systems; in addition to identifying biometric features used to authenticate people and find out what mobile platforms were created for. It was found that the smartphone is the device with more biometrics systems, and fingerprints are the most used feature; also, that the Android operating system is the most widely used mobile platform for these purposes.
An Investigation into Permissions Requested by Mobile Banking on Android Platform
Authors: Er-Rajy Latifa , El Kiram M. Ahmed
Published: April 2021

In the past, banking took place only inside bank rooms, which was a task for customers and bankers at the same time. But in our day, thanks to the high-speed development and growth of mobile technology, the mobile phone platform had the power to create great opportunities for customers of the physical bank due to its capabilities and coverage of the population; this can be proved by the number of mobile subscriptions that approximates the world population figures. In order to explore these opportunities, most banks have already launched their mobile apps or have redesigned the mobile version of their websites. Among the advantages of using mobile banking is that users have the ability to make banking transactions, online payments or transfers, anywhere and at any time. In this article, we investigated the danger of the permissions requested by mobile banking applications, their effects on sensitive user data and their relationship with the attack called “Man in the middle” and its different forms. We took Morocco as a case of study.
An Ontology-Based Information Extraction System for Organic Farming
Authors: Abayomi-Alli Adebayo Adewumi , Arogundade Oluwasefunmi 'Tale , Misra Sanjay , Akala Mulkah Opeyemi , Ikotun Abiodun Motunrayo , Ojokoh Bolanle Adefowoke
Published: April 2021

In the existing farming system, information is obtained manually, and most times, farmers act based on their discretion. Sometimes, farmers rely on information from experts and extension officers for decision making. In recent times, a lot of information systems are available with relevant information on organic farming practices; however, such information is scattered in different context, form, and media all over the internet, making their retrieval difficult. The use of ontology with the aid of a conceptual scheme makes the comprehensive and detailed formalization of any subject domain possible. This study is aimed at acquiring, storing, and providing organic farming-based information available to current and intending software developer who may wish to develop applications for farmers. It employs information extraction (IE) and ontology development techniques to develop an ontology-based information extraction (OBIE) system called ontology-based information extraction system for organic farming (OBIESOF). The knowledge base was built using protégé editor; Java was used for the implementation of the ontology knowledge base with the aid of the high-level application programming language for working web ontology language application program interface (OWL API). In contrast, HermiT was used to checking the consistencies of the ontology and for submitting queries in order to verify their validity. The queries were expressed in description logic (DL) query language. The authors tested the capability of the ontology to respond to user queries by posing instances of the competency questions from DL query interface. The answers generated by the ontology were promising and serve as positive pointers to its usefulness as a knowledge repository.
Bi-Objective Competition Pricing Model for Component Web Service Economy
Authors: Wang Yu , Li XiaoLin , Chen HuaPing
Published: April 2021

In the web service marketplace, component-based economy has been proposed for describing participants' behavioral patterns. Composite service networks combine multiple composite services required by various service consumers. With each composite service as a product, web services comprise heterogeneous products. In this study, the pricing behavior of networked individual service providers is investigated. With the objective of service survival or high profitability, service providers compete both on the single-service and service-network levels. Using examples, several mild assumptions are formulated and analyzed. Then, a bi-objective optimization model is proposed based on these assumptions, which attempts to maintain a reasonable effectiveness-fairness trade-off from the individual service providers' perspective. The NP-completeness of the single-objective version is demonstrated by transforming the problem into a subset sum problem, which highlights the challenge of obtaining a pareto set for the bi-objective model. Finally, to validate the proposed model, numerical experimentation and case study are conducted, and both the bi-objective and many-objective versions of the problem are discussed.
Information disclosure and attitude towards privacy on Facebook among undergraduates: A survey at the Eastern University, Sri Lanka
Authors: Lavanya J. , Santharooban S.
Published: April 2021

Users of Facebook has been increasing exponentially in the last two decades, allowing millions of people to expose their profiles to the public and with no or little privacy for individuals. Facebook, in today's context has created a concern regarding privacy of its users and the consequences of information disclosure. Based on current reports regarding negative consequences of disclosure of information on social network sites, students seem to be unconcerned about the potential negative impacts of the same. The objectives of the study are to analyze the pattern of information disclosure on Facebook, examine the relationship between information disclosure and gender, determine the methods used for making friends on Facebook and its association with gender and, measure the attitudes towards privacy on social networking sites. A quantitative research approach was employed using a self-administrated questionnaire to gather responses from undergraduates of the Eastern University, Sri Lanka. The results revealed that the majority of undergraduates disclose their real name (82.3%), hometown (63.2%), e-mail address (60.53%) and, education (62.13%), and rarely share the relationship status (32%). Education is the highest criteria which both gender use to select friends (Male-56.12% & Female-55.89%). Moreover, the results revealed that females seldom share this information than males (p<0.05).  Further, there was a tendency, to share different information with different groups of people which was statistically significant. The favourite, events, and location are associated with friends, while location and opinions are associated with the public. However, political views, and photos are appearing towards not sharing category. Relatively 41.1% of respondents were satisfied with the privacy setting of SNS. It gives evidence that privacy settings are still neglected, and it stresses the need for awareness programmes on privacy concerns on SNS for undergraduates.
Ectonucleotidases in Inflammation, Immunity, and Cancer
Authors: Haas Clarissa Branco , Lovászi Marianna , Braganhol Elizandra , Pacher Pál , Haskó György
Published: April 2021

Nucleoside triphosphate diphosphohydrolases (NTPDases) are a family of enzymes that hydrolyze nucleotides such as ATP, UTP, ADP, and UDP to monophosphates derivates such as AMP and UMP. The NTPDase family consists of eight enzymes, of which NTPDases 1, 2, 3, and 8 are expressed on cell membranes thereby hydrolyzing extracellular nucleotides. Cell membrane NTPDases are expressed in all tissues, in which they regulate essential physiological tissue functions such as development, blood flow, hormone secretion, and neurotransmitter release. They do so by modulating nucleotide-mediated purinergic signaling through P2 purinergic receptors. NTPDases 1, 2, 3, and 8 also play a key role during infection, inflammation, injury, and cancer. Under these conditions, NTPDases can contribute and control the pathophysiology of infectious, inflammatory diseases and cancer. In this review, we discuss the role of NTPDases, focusing on the less understood NTPDases 2–8, in regulating inflammation and immunity during infectious, inflammatory diseases, and cancer.
Optimization of High-Speed Electrolytic Plating of Copper Pillar to Achieve a Flat Top Morphology and Height Uniformity
Authors: Ikumoto Raihei , Itakura Yuki , Tachibana Shinji , Yamamoto Hisamitsu
Published: April 2021

Cu plating bath for high-speed electrodeposition of Cu pillar was designed in consideration of a flat top morphology of pillar and a pillar height uniformity. An ideal polarization curve was assumed for the flat top morphology. To obtain the ideal polarization curve, an effect of organic additive concentration and solution agitation on the polarization curve were investigated. The basic bath components were optimized considering a Wagner number to improve the pillar height uniformity. To confirm the pillar top morphology and the pillar height uniformity, a 300-mm diameter wafer was plated with Cu at 20 A/dm2. As a result, improved pillar top morphology and pillar height uniformity were obtained. The optimized plating bath was applied to the plating of a large-size panel of 415 × 510 mm.
Patient characteristics, adherence, and costs of oral anticoagulation therapy in non-valvular atrial fibrillation using the Dubai Real-World Claims Database
Authors: Kadri Moutaz El , Ghorab Ahmed , Joury Jean , Farghaly Mohamed , Awad Nancy , Ramachandrachar Badarinath Chickballapur , Natarajan Ashok
Published: April 2021

Background: Non-vitamin K antagonist oral anticoagulants (NOACs) reduce the risk of stroke in patients with non-valvular atrial fibrillation (NVAF) and have better safety profile than vitamin K antagonists (VKAs). However, there is a dearth of quality, real-world, patient data on the use of these drugs to guide healthcare policies in United Arab Emirates (UAE). Aims and Objectives: The aim is to address the knowledge gap in demographic and clinical profiles of NVAF patients on NOACs (apixaban, rivaroxaban, and dabigatran) and warfarin in UAE. Materials and Methods: This retrospective cohort analysis utilized the Dubai Real-World Claims Database to extract anonymized longitudinal data on NVAF patients with at least one NOAC or warfarin claim between January 2015 and March 2019. Data examined included comorbidities, healthcare resource utilization (HCRU), treatment adherence, and clinical events. Results: From 11,086 NVAF patients in the database, 940 patients on oral anticoagulant treatment were selected with mean age of 58.6 ± 14.7 years and 73.7% men. At baseline, the mean CHA2DS2-VASc risk score was 2.4, and the mean Deyo–Charlson comorbidity index (CCI) score was 1.6. Most patients (71%) started oral anticoagulation treatment on a standard index dose. High medication possession ratio (MPR) and proportion of days covered (PDC) were observed in 86.8% and 43.1% of the overall cohort. The mean number of HCRU claims and cost during the 180-day follow-up period was 18.5 and 9,747 USD, respectively. Warfarin users accounted for both the highest number of claims and cost, whereas apixaban accounted for the lowest figures. Time to first major bleeding was shorter for warfarin users compared with patients on NOACs. Longer times to first stroke/systemic embolism (SE) were observed for rivaroxaban and warfarin. Conclusion: This study provides important comparative insights about comorbidities, adherence, HCRU, and outcome events among NOAC and warfarin users from real-world clinical practice settings.
Papillary thyroid carcinoma in a 5-year old child, mimicking lymphoma in presentation
Authors: Aladily Tariq N , Khader Majd , Bustami Nadwa , Samara Osama A
Published: April 2021

Thyroid cancer is very rare in children and papillary thyroid carcinoma (PTC) represents the most common type. Patients are frequently in the second decade of life and complain of painless enlargement of the gland. Pediatric PTC has unique clinicopathologic characteristics that make it different from the adult counterpart. The biologic behavior tends to be aggressive and patients frequently present with advanced disease. Herein, we report a case with an unusual presentation. A 5-year-old child manifested with fever, night sweats, cervical lymphadenopathy, and weight loss for 2 months. He also complained of mild cough and shortness of breath. Clinical suspicion of tuberculosis or lymphoma was raised, but laboratory workup was unremarkable. Cervical lymph node excision was done, and the histopathologic examination showed metastatic PTC. The patient underwent surgical and radioactive therapy and remained in complete remission for 5 years. Unfortunately, the disease ultimately relapsed with disseminated metastasis and the patient passed away.
Serial blood serotonin levels in a randomized controlled trial comparing the efficacy of low-dose amitriptyline, amitriptyline with pindolol and surrogate placebo in patients with chronic tension-type facial pain
Authors: Agius A.M. , Jones N.S. , Muscat R.
Published: April 2021

Background: Patients often present with chronic facial pain despite normal nasal endoscopy and sinus computerized tomography. Such pain has increasingly been recognized as being of neurological origin with one of the commonest underlying causes being mid-facial segmental tension-type pain (MFP) which is a version of tension headache in the face. Descending serotonergic neuronal projections are known to modulate pain and intra-platelet serotonin levels are an accepted model reflecting central intra-neuronal serotonin. Objectives: 1.To determine whether low-dose amitriptyline significantly changes whole blood serotonin compared to a surrogate placebo in patients with chronic MFP 2. To determine whether the addition of pindolol, a beta blocker with serotonin receptor blocking properties further alters blood serotonin. Methodology: Sixty-two patients were randomized to three treatment groups a) amitriptyline , b) amitriptyline with pindolol, and c) loratadine as surrogate placebo. Whole blood serotonin was taken before and after 8 weeks of treatment. Serotonin was also measured in 40 age-matched healthy controls. Results: There was a significant reduction in blood serotonin levels in the amitriptyline with pindolol group. A non-significant reduction was seen in the amitriptyline group, with no change in serotonin levels in the surrogate placebo group. A comparison of change in serotonin with change in pain frequency and intensity scores is presented. Women in the control group had significantly higher serotonin levels than men. Women with tension-type facial pain who failed to respond to treatment had significantly lower blood serotonin than women in the control group. Conclusion: When linked to the clinical response this study provides evidence that the serotonergic system is involved in the modulation of chronic MFP. Serotonin levels are sex-dependent and related to treatment response.
Race and Gender Bias in Internal Medicine Program Director Letters of Recommendation
Authors: Zhang Neil , Blissett Sarah , Anderson David , O'Sullivan Patricia , Qasim Atif
Published: April 2021

Background

While program director (PD) letters of recommendation (LOR) are subject to bias, especially against those underrepresented in medicine, these letters are one of the most important factors in fellowship selection. Bias manifests in LOR in a number of ways, including biased use of agentic and communal terms, doubt raising language, and description of career trajectory. To reduce bias, specialty organizations have recommended standardized PD LOR.

Objective

This study examined PD LOR for applicants to a cardiology fellowship program to determine the mechanism of how bias is expressed and whether the 2017 Alliance for Academic Internal Medicine (AAIM) guidelines reduce bias.

Methods

Fifty-six LOR from applicants selected to interview at a cardiology fellowship during the 2019 and 2020 application cycles were selected using convenience sampling. LOR for underrepresented (Black, Latinx, women) and non-underrepresented applicants were analyzed using directed qualitative content analysis. Two coders used an iteratively refined codebook to code the transcripts. Data were analyzed using outputs from these codes, analytical memos were maintained, and themes summarized.

Results

With AAIM guidelines, there appeared to be reduced use of communal language for underrepresented applicants, which may represent less bias. However, in both LOR adherent and not adherent to the guidelines, underrepresented applicants were still more likely to be described using communal language, doubt raising language, and career trajectory bias.

Conclusions

PDs used language in a biased way to describe underrepresented applicants in LOR. The AAIM guidelines reduced but did not eliminate this bias. We provide recommendations to PDs and the AAIM on how to continue to work to reduce this bias.
Monocyte-to-HDL-cholesterol ratio is associated with Ascending Aorta Dilatation in Patients with Bicuspid Aortic Valve
Authors: Acar Burak , Yayla Cagrı , Gul Murat , Karanfil Mustafa , Unal Sefa , Uçar Fatih , Mevlut Kuyumcu Serdar , Goktug Ertem Ahmet , Ozen Yasin , Bilal Ozbay Mustafa , Ozeke Ozcan , Aydogdu Sinan
Published: April 2021

Background: The importance of monocyte count-to-HDL-cholesterol ratio (MHR) in cardio- vascular diseases has been shown in various studies. Ascending aortic dilatation (AAD) is a common complication in the patients with bicuspid aortic valve. In this study, we aimed to investigate the relationship between MHR and the presence of aortic dilatation in the pa- tients with bicuspid aortic valve.

Methods: The study population included totally 347 patients with bicuspid aortic valve.169 patients with aortic dilatation (ascending aorta diameter ≥ 4.0 cm) and 178 patients with no aortic dilatation. Echocardiographic and laboratory measure- ment was done and compared between groups.

Results: The mean age of the participants was 44.7 ± 15.4 years and average ascending aorta diameter was 3.2 ± 0.3 cm in dilatation negative group and 4.4 ± 0.4 cm in positive group. MHR was significantly increased in in patients with aortic dilatation. MHR and uric acid level was independently associated with the presence of aortic dilatation in the patients with bicuspid aortic valve.

Conclusion: We found a significant relationship between MHR and aortic dilatation in the patients with bicuspid aortic valve.

Keywords: Bicuspid aorta; aorta aneurysm; monocyte HDL ratio; inflammation.
What differs former, light and heavy smokers? Evidence from a post-conflict setting
Authors: Gazibara Tatjana , Milic Marija , Parlic Milan , Stevanovic Jasmina , Mitic Nebojsa , Maric Gorica , Kisic Tepavcevic Darija , Pekmezovic Tatjana
Published: April 2021

Background: Evidence suggests that people who live in regions affected by the armed conflict are more likely to smoke.

Objective: The purpose of this study was to assess factors associated with smoking status in a sample of students in the northern Kosovo province.

Materials and methods: A total of 514 students enrolled in University in Kosovska Mitrovica, Kosovo, were recruited be- tween April to June 2015 at Student Public Health Center during mandatory health checks. Participants filled in socio-demo- graphic and behavioral questionnaire and Beck Depression Inventory (BDI). Based on responses about smoking, students were categorized in non-smokers, former smokers, light smokers (1-13 cigarettes/day) and heavy smokers (> 13 cigarettes/ day).

Results: Of 514 students, 116 (22.6%) classified themselves as smokers. Higher education level of fathers (Odds ra- tio [OR]=2.89, 95% confidence interval [CI] 1.30-6.44, p=0.009), not living with smokers (OR=0.42, 95%CI 0.15-0.97, p=0.017) and longer exposure to second hand smoke (OR=1.07, 95%CI 1.01-1.13, p=0.036) was associated with former smoking. Studying medical and natural sciences (OR=2.07, 95%CI 1.05-4.18, p=0.040), consuming alcohol (OR=2.98, 95%CI 1.19-10.03, p=0.020), living with smokers (OR=2.88, 95%CI 1.49-5.56, p=0.002), longer exposure to second hand smoke (OR=1.06, 95%CI 1.01-1.11, p=0.019) and having a more intense depressive symptoms (OR=1.08, 95%CI 1.03-1.13, p=0.002) was associated with light smoking. Being male (OR=0.22, 95%CI 0.07-0.41, p=0.001), older (OR=1.47, 95%CI 1.21-1.78, p=0.001), living with smokers (OR=3.78, 95%CI 1.69-8.07, p=0.001), longer daily exposure to second-hand smoke (OR=1.10, 95%CI 1.04-1.16, p=0.001), and having more severe depressive symptoms (OR=1.12, 95%CI 1.07-1.18, p=0.001) were associated with heavy smoking.

Conclusion: Smoking prevention and cessation programs should include the entire community, because exposure to en- vironmental second hand smoke may facilitate initiation and more intense smoking. Screening of student smokers for depression should be prioritized in the process of rebuilding the framework for primary and secondary prevention in the post-conflict period.

Keywords: Students; smoking; tobacco; prevention.
Indian scenario of IgA nephropathy: a systematic review and meta-analysis
Authors: Khairwa Anju
Published: April 2021

Background: IgA nephropathy (IgAN) is most common primary glomerulopathy. There are variations in prevalence of IgAN and its clinical features in different studies from India.

Aim: To summarize overall scenario of IgAN in India.

Methods: In this systematic review, studies related to IgAN and related renal disease were included. Data searched were PubMed, EMBASE, Google scholar, and Cochrane Database from inception to 31st January 2019.

Results: Total 49 studies (N=2480) were included: 21studies (N=2309) of primary IgAN; 19 studies (N=21) of Secondary IgAN; four studies (N=133) of IgA vasculitis nephropathy (IgAVN); and five studies (N=17) of IgA dominant nephropathy (IgADN). Prevalence of IgAN was 16.5% in India. Age of affected persons was ranging from 27.2±16.7 to 48.6±21.3 years . Male female ratio was 1.8:1. Clinical features of Primary IgAN, IgAVN, IgADN & Secondary IgAN were microscopic hematuria (49.6%, 44.4%, 15.6% & 59.5%), macroscopic hematuria (5.1%, 0.4%,40.9%,& 35.7%), Subnephrotic proteinuria (42.1%, 29.4%, 23.2%, & 52.3%), nephrotic proteinuria (16.0%, 4.4%, 76.8%,& 47.6%), and hypertension (25.8%,18.3%, 35.5%,& 47.6%).. The 24 hours proteinuria was ranging from 2.6±1.5 to 4.7±2.3 gm/day and serum creatinine (mg/dl) was ranging from 0.9±0 to 3.5±3.9 mg/dl. Histolomorphologically, all type of IgAN showed mesangial hypercellularity and Immunofluorescence revealed IgA deposition.

Conclusion: The overall prevalence of primary IgAN in India was 16.5%. The subnephrotic proteinuria and microscopic hematuria were common clinical features.

Keywords: IgA Nephropathy; histomorphology; prevalence; India.
COVID-19 mortality rate prediction for India using statistical neural networks and gaussian process regression model
Authors: Dhamodharavadhani S , Rathipriya R
Published: April 2021

The primary purpose of this research is to identify the best COVID-19 mortality model for India using regression models and is to estimate the future COVID-19 mortality rate for India. Specifically, Statistical Neural Networks ( Radial Basis Function Neural Network (RBFNN), Generalized Regression Neural Network (GRNN)), and Gaussian Process Regression (GPR) are applied to develop the COVID-19 Mortality Rate Prediction (MRP) model for India. For that purpose, there are two types of dataset used in this study: One is COVID-19 Death cases, a Time Series Data and the other is COVID-19 Confirmed Case and Death Cases where Death case is dependent variable and the Confirmed case is an independent varia- ble. Hyperparameter optimization or tuning is used in these regression models, which is the process of identifying a set of optimal hyperparameters for any learning process with minimal error. Here, sigma (σ) is a hyperparameter whose value is used to constrain the learning process of the above models with minimum Root Mean Squared Error (RMSE). The perfor- mance of the models is evaluated using the RMSE and 'R2 values, which shows that the GRP model performs better than the GRNN and RBFNN.

Keywords: Covid-19; India; mortality rate; mortality prediction; regression model; hyperparameter tuning; GPR; GRNN; RBFNN.
Risk factors for wound infection caused by Methicillin Resistant Staphylococcus aureus among hospitalized patients: a case control study from a tertiary care hospital in India
Authors: Thimmappa Latha , Bhat Anil , Hande Manjunatha , Mukhopadhyay Chiranjay , Devi Elsa , Nayak Baby , George Anice
Published: April 2021

Background: Methicillin Resistant Staphylococcus aureus (MRSA) causes infection in hospitals and communities. The preva- lence and risk factors of MRSA infection is not homogenous across the globe.

Objective: To find the risk factors of MRSA infection among hospitalized patients.

Methods: Cross-sectional case control study was conducted at a tertiary care hospital in India. The risk factors were collected using checklist from 130 MRSA and 130 Methicillin sensitive staphylococcus aureus (MSSA) infected patients. The pathogens were isolated from the wound swabs according to Clinical and Laboratory Standards Institute guidelines.

Results: Both the groups were comparable in terms of age, gender, diabetic status, undergoing invasive procedures, urinary catheterization and smoking (p>0.05). Multivariate logistic regression revealed surgical treatment (OR 4.355; CI 1.03, 18.328; p=0.045), prolonged hospitalization (OR 0.307; CI 0.11, 0.832; p=0.020), tracheostomy (OR 5.298, CI 1.16, 24.298; p=0.032), pressure/venous ulcer (OR 7.205; CI 1.75, 29.606; p=0.006) and previous hospitalization (OR 2.883; CI 1.25, 6.631; p=0.013) as significant risk factors for MRSA infection.

Conclusion: Surgical treatment, prolonged and history of hospitalization, having tracheostomy for ventilation and pressure/venous ulcer were the key risk factors. Therefore, special attention has to be given to the preventable risk factors while caring for hospitalized patients to prevent MRSA infection.

Keywords: MRSA; infection; India.
Quality of life of adult individuals with intestinal stomas in Uganda: a cross sectional study
Authors: Ssewanyana Yasin , Ssekitooleko Badru , Suuna Bashir , Bua Emmanuel , Wadeya Joseph , K Makumbi Timothy , Ocen William , Omona Kizito
Published: April 2021

Introduction: Intestinal stomas remain important life-saving surgical options in a wide range of gastrointestinal pathologies globally. Living with a stoma has potential to impair the patient’s quality of life, often with associated negative psychological effects.

Objective: To evaluate the quality of life among intestinal stoma patients under Mulago National Referral Hospital (MNRH), with emphasis on psychological effects and effects on family-social interactions.

Methodology: A cross-sectional study carried out at surgical outpatient clinics of MNRH between January and June 2018. Data was collected using Stoma-QOL questionnaire, PHQ-9 and GAD-7 from 51 participants who had lived with intestinal stomas for at least a month.

Results: Of the 51 participants, male: female ratio was 4:1 and aged 18-84 years (mean age 44.04+18.47 years). 76.5% had colostomy; 23.5% had ileostomy. Majority (88.2%) had temporary stomas. The overall mean Stoma-QOL score was 55.12+ 17.04. Only about a quarter (24%) of participants had Stoma-QOL scores >70 (best). Most patients exhibited negative psy- chological effects (anxiety-100%, concerns about changed body image - 96.1% and depression - 88.4%).

Conclusion: Most participants had low levels of stoma-related quality of life, suffered negative psychological effects and exhibited limited social interactions. This calls for efforts to support Stoma patients adapt beter life.

Keywords: Stoma; Quality of Life (Stoma-QOL); Psychological effects; Patient Health Questionnaire (PHQ-9); General- ized Anxiety Questionnaire (GAD-7).
Visual function, spectacle independence, and patients’ satisfaction after cataract surgery- a study in the Central Region of Ghana
Authors: Kyei Samuel , Kwadwo Amponsah Bio , Asiedu Kofi , Osei Akoto Yaw
Published: April 2021

Background: Reduced visual function is associated with diminished quality of life as well as decreased physical and mental health. Poor visual function related to cataracts is also a risk factor for falls and traffic accidents, which may lead to hospital admissions and limit independence.

Objective: To evaluate patients’ satisfaction, visual functions and spectacle independence among patients in the Central Region of Ghana who had cataract surgery in one eye.

Methods: A hospital-based prospective cohort study was carried out on 146 patients booked for cataract surgery: 16 were lost through follow-ups whilst 130 completed the study. Visual functions including visual acuity, contrast sen- sitivity, stereopsis and colour vision were assessed before and after a month of cataract surgery. Objective and subjective refractions were performed to determine the post-surgery refractive status of the participants. Participants completed the NEI-VFQ 25 questionnaire and the scores obtained were used as a construct of their satisfaction.

Results: The NEI-VFQ 25 questionnaire scores indicated patients’ satisfaction was high with an average quality of life score of 77.46. Patients satisfaction was strongly correlated with contrast sensitivity (r=0.653, p<0.001) but moderately correlated with visual acuity (r=-0.554, p<0.001), stereopsis (r=0.490, p<0.001) and colour vision (r=0.466, p<0.001). Contrast sensitivity was a better predictor of patients’ satisfaction than visual acuity and stereopsis. Spectacle independence at distance was achieved in only 44.6% of the participants and 5.4% at near. There was a significant (p>0.001) association between spectacle independence and the two types of cataract surgery performed which included Small Incision Cataract Surgery (SICS) and Extracapsular Cataract Extraction (ECCE). Among those who were spectacle independent, 53.4% of them were low vision patients.

Conclusion: Satisfaction of patients after cataract surgery was high but was greatly influenced by visual functions with contrast sensitivity being a better predictor of satisfaction than visual acuity and stereopsis. Spectacle independence after cataract surgery was low at distance and extremely low at near. The type of cataract surgery performed influenced thespec- tacle independence.

Keywords: TNO; contrast sensitivity; spectacle independence; cataract surgery; intraocular lens.