bluuebunny/crossref_metadata_2025 huggingface dataset:
Schizophrenia and Nicotine - A Bittersweet Psychiatric Story
Authors: Ghosal Satrajit , Halder Ankit , Keshri Sarthak , Ravindran Navna Panchami , Joshi Akhil
Published: March 2024

Background:

Schizophrenia is a chronic mental disorder affecting mood, perception, and most importantly cognition. This severely interferes with the functioning of such patients. On the other hand, nicotine use (both smoke and smokeless tobacco) is very much prevalent in schizophrenic patients, much more than normal population. This study aims to find the relation between nicotine use and cognition in schizophrenic patients.

Methodology:

Fifty-six new patients diagnosed with schizophrenia of both sexes between ages 18 and 60 years, giving valid and informed consent, were selected for the study. Fagerstrom test for nicotine dependence was done and the patients were divided into two groups: scores 4 or less (low-to-moderate dependence) and scores 5 or more (severe dependence). The Cognitive Assessment Interview was performed. Then, an independent sample t-test was used to compare the scores on various cognitive domains between the two groups.

Results:

The cognitive scores were better in the group with severe tobacco dependence, both globally and across individual domains. These associations were statistically significant (P = 0.001). The mean difference was highest in the social cognition group. Among all the domains, the t-value was highest for the speed of processing domain, indicating that this particular cognitive domain has the best discriminative value when compared between two groups of nicotine users.

Conclusions:

Hence, to conclude, whether nicotine has indeed a beneficial effect on cognition in schizophrenia has to be investigated longitudinally so that a possible treatment option to address cognitive impairment in schizophrenia is obtained. Extensive longitudinal studies needs to be conducted to better understand the long-term effect of tobacco use and cognition in schizophrenia patients.
Rituximab treatment for refractory and moderate-to-severe pemphigus patients in the pandemic era: A single-center retrospective study
Authors: Avcı Ceylan , Akın Gülfem Nur , Akarsu Sevgi , Aktan Şebnem
Published: March 2024

Background:

The management of refractory pemphigus in the pandemic conditions is challenging. There are limited data comparing the safety of rituximab and other immunosuppressive therapies during the COVID-19 pandemic.

Objectives:

We evaluated the safety and efficacy of rituximab and conventional treatments in patients with pemphigus who received treatment during the COVID-19 pandemic period.

Methods:

The patients with pemphigus treated with immunosuppressive treatments in a university hospital between September 2020 and May 2023 were retrospectively evaluated. All patients initially received conventional treatments. Fifteen of them who were refractory to prior treatments or could not use prednisolone due to adverse effects received rituximab. Eighteen patients were treated with only conventional treatments.

Results:

Thirty-three patients with a mean age of 50 ± 15 years were included in the study. Twenty-two of the patients (66.7%) were female. The baseline mean pemphigus disease area index (PDAI) score of the patients was 37 ± 34 (range: 4–168). The mean follow-up time was 13.8 ± 6.8 months. The mean PDAI scores were significantly lower after treatment in both rituximab and conventional treatment groups (P: 0.001, P < 0.001; respectively). In the rituximab group, the monthly mean prednisolone dose was statistically reduced after rituximab treatment compared to before treatment (P < 0.001). There was no statistically significant difference in the relative odds of COVID-19 positivity or death between the groups (3.06 (95% [confidence interval (CI): 0.68–13.79]; 0.57 [95% CI: 0.05–7.00], respectively). Of 11 patients diagnosed with COVID-19, one patient (1/7, 14.3%) in the rituximab group and two patients (2/4, 50%) in the conventional treatment group died from SARS-CoV-2.

Conclusion:

We observed that rituximab treatment was effective and safe for treatment-resistant moderate-to-severe pemphigus patients during the COVID-19 pandemic.
Assessment of Dependency in Activities of Daily Living (ADL) and its Predictors: A Cross-Sectional Study among the Elderly Rural Population in a Sub-Himalayan UT of India
Authors: Kumari Rashmi , Gupta Rajiv Kumar , Shalli  , Bahl Rakesh , Langer Bhavna
Published: March 2024

Background:

With an increase in life expectancy over the last few decades, there has been a parallel increase in the prevalence of disabilities among the elderly population. To estimate the prevalence of dependency in activities of daily living (ADL) and its predictors among the rural elderly population.

Material and Methods:

This was a cross-sectional study carried out in the community among the rural geriatric population in the field practice area of PG Department of Community Medicine, Government Medical College Jammu. The Barthel Scale Index was used to measure ADL dependency. PSPP software was used to analyze the data.

Results:

The mean age of study participants was 68.31 ± 7.9 years. ADL dependency was observed in 46.3% of the subjects, with the majority demonstrating mild to moderate dependence. Only 2.5% of the respondents reported a severe degree of ADL dependence. The mean ADL score was 94.47 ± 8.98. On multivariate logistic regression analysis, age, educational status, the presence of stress in the family, personal history, and the presence of co-morbidities emerged to be independent predictors of ADL dependence.

Conclusion:

High prevalence of physical disability in the geriatric population is now an area of major concern. This emphasizes the significance of setting up geriatric care centers especially in rural areas preferably integrating with health and wellness centers.
Predictors for Concurrent Diabetes in Tuberculosis Patients. Perspectives from Two Mining Districts of Eastern Tribal State Jharkhand, in India
Authors: Rai Sandeep , Jha Ravi Ranjan , Prasad Santosh , Kumar Dewesh , Rana Rishabh Kumar
Published: March 2024

Background:

Tuberculosis and diabetes both diseases are present in large numbers in the country and we are major contributors to both globally. With the objective to understand the various traits of patients having both tuberculosis and diabetes and to ascertain various possible predictors for such occurrence based on the public health database we carried out this study. We seek answers to questions like they have any effects? Are they having any additive role to play?

Methods:

One-year data from the NIKSHAY portal of both districts were analyzed to look for possible associations and other variable traits. Data were analyzed using standard methods to express data in frequency and percentage. Chi-square test was used to establish association, while step-wise approach was used to calculate univariate and multivariate logistic regression analysis for knowing various predictors. P-value of <0.05 was considered statistically significant.

Results:

Concurrent diabetes in tuberculosis patients was close to 294 (6%) in the 4933 individuals. In total, 65.2% of the study population were male. Diagnosis of tuberculosis was made most of the time by chest X-ray (49.4%) followed by Microscopy ZN staining and cartridge-based nucleic acid amplification test (CBNAAT). Death was more among diabetics (4.4%) as compared to nondiabetics (3.5%).

Conclusion:

Diabetes is increasing in tuberculosis patients; improvement in data quality is needed. More research is required to reveal various other reasons that make tuberculosis patients more prone to develop diabetes.
Fathers’ Attitudes Toward Mothers with Infants and its Association with Exclusive Breastfeeding in a Rural Community of Karnataka
Authors: Kushwaha Anupriya , Jacob Ankeeta Menona
Published: March 2024

Male participation in reproductive and child health improves breastfeeding rates. The role of fathers in breastfeeding may be crucial in improving exclusive breastfeeding (EBF) rates. This study explored the fathers’ attitudes and support and its association with EBF in mothers with infants attending a rural primary health center in Karnataka. A cross-sectional descriptive study was conducted on mothers with infants visiting a rural primary health center between December 2020 and February 2021. A pretested semi-structured questionnaire was used to collect data to ascertain the exclusivity of breastfeeding and other sociodemographic factors. The fathers’ attitudes and support toward mothers during and after pregnancy were measured on a 5-point Likert scale. Quantitative variables were expressed in median and interquartile ranges, and qualitative variables were expressed using percentages and proportions. The association was determined using the Chi-square test and Spearman’s correlation test. The data were collected using Epi Data and analyzed using Epi info v 3. A total of 169 mothers participated in the study. The self-reported EBF was 148 (87.1%). The fathers’ attitudes and support to the mothers were found to be more favorable during the antenatal period in 97% of the women. The fathers’ attitudes and support in the antenatal period and after delivery were not associated with the mothers’ exclusivity in breastfeeding. The present study concluded that there is no association between the fathers’ attitudes and support before and after the delivery of the infant and mothers’ exclusivity in breastfeeding.
Can the Emergency Medical Service (EMS) System Help in Improving the Healthcare Access – Evidence from Maharashtra EMS
Authors: Jena Biranchi N. , Shelke Dnyaneshwar , Saunik Sujata
Published: March 2024

Background:

For many people in the remote regions of India, medical help is inaccessible as 66% of rural Indians do not have access to critical medicine and 31% of the population travel more than 30 km seeking health care in rural India. Timely non-availability of doctors in healthcare facilities, especially in primary health centers (PHCs), leads to more dependency on the private healthcare practitioners for the out-patient department services. This needs immediate attention.

Materials and Methods:

The healthcare authority in Maharashtra has allowed doctors in 108 emergency ambulances to provide consulting services. The current study is based on the total consultations managed by the doctors on-board on the 108 ambulances in the state of Maharashtra in the years 2020, 2021, and 2022. The data are procured from the state-run Emergency Response Centre, and the analysis is done by using the basic statistical technique in MS Excel and SPSS16.0.

Results:

More than 9.35 lakh medical consultations were provided with an average 856 consultations per ambulance in the year 2022, showing a significant growth of 452% over the consultations in 2020. The base location of the 32% ambulance (298) in the PHCs has improved the round the clock accessibility in 16% of the total PHCs in the state of Maharashtra.

Conclusion:

The availability of the doctors in the state-run emergency ambulances for general healthcare services has improved the adherence of Indian Public Health Standards, and such practice must be examined for implementation in other states.
Incidence of Sudden Cardiac Death in Low- and Middle-Income Countries: A Systematic Review of Cohort Studies
Authors: Thakkar Nandan , Alam Prima , Thaker Abhi , Ahukla Aakansha , Shah Jay , Saxena Deepak , Shah Komal
Published: March 2024

Sudden cardiac death (SCD) is a leading cause of mortality worldwide and, in recent years, has become an urgent public health concern in low- and middle-income countries (LMICs). Data from LMICs, however, remains limited. As such, the aim of this article is to systematically review the current literature on the incidence of SCD in LMICs to inform policymakers and identify potential research gaps. A search of PubMed and Embase was utilized to capture the targeted condition, outcome, and setting. Only peer-reviewed cohort studies in LMICs reporting SCD incidence estimates in the general population of individuals aged ≥1 year were eligible for selection. Papers providing incidence data for specific types of SCD, including sudden coronary death or death from sudden cardiac arrest, were also included. After deduplication, 1941 citations were identified and screened. Seven studies representing four countries—Cameroon, China, India, and Iran—met the criteria for inclusion and were considered in our analysis. The crude incidence rate for SCD ranged from 19.9 to 190 cases per 100,000 person-years, while age-adjusted rates ranged from 33.6 to 230 cases per 100,000 person-years. There was notable variability in methods utilized to ascertain SCD cases. These findings suggest that the incidence of all-cause SCD in LMICs and may exceed that of high-income countries; however, observed disparities may be partly attributable to differences in case ascertainment methods. Additional research is needed to better understand the true incidence of SCD in developing countries. It is crucial that future studies across regions utilize standard diagnostic criteria and methodology for identifying SCD, which would provide a framework by which to compare outcomes between settings.
Effect of Right Nostril Breathing on Cardiorespiratory Parameters and Reaction Time in Young, Healthy Humans: An Interventional Study
Authors: Bargal Sheela , Nalgirkar Vivek , Patil Anant , Langade Deepak
Published: March 2024

Background and Objective:

Yogic breathing helps in reduction of stress and strain in the body. Right and left nostril breathings (RNB and LNB, respectively) have different effects on cardiorespiratory parameters. The study was performed to examine the effect of RNB exercise on cardiorespiratory parameters and reaction time in young, healthy human volunteers.

Materials and Methods:

In this prospective, interventional study, 110 young healthy volunteers underwent systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR), respiratory rate (RR), vital capacity (VC), peak expiratory flow rate (PEFR), and reaction time (RT) examination before and after 2 weeks of performing 45 min of RNB exercise daily.

Results:

There was notable increment in SBP (113.39 ± 17.72 vs. 117.74 ± 10.83 mmHg, P = 0.002) and DBP (67.64 ± 10.32 vs. 71.27 ± 8.68 mmHg, P = 0.002). PR increased nonsignificantly (86.44 ± 12.65/min vs. 87.32 ± 13.43/min, P = 0.476). Significant decrease in RR (14.40 ± 2.48/min vs. 12.31 ± 2.23/min, P < 0.0001) was observed. VC (3.57 ± 0.57 vs. 3.82 ± 0.55 L/min, P < 0.0001) and PEFR (441.36 ± 50.22 vs. 468.91 ± 53.66 L/min, P < 0.0001) also increased significantly. Substantial reduction in auditory reaction time (ART) (165.58 ± 32.18 vs. 147.42 ± 23.39 ms, P < 0.0001) and visual reaction time (VRT) (191.04 ± 37.94 vs. 165.86 ± 28.74 ms, P < 0.0001) was seen. After engaging in cardiorespiratory exercise, the maximal heart rate (MHR) remained unchanged (P = 0.929).

Conclusion:

RNB results in increase in blood pressure, heart rate, VC, and PEFR and decrease in ART and VRT. Further studies in patients with cardiorespiratory diseases are necessary to understand its clinical utility.
Post-Marketing Surveillance of the World’s First Novel Cocktail of Rabies Monoclonal Antibodies: TwinRab™ in Real \-World Setting
Authors: Tambe Muralidhar P. , Parande Malangori A. , Nanaware Mangesh B. , Salunke Nandkumar M. , Dutta Trayambak , Mahajan Manish
Published: March 2024

Rabies presents with a high fatality rate, which imposes a significant global public health challenge, and therefore the use of post-exposure prophylaxis (PEP) is crucial for prevention. Monoclonal antibodies (mAbs) have emerged as a promising substitute for rabies immunoglobulins (RIGs) due to their high efficacy and standardized manufacturing process. A prospective, open-label, post-marketing surveillance study (PMS) was conducted at Byramjee Jeejeebhoy Medical College (BJMC), Pune. The study included patients aged more than 2 years who had recently sustained Category III-suspected rabid animal bite exposures. These patients were administered TwinRabTM at a dosage of 40 IU/kg in and around the wound as intralesional transfer, along with the anti-rabies vaccine (ARV). Adverse events (AEs) grading was performed with reference to the Food and Drug Administration (FDA) toxicity grading. In this study, 215 subjects received the TwinRabTM mAb with a 100% completion rate. Out of 215 patients, three (1.3%) patients in the range of 18 to 65 years of age showed solicited local AEs, which were resolved after the appropriate treatment intervention, but causality assessment was non-assessable. The overall tolerability assessment showed positive ratings from doctors (91.63%) and patients (67.91%) for the mAb cocktail. The PMS demonstrated the safety of TwinRabTM in patients who experienced Category III-suspected rabid animal bites, thereby supporting its potential as an alternative option for post-exposure prophylaxis in the management of animal bites for the prevention of rabies
Prevalence of Selected Cardiovascular Risk Factors and Their Associated Factors among People Living with HIV/AIDS in India
Authors: Sakthivel Manikandanesan , Jayaseelan Venkatachalam , Chinnakali Palanivel , Hamide Abdoul , Surendran Gayathri , Krishnamoorthy Yuvaraj
Published: March 2024

Background:

Low- and middle-income countries face the dual problem of infectious and non-infectious diseases. Persons living with HIV/AIDS (PLHIV) are also at risk of cardiovascular diseases. Hence, we did this study to determine the prevalence of cardiovascular risk factors (CVRF) among PLHIV and to find the factors associated with it.

Methods:

We carried out a cross-sectional analytical study among all adults aged ≥18 years registered at a facility-integrated anti-retroviral therapy center in Puducherry, India, from September 2016 to February 2018. After obtaining informed consent, we interviewed the participants to assess physical activity, alcohol, and tobacco use. We measured weight, height, abdominal circumference, and blood pressure, with biochemical investigations such as blood glucose and lipid profile.

Results:

Of the total 316 adults PLHIV studied, the most common cardiovascular risk factor found was dyslipidemia (82.7%), followed by inadequate physical activity (74.4%). Other behavioral risk factors studied, such as current tobacco use and current alcohol use, showed a prevalence of 12.8% and 5.4%, respectively, among male participants. The prevalence of hypertension among adult PLHIV studied was 15.8%, and diabetes was 12.3%. In the multivariate analysis, diabetes, and hypertension were significantly associated with age and literacy. Obesity was found to be associated with diabetes and abdominal obesity with dyslipidemia.

Conclusion:

Dyslipidemia was the most common cardiovascular risk factor, followed by inadequate physical inactivity among PLHIV. Regular screening with blood glucose, blood pressure, and lipid profile, and timely cross-referrals can help in the early detection of CVRF among PLHIV and hence improve their quality of life through appropriate treatment.
Evaluation of Serum and Salivary Lactate Dehydrogenase Levels in Patients with Oral Potentially Malignant Conditions/Lesions: A Clinical and Biochemical Study
Authors: Rao Kumuda , Babu Subhas G. , Shetty Shishir Ram , Castelino Renita Lorina
Published: March 2024

Background:

Oral cancer encompasses all malignancies that originate in the oral tissues and remains a major public health problem throughout the world as an important case of poor health and illness. Head and neck cancer accounts for 9.8% of the estimated 6,44,600 incidental cancer cases in India. Oral Squamous Cell Carcinoma (SCC) is a serious and developing concern globally, accounting for more than 90% of malignant cancers of the oral cavity. Salivary diagnostics have been demonstrated to have potential in the detection and screening of oral pre-cancer and cancer in a variety of research settings. The continual and close contact between saliva and the mucosa, where cancer develops, is the foundation of this diagnostic capability.

Materials and Methods:

This research utilized spectrophotometry to quantify Lactate Dehydrogenase levels in serum and saliva of 30 healthy people which consisted the control group and 31 Oral Potentially Malignant people which constituted the study group.

Results:

On estimation and comparison, the mean Lactate Dehydrogenase levels in serum (397.4968+71.6392 IU/L) and saliva (675.4935+139.3352 IU/L) among patients with Oral Potentially malignant lesions/conditions were higher than the mean Lactate Dehydrogenase levels in serum (390.8667+71.0953 IU/L) and saliva (201.3700+89.1439 IU/L) among controls.

Conclusion:

Higher serum and salivary LDH levels in Oral Potentially malignant lesions/conditions than in control groups signifies the importance of assessing salivary LDH levels, in the prognosis of the same. Further prospective longitudinal studies are required to assess the salivary LDH levels among the patients with malignant transformation of Oral Potentially malignant lesions/conditions to oral cancers.
Effectiveness of Digital Learning in Community Mental Health Care Among Nurses in India
Authors: Govindan Radhakrishnan , Gandhi Sailaxmi , Nattala Prasanthi , Ramu Rajalakshmi , Marimuthu P
Published: March 2024

Background:

Digital learning is a cost-effective and time-saving approach in higher education. The present study aimed to check the impact of continuing nursing education programs through digital learning by connecting Indian nurses to NIMHANS Digital Academy (NDA).

Materials and Methods:

One group pre-test and post-test design was used for this study. Overall, 217 nurses registered for the course and 146 nurses were recruited on the basis of eligibility and their Expression of Interest (EoI) through the online registration portal. All the nurses who had access to the internet and enough internet literacy were included in the study. 64 nurses had not submitted the post-test due to various reasons within the stipulated time. Hence, the final sample achieved and calculated for the analysis was n = 82. The data for this study were collected through the retrospective chart review method.

Result:

The findings of this study reveal that most of the nurses in India had willingness and readiness for digital learning. All the nurses who joined the NDA learning program stated that they would like to improve their knowledge regarding mental health and illness, to identify and manage mentally ill patients efficiently. The results indicated that the training provided through NDA positively impacted the nurses’ knowledge and fulfilled their learning needs. Statistical analysis showed a significant difference between knowledge, practice, and confidence score changes for the two-time point period, i.e. before and after the training.

Conclusion:

It can be concluded that conducting Continuing Nursing Education (CNE) through a digital learning program is an effective teaching-learning method in the nursing curriculum.
Pregnancy-related Factors Responsible for Delivering Low Birth Weight Babies: An Institutional-based Cross-sectional Study, Jamnagar, Gujarat
Authors: Patel Harsh K. , Mehta Jitesh P. , Patel Bela A. , Ram Rohitkumar , Parmar Dipesh V.
Published: March 2024

Background:

The WHO defines LBW as “Birth weight less than 2500 grams” regardless of gestational age. Being born with a low birth weight also incurs enormous economic costs, including higher medical expenditures and social service expenses, and decreased productivity in adulthood.

Objective:

To study distribution of newborns’ according to pregnancy related factors and its association with newborns’ birth weight.

Methods:

An institutional based cross-sectional study. New-borns delivered at study institute were considered as study participants. Estimated final sample size was 500. Guardians (mothers) were face-to-face interviewed and also recorded data were collected from the case file and Mother and Child Protection Card.

Results:

Prevalence of LBW newborns was higher in mothers with late ANC registration, <4 ANC visits, chronic medical conditions, infection during pregnancy, PIH, anemia, consuming tobacco, exposure to second hand smoke, LSCS/Assisted delivery, in female newborns’, current pregnancy birth order number more than 2, in pre term newborns’ and mothers with bad obstetric history.

Conclusion:

Create awareness and adoption of suitable family planning methods. Need to do early (within 12 weeks) ANC registration with minimum four ANC visits for better pregnancy outcome. Effective tracking and suitable intervention provided to improve current pregnancy outcome. Health care professional should pay special attention to high-risk pregnancy. Develop social culture in such a way that females are neither addicted nor exposed to any tobacco containing products in their life.
Nursing Intervention Strategies and Their Effectiveness on Restless Leg Syndrome and Psycho-Social Problems in Chronic Kidney Disease Patients
Authors: Kaur Prabhjot , Jaspal Surinder , Kaur Tejinder
Published: March 2024

Background:

Chronic kidney disease is a global health problem affecting 843.6 million people with 1 million deaths and the 12th leading non-communicable cause of death worldwide. Insomnia is a disturbing problem found in chronic kidney disease patients, leading to physiological problems like fatigue, edema, and restless leg syndrome most of the time. The objective of this study was to assess the effectiveness of nursing intervention strategies on physiological and psycho-social problems.

Materials and Methods:

A quantitative research approach with quasi-experimental pre-test and post-test design was used to assess the effectiveness of nursing intervention strategies on physiological and psycho-social problems among 30 chronic kidney disease patients, 15 in control and experimental each, admitted in a selected hospital of Punjab. Convenience sampling was used to assign the samples, and data were collected through an interview schedule by using standardized scales. IEC number: 2017/08/5051.

Results:

The result of the study showed that the baseline restless leg syndrome mean score was 9.67, whereas the psycho-social problem baseline mean score was 79.80, and after post-test, the mean score was reduced to 7.67 in physiological and 66.87 in psycho-social problems in the experimental group. Intervention was found to be effective in reduction of physiological and psycho-social symptoms of chronic kidney disease patients significantly (P ≤ 0.05).

Conclusions:

The study showed that nursing intervention strategies were effective in reduction of physiological and psycho-social symptoms.
Factors Influencing the Consumption of Tobacco amongst the Khasi Indigenous People in Northeast India
Authors: Deb Roumi , Kumari Soni , Mohan Meenakshi , Shangplia Melbaraine , Samtani Ratika , Langstieh W. B
Published: March 2024

Background:

Tobacco use in any form is a major public health concern. It accounts for nearly 1.35 million deaths every year. Many chronic illnesses occur due to the consumption of tobacco, either smoke or smokeless form. The study aims to explore how smoking and smokeless tobacco consumption are distributed across a range of demographic and socioeconomic markers among Khasi indigenous people in Northeast India.

Materials and Methods:

It is a case-control study conducted in adults over 31 years of age. The study was carried out between June 2020 and August 2021. An Independent t-test was performed to determine the significant difference in age between smoking/smokeless tobacco users and non-tobacco users. Univariate and Multivariate analyses were conducted to determine the significant predictors affecting the use of smoking/smokeless tobacco in the respondents.

Results:

A total of 505 respondents were included in the present study. There was a high statistically significant difference in the income level of tobacco and non-tobacco users (P value- 0.002). In Univariate analysis, it was found that the odds of consuming both forms of tobacco were significantly lower in the respondents aged between 51–60 (OR = 0.61, P value = 0.0453). The participants who studied till graduation and above had lower odds of both using forms of tobacco as compared to respondents who were illiterate/primary educated only (OR = 0.85, P value = 0.046).

Conclusion:

In conclusion, smoking and smokeless tobacco consumption are still widely prevalent in this region and strongly associated with age, gender, level of education, and place of residence. There is a need for further detailed analysis to identify risk factors that are strongly associated with the use of smoke and smokeless tobacco so that the community will be conscious about the hazardous effects of tobacco use in any form.
Gender-based Violence and its Predictors: A Cross-sectional Study Among the Adolescents of Madhya Pradesh, Central India
Authors: Bali Surya , Sembiah Sembagamuthu , Burman Jayeeta
Published: March 2024

Background:

Gender-based violence (GBV) is a global public health concern. India’s socio-cultural and regional diversity poses challenges for obtaining accurate and comprehensive indicators of gender-based violence. This study aimed to explore the prevalence and predictors of GBV among adolescents. This was a community-based cross-sectional study conducted among adolescents aged 10 to 19 years in six districts of Madhya Pradesh, the central part of India, from December 2017 to 2019.

Methods and Material:

GBV was assessed using a validated questionnaire adapted from a nationwide survey. Data were analyzed using SPSS (version 16.0). Logistic regression analysis was performed to identify factors associated with GBV.

Results:

The study revealed that 10.4% of adolescents were victims of GBV. The multi-variable logistic regression showed that girls were at higher risk (odds ratio = 5.7) of facing GBV. Other significant factors associated with GBV included older adolescents (15–19 years old), those belonging to scheduled caste/tribal areas, those whose mothers were literate, those who had a boyfriend/girlfriend, and those who justified wife beating.

Conclusion:

GBV is a serious public health problem among adolescents, with one in every 10 adolescents experiencing GBV. It is essential to instil awareness of gender-equal norms from early childhood and within households. Implementing violence prevention policies and strategies in educational and work institutions, as well as at the community level, is crucial.
Socio-Cultural Discourses of Children Engaged in Child Labor in India: A Macro-Ethnographic Study
Authors: Bharat Pareek , Dhimaan Nidhi , Raddi Sudha A. , Bist Lekha , Kaur Kamaljit , Tiwari Jyoti , Kaur Daljit
Published: March 2024

Background:

Child labor is considered one of the main social problems that affect the community and has a physical and psychosocial impact on a child’s health, growth, and development. The study aimed to describe the sociocultural discourses of children involved in child labor. A macroethnographic approach was used to collect the data from the selected community areas of Punjab, India.

Materials and Methods:

A community-based qualitative study using purposive sampling was carried out among children engaged in child labor (n = 8). The data were gathered through in-depth or semi-structured interviews and non-participant observation under four phases: community context assessment, egocentric network analysis, validation, and dissemination of study findings. The guide for consolidated criteria for reporting qualitative research (COREQ) was followed. Ongoing analysis was conducted using Spradley’s analysis approach to identify the themes.

Results:

Thematic analysis resulted in the emergence of various themes related to child labor, namely, adaptability, money-centric attitude, sense of being underserved, social deprivation, work burden, reduced emotional expression, workaholism, abuse, family shoulder, family cohesion, and sense of industry. Apart from that, inhuman living and working conditions, as well as school deprivation among study subjects, were observed. Poverty emerged as the single most compelling factor for child labor in India.

Conclusion:

The study concluded that child labor had a negative impact on children’s overall development. An effective intervention to stop child labor is if vulnerable children are identified through primary healthcare, and a relationship of trust is built that allows for the provision of health care, education, support, and referral to additional services outside the health sector.
Machine learning-assisted prediction of trabeculectomy outcomes among patients of juvenile glaucoma by using 5-year follow-up data
Authors: Birla Shweta , Varshney Toshit , Singh Abhishek , Sharma Arun , Panigrahi Arnav , Gupta Shikha , Gupta Dinesh , Gupta Viney
Published: March 2024

Objective:

To develop machine learning (ML) models, using pre and intraoperative surgical parameters, for predicting trabeculectomy outcomes in the eyes of patients with juvenile-onset primary open-angle glaucoma (JOAG) undergoing primary surgery.

Subjects:

The study included 207 JOAG patients from a single center who met the following criteria: diagnosed between 10 and 40 years of age, with an IOP of >22 mmHg in the eyes on two or more occasions, open angle on gonioscopy in both eyes, with glaucomatous optic neuropathy, and requiring a trabeculectomy for IOP control. Only the patients with a minimum 5-year follow-up after surgery were included in the study.

Methods:

A successful surgical outcome was defined as IOP ≤18 mmHg (criterion A) or 50% reduction in IOP from baseline (criterion B) 5 years after trabeculectomy. Feature selection techniques were used to select the most important contributory parameters, and tenfold cross-validation was used to evaluate model performance. The ML models were evaluated, compared, and prioritized based on their accuracy, sensitivity, specificity, Matthew correlation coefficient (MCC) index, and mean area under the receiver operating characteristic curve (AUROC). The prioritized models were further optimized by tuning the hyperparameters, and feature contributions were evaluated. In addition, an unbiased relationship analysis among the parameters was performed for clinical utility.

Results:

Age at diagnosis, preoperative baseline IOP, duration of preoperative medical treatment, Tenon’s thickness, scleral fistulation technique, and intraoperative mitomycin C (MMC) use, were identified as the main contributing parameters for developing efficient models. The three models developed for a consensus-based outcome to predict trabeculectomy success showed an accuracy of >86%, sensitivity of >90%, and specificity of >74%, using tenfold cross-validation. The use of intraoperative MMC and a punch for scleral fistulation compared to the traditional excision with scissors were significantly associated with long-term success of trabeculectomy.

Conclusion:

Optimizing surgical parameters by using these ML models might reduce surgical failures associated with trabeculectomy and provide more realistic expectations regarding surgical outcomes in young patients.
The expanding roles of eye banks in India: Past, present, and future
Authors: Chaurasia Sunita , Dureja Rohit , Roy Arvind , Das Sujata
Published: March 2024

This review highlights the evolution in the scope of eye banking activities in India. The roles and responsibilities of the eye banks have expanded to match the requirements and necessities that arose because of advancements in keratoplasty techniques and the need for corneal surgeons. Adoption of different types of corneal preservation solutions and methods of donor cornea preservation was a consequence of the changing and unprecedented times. The growth of eye banking in India has been a commendable journey and has placed the country in an “almost sufficient” category in eye banking and corneal transplantation. There exists a potential to reach the status of cornea surplus country in the future. The rules and laws governing eye banking operations need dynamic amendments based on the trends in keratoplasty, surgical practice patterns, and status of self-sufficiency. Newer technological advances and quality measures must be adopted in donor cornea evaluation and tissue preparation. Research should be integrated as an important component of eye banking, especially in developing novel methods of donor preservation, and evaluating and validating the existing and changing practices of eye banking.
Efficacy and safety of trigeminal parasympathetic pathway stimulation for dry eye: A systematic review and meta-analysis
Authors: Hu Jindong , Ju Mohan , Shi Yongjun , Liu Xinquan , Zhu Yongbao
Published: March 2024

This study aimed to investigate the efficacy and safety of trigeminal parasympathetic pathway (TPP) stimulation in the treatment of dry eye. A comprehensive search for randomized clinical trials was performed in seven databases (MEDLINE, Embase, CENTRAL, etc.) up to 28 February 2023. After screening the suitable studies, the data were extracted and transformed as necessary. Data synthesis and analysis were performed using Review Manager 5.4, and the risk of bias and quality of evidence were evaluated with the recommended tools. Fourteen studies enrolling 1714 patients with two methods (electrical and chemical) of TPP stimulation were included. Overall findings indicate that TPP stimulation was effective in reducing subjective symptom score (standardized mean difference [SMD], -0.45; 95% confidence interval [CI], -0.63 to -0.28), corneal fluorescence staining (mean difference [MD], -0.78; 95% CI, -1.39 to -0.18), goblet cell area (MD, -32.10; 95% CI, -54.58 to -9.62) and perimeter (MD, -5.90; 95% CI, -10.27 to -1.53), and increasing Schirmer's test score (SMD, 0.98; 95% CI, 0.65 to 1.31) and tear film break-up time (SMD, 0.57; 95% CI, 0.19 to 0.95). Compared to inactive or low-activity stimulation controls, it has a higher incidence of adverse events. Therefore, TPP stimulation may be an effective treatment for dry eye, whether electrical or chemical. Adverse events are relatively mild and tolerable. Due to the high heterogeneity and low level of evidence, the current conclusions require to be further verified.
Analysis of foveal avascular zone by using spectral-domain optical coherence tomography angiography in healthy Indian eyes
Authors: Gupta Priyadarshi , Thakar Meenakshi , Rajurkar Ketaki , Jaisingh Kirti , Shaw Ekta , Dipu Taw Anne
Published: March 2024

Purpose:

To analyze FAZ superficial (s) and deep (d) area and dimensions by using spectral-domain optical coherence tomography angiography (OCTA) in healthy eyes and to assess effect of age, gender, axial length (AL), central foveal thickness (CFT), and central choroidal thickness (CCT) on FAZ. We aimed to study FAZ dimensions with OCTA in healthy Indian eyes with the purpose of creating a normative database.

Settings and Design:

Observational cross-sectional study.

Methods:

In total, 200 healthy eyes in the age group of 20–60 years having best corrected visual acuity better than 6/12 (Snellen’s) with no systemic illness/intraocular surgery were included. FAZ parameters were calculated using OCTA, and the same was evaluated for any correlation with different ocular parameters mentioned above. The data were reported as frequencies/percentages and mean ± SD. The association between quantitative variables was evaluated using Pearson’s correlation coefficient.

Results:

The dFAZ area (0.56 ± 0.12 mm2) was larger than the sFAZ area (0.42 ± 0.13 mm2). Females had larger FAZ than males. AL and CFT had a negative correlation, whereas CCT had a positive correlation with FAZ. Age did not influence FAZ. sFAZ and dFAZ varied significantly in healthy eyes.

Conclusion:

FAZ parameters calculated using OCTA in healthy Indian eyes suggested that the area and dimensions in both SCP and DCP are larger in individuals from the Indian subcontinent when compared to other parts of the world. FAZ area and dimensions, when compared to previous studies, were variable. Thus, there is a need to establish normative data for ethnicity for proper interpretation of FAZ using OCTA.
Visual axis opacification after pediatric cataract surgery – An analysis of morphology and etiology
Authors: Khokhar Sudarshan , Chandel Lekha , Rani Deeksha , Rathod Aishwarya , Nathiya Venkatesh , Pujari Amar
Published: March 2024

Purpose:

To investigate the morphological types and delineate the clinical and surgical variables associated with VAO in children undergoing pediatric cataract surgery.

Methods:

We included 33 eyes of 28 children who developed clinically significant visual axis opacification (VAO) after congenital or developmental cataract surgery. All eyes underwent a comprehensive examination under anesthesia followed by a membranectomy to clear the visual axis. We classified VAO into three subgroups: fibrotic, proliferative, and combined morphologies. We reviewed and analyzed the retrospective data and the findings during membranectomy to identify the etiological variables associated with various morphologies of VAO.

Results:

The median age at primary surgery was 7 (2–96) months. The median interval from primary surgery to the first documentation of VAO was 6 (1–22) months. Younger children developed VAO sooner than older children. VAO was fibrotic in 11 eyes (33%), proliferative in 18 eyes (54.5%), and combined in four eyes (12.12%). Most children with fibrotic VAO belonged to economically disadvantaged sections of society (P = 0.04).

Conclusion:

Lower age at primary surgery was the predominant risk factor for the development of VAO. Besides primary posterior capsulotomy and adequate anterior vitrectomy, a strict adherence to anti- inflammatory measures and follow up in necessary to prevent the occurrence of VAO. A close follow-up facilitates early detection and management, which can prevent the onset of visually impairing amblyopia.
Variations in choroidal thickness between emmetropic and myopic eyes after caffeine intake
Authors: Alotaibi Wafa , Alhazmi Mohammed , Khormi Salha , Almaslokh Turki , Alanazi Muteb , Althomali Mohammed
Published: March 2024

Purpose:

To investigate the variations in choroidal thinning between emmetropic and myopic subjects after caffeine intake.

Methods:

Forty-five healthy participants (age mean ± standard deviation [SD]: 20.75 ± 1.6 years) recruited in a prospective cross-sectional study. They were divided into three groups, based on refractive error status, emmetropes (spherical equivalent [SE] -0.25 to +0.25D), myopes (SE ≥-0.50D to ˂-6.00D), and high myopes (SE ≥-6.00D). The participants underwent choroidal thickness [ChT] measurements using optical coherence tomography [OCT] (Topcon 3D OCT-1 Maestro System) at baseline, 20, 40, and 60 minutes after consuming 200 mg of caffeine. The measurements of ChT were taken from five different areas horizontally.

Results:

Compared to baseline measurement, the ChT significantly decreased after 200 mg caffeine intake in all conditions (P< 0.001). There was a statistically significant difference in ChT at baseline between the refractive groups (χ2(2)=6.548,P= 0.038) as the high myope group showed lesser horizontal ChT within Nasal at (1 mm) area compared to the myope group (P= 0.032), however, no other significant differences in mean scores of horizontal ChT at baseline were found. The thinning in ChT in the high myope group was lesser compared to both emmetrope and myope groups; however, it was not statistically significant (P> 0.05).

Conclusion:

The results of this study suggest that the reduction in ChT due to caffeine consumption is not significantly affected by the refractive status of the eye. Thus, it is safe to hypothesize that the vascular part of the choroid behaves identically to vasoconstrictive in both emmetropic and myopic eyes. The choroidal thinning found in myopic and high myopic eyes and/or the reduced choroidal vascularity index were not apparent in this study. Therefore, further longitudinal studies recruiting greater numbers of participants, including myopes and high myopes, and measuring both vascular and stromal layers to investigate such variations are warranted.
The scope of artificial intelligence in retinopathy of prematurity (ROP) management
Authors: Maitra Puja , Shah Parag K , Campbell Peter J , Rishi Pukhraj
Published: March 2024

Artificial Intelligence (AI) is a revolutionary technology that has the potential to develop into a widely implemented system that could reduce the dependence on qualified professionals/experts for screening the large at-risk population, especially in the Indian scenario. Deep learning involves learning without being explicitly told what to focus on and utilizes several layers of artificial neural networks (ANNs) to create a robust algorithm that is capable of high-complexity tasks. Convolutional neural networks (CNNs) are a subset of ANNs that are particularly useful for image processing as well as cognitive tasks. Training of these algorithms involves inputting raw human-labeled data, which are then processed through the algorithm’s multiple layers and allow CNN to develop their own learning of image features. AI systems must be validated using different population datasets since the performance of the AI system would vary according to the population. Indian datasets have been used in AI-based risk model that could predict whether an infant would develop treatment-requiring retinopathy of prematurity (ROP). AI also served as an epidemiological tool by objectively showing that a higher ROP severity was in Neonatal intensive care units (NICUs) that did not have the resources to monitor and titrate oxygen. There are rising concerns about the medicolegal aspect of AI implementation as well as discussion on the possibilities of catastrophic life-threatening diseases like retinoblastoma and lipemia retinalis being missed by AI. Computer-based systems have the advantage over humans in not being susceptible to biases or fatigue. This is especially relevant in a country like India with an increased rate of ROP and a preexisting strained doctor-to-preterm child ratio. Many AI algorithms can perform in a way comparable to or exceeding human experts, and this opens possibilities for future large-scale prospective studies.
Clinical and demographic profile of herpes zoster ophthalmicus: A hospital-based study of 1752 Indian patients
Authors: Rathi Anubha , Das Anthony V , Ramappa Muralidhar
Published: March 2024

Purpose:

To describe the clinical and demographic profile of herpes zoster ophthalmicus (HZO) in patients presenting to a multitier ophthalmology hospital network in India.

Methods:

Cross-sectional hospital-based study included 3,004,470 new patients between August 2010 and October 2021. Patients with a clinical diagnosis of HZO in at least one eye were included. Data were collected using an electronic medical record system.

Results:

In total, 1,752 (0.058%) patients were diagnosed with HZO. Nearly two-thirds were male (63.76%) in the seventh decade of life (339;19.35% patients) with unilateral (98.34%) affliction. Higher prevalence was seen in patients from higher socioeconomic status (0.059%) and metropolitan geography (0.062%). Most common ocular signs included eyelid edema (44.19%), conjunctival congestion (65.69%), punctate keratopathy (23.36%), and anterior uveitis (21.22%). Of the 1,781 eyes, mild/no visual impairment was seen in 952 (53.45%) eyes, moderate in 258 (14.49%) eyes, and severe to blindness in 363 (20.39%) eyes. Oral antivirals were started within 72 h (Group A) in 361 (20.61%) patients and after 72 h in 1391 (79.39%) patients (Group B). Significantly lesser severity of ocular involvement was noted in Group A (P < 0.00001). Surgical intervention was required in 211 (11.85%) eyes.

Conclusion:

HZO more commonly affects males in the seventh decade of life and is predominantly unilateral. It more commonly affects those from higher socioeconomic strata and metropolitan regions. Half of the eyes have mild or no visual impairment, while others have moderate to severe impairment. Institution of antivirals within 72 h is associated with less severe involvement. Surgical intervention is warranted in a tenth of the eyes.