bluuebunny/crossref_metadata_2025 huggingface dataset:
Parkinson's Disease and Wearable Technology
Authors: Bagrodia Vaishali , Holla Vikram V. , Kamble Nitish L. , Pal Pramod K. , Yadav Ravi
Published: August 2023

Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder. In India, an accurate number of PD patients remains uncertain owing to the unawareness of PD symptoms in the geriatric population and the large discrepancy between the number of PD patients and trained neurologists. Constructing additional neurological care centers along with using technology and integrating it into digital healthcare platforms will help reduce this burden. Use of technology in PD diagnosis and monitoring started in 1980s with invasive techniques performed in laboratories. Over the last five decades, PD technology has significantly evolved where now patients can track symptoms using their smartphones or wearable sensors. However, the use of such technology within the Indian population is non-existent primarily due to the cost of digital devices and limited technological capabilities of geriatric patients especially in rural areas. Other reasons include secure data transfers from patients to physicians and the general lack of awareness of wearables devices. Thus, creating a simple, cost-effective and inconspicuous wearable device would yield the highest compliance within the Indian PD patient population. Implementation of such technology will provide neurologists with wider outreach to patients in rural locations, remote monitoring and empirical data to titrate medication.
Airway Management of Thyroid Malignancy with Cervical Spine Metastasis for a Two-Stage Dual Procedure; Discretion Dictates Never Burn Your Bridges
Authors: Bedekar Unmesh Pramod , Monteiro Joseph Nascimento , Goraksha Shwetal , Shilimkar Renuka
Published: August 2023

Thyroid swellings are a known cause of airway obstruction and potentially difficult intubation due to compression and deviation of the trachea. We encountered a unique challenging case of a malignant retrosternal goitre compressing the trachea, with cervical spine metastasis causing paresthesia and weakness in all four limbs, for a two-stage dual procedure, embolisation and excision of thyroid, and embolisation and fixation of the cervical spine.
Management of a Case of Tracheal Tumour Causing Near Total Airway Obstruction
Authors: Singh Shiksha , Bhatti Rishikesh , Tilak Aditi , Saksena Shalini
Published: August 2023

Tracheal tumours are rare and often present as asthma or chronic obstructive airway disease. These tumours can cause partial or complete airway obstruction, especially after giving anaesthesia. Here, we present a case of tracheal tumour posted for bronchoscopic excision. These tumours present as a real challenge to anaesthesiologists as the airway is shared with the surgeons and maintaining a patent airway can be difficult.
Mechanics and Dynamics of the Pharynx
Authors: Patwa Apeksh , Shah Amit , Patwa Apeksha
Published: August 2023

Maintaining airway patency during anaesthesia is the primary responsibility of the anaesthesiologist. Apart from anaesthetic agents, there are many factors which influence the pharyngeal patency. Understanding the pharyngeal collapsibility and behaviour of the upper airway during sleep would help in increasing the safety of patients under anaesthesia. The mechanism of pharyngeal collapse, the role of pharyngeal dilators, negative intra-thoracic pressure and multiple other factors involved to maintain pharyngeal patency are described in the article. Clinical and radiological tools to predict upper airway collapsibility have also been explained with supportive evidence. This article should be considered a resource for concepts of pharyngeal dynamics and mechanics to improve airway patency and to predict pharyngeal collapsibility and thereby safety during anaesthesia.
Clinical and prognostic effect of MYC protein score in patients with diffuse large B-cell lymphoma in relation to blood group secretor status
Authors: Elgammal Maha A , Sadek Nadia A , Maghraby Hala K , Yahia Mona , Bakr Feissal Maha A , Balbaa Ola A
Published: August 2023

Background

Lymphoma is the most common blood cancer. Diffuse large B-cell lymphoma (DLBCL) is the most common form of NHL. In Egypt, It represents about 49% of NHL presenting to the National Cancer Institute (NCI), Cairo University. It is an aggressive lymphoma where multiple clinical and laboratory prognostic factors affect its clinical course.

Aim

The aim of the present study was to determine MYC protein score immunohistochemically and by using image optical density (IOD) in relation to secretor status in patients with DLBCL in order to extrapolate their clinical and prognostic impact.

Method

Thirty DLBCL patients were enrolled in this study during the period from Oct.1st, 2014 to Oct.1st, 2016 and 15 matched normal subjects as control. The follow up period for the patients was 24 months. A full medical history was taken together with laboratory analyses.

Results

According to our findings, a high significant relation was found between c-Myc score and IPI (p = 0.009). The mean IOD for Myc expression was statistically and significantly higher in patients with high IPI ((p = 0.001) at a cut off value of 50%) splenomegaly was higher among male patients, lymphocyte/monocyte ratio (LMR) was significantly lower in patients than in the control group and was associated with positive MYC protein expression with high scores (≥50%). Our study also confirmed that secretor status (B +ve) Lewis blood group phenotype carried a better prognosis, a higher overall survival associated and a lower MYC protein score. MYC protein in our patients was significantally correlation to β2M (r= 0.791), LDH (r= 0.697), IPI (r= 0.562) and IOD (r= 0.996). There was a significant negative correlation to Absolute Lymphocytic Count (ALC) (r= - 0.590) and LMR (r= - 0.694). Age, hemoglobin, TLC and platelet count did not show any significantt correlation to MYC protein.

Conclusion

Expression Determination of MYC scoring and secretor state are highly recommended at the initial evaluation of DLBCL patients.
The role of HBG2, BCL11A, and HBS1L-MYB in early diagnosis of transfusion-dependent thalassemia among Egyptian children
Authors: Shabaan Howyda M K , Ahmed Saad S A , Shalaby Marwan A B , Fallah Asmaa A
Published: August 2023

Background

Hereditary hemoglobinopathies are the most frequent diseases accountable to a single gene defect. Common mutations of the beta-globin gene are detected by PCR-based techniques.

Objective

To evaluate the role of HBG2, BCL11A, and HBS1L-MYB polymorphisms in addition to Thalassemia Severity Score (TSS) in the early diagnosis of transfusion-dependent thalassemia patients among Egyptian children and their impact on clinical decision.

Patients and methods

Thalassemia mutation analysis was performed by the Beta-Thal Modifier Strip Assay to determine the five polymorphisms associated with severity, and an automated online calculator (TSS).

Results

The transfusion-dependent group showed significantly higher TSS (P<0.001), with a sensitivity of 75%, specificity of 95%, positive predictive value of 93.8%, negative predictive value of 79.2%, and an accuracy of 85%. HBG2 CT and CC genotypes were significantly associated with younger age of first transfusion and higher transfusion rates. Deletion in alpha gene was significantly associated with TT genotype, followed by GG and then GT. TSS decreased gradually through wild, heterozygous, and homozygous rs7482144 and rs1427407 genotypes. Transfusion-free survival tends to decrease gradually with increased TSS severity (P<0.001). The HBS1L-MYB rs9399137 TC genotype was associated with poor transfusion-free survival by Cox regression analysis. Beta phenotype mild/mild, mild/severe, rs7482144 CT, TT, and rs1427407 GT, TT were associated with the protective effect against higher severity.

Conclusion

HBG2, BCL11A, and HBS1L-MYB have an important role in early diagnosis and prognosis of transfusion-dependent thalassemia among Egyptian children.
The association between hemostatic and genetic parameter variation and the susceptibility to develop vascular complications in Egyptian Bechet’s disease patients
Authors: Raslan Hanan N A , El-Jaafary Shaimaa I , Hassan Aya O S , Yousry Sherif , El Sissy Maha H
Published: August 2023

Objectives

Bechet’s disease (BD) is a multisystem inflammatory disorder with predominant and frequent vascular complications. The pathogenesis of thrombosis in BD is not clearly known, vasculitis and/or multifactorial procoagulant activities are the cornerstone histopathological features of the disease.

Patients and methods

In this study, we investigated the role of hypercoagulable state and the hemostatic alteration in BD patients and their susceptibility to develop vascular thrombotic complications using ViennaLab CVD StripAssay for molecular detection of thrombophilia gene mutation by PCR and reverse hybridization to allele-specific oligonucleotide probes immobilized on test strip. Natural anticoagulant levels were also assessed to trace the association between activated coagulation system and increased susceptibility of BD patients to develop vascular complication.

Results

The study revealed a significant association between human platelet antigen-1 polymorphism and the presence of vascular thrombosis, either arterial or venous, in BD patients. Also, there was a significant relationship between mutant MTHFR genotype and venous thrombosis. But, there was an insignificant association between vascular complications in BD patients from one side and the levels of natural anticoagulants (protein C, protein S, and antithrombin III) and mean platelet volume (MPV) level from the other side.

Conclusion

Despite the association of some thrombophilic factors with the thrombotic tendency seen in BD, the usage of anticoagulants in BD patients with thrombosis may be unnecessary.
Peripheral blood lymphocyte subset count in COVID-19 patients
Authors: Shahin Doaa , Mortada Metwaly I , Abousamra Nashwa , El Menshawy Nadia , Hasan Ahmed S , Eisa Noha , EL-Ashwah Shaimaa , Emarah Ziad , Elmaria Marwa O , Bakeer Mostafa , Saleh Ahmed , Ghannam Mayada A
Published: August 2023

Background:

(COVID-19) pathophysiology and the predictive factors are not fully understood, but lymphocyte dysregulation appears to play a role.

Aim and Objectives:

To explore the clinical value of lymphocyte subset changes in COVID-19 patients’ peripheral blood, which may illustrate the pathogenesis of COVID-19.

Methods:

This is prospective cohort study of 73 hospitalized patients with confirmed COVID-19 who were classified into two groups: non-severe and severe. Lymphocyte subsets (CD3, CD4, CD8, CD19, and CD56) were assessed using flow cytometry.

Results

Lymphocyte gate, CD3, CD4, CD8, and CD56 counts were significantly reduced in severe cases compared with nonsevere cases (P0.001, 0.006, 0.016, 0.011, and 0.008 respectively). Patients were divided into two groups according to cut off age (<50 and ≥ 50years) and (NLR) (NLR <4.14 and NLR ≥ 4.14). There was a significant difference in severe illness probability in two groups P0.001 and 0.001 respectively). Then, patients were divided into four groups by both NLR cutoff and age, There also significant difference in severe illness probability between four groups (P<0.001).

Conclusion

Based on our data, management of patients with COVID-19 pneumonia can be improved based on NLR and age model. We suggest that patients with NLR ≥ 4.14 should be admitted to isolation ward with close follow-up and actively transfer to intensive care unit.
Effect of platelet storage on complement activation
Authors: Mahmoud Amal A , Mohamed Maha A , Ahmed Shimaa A , Abdallah Mariam E
Published: August 2023

Background

Many specialists involved in patient care, from laboratory personnel to clinical physicians, are interested in platelet transfusion. In the field of transfusion medicine, the complement cascade is crucial. The study aimed to detect the complement levels of platelet-rich plasma to see whether there was a risk of transfusion of stored platelets.

Study design and methods

For 5 days, 10 U of platelet-rich plasma were stored on a platelet rotator at a temperature of 22–24°C. On days 0 (baseline), 3, 4, and 5, samples were taken using a sterile technique. C3a and C4d were tested as complement components to evaluate the level of complement activation. Both the platelet count and culturing were performed on the same day.

Results

Both C3a and C4d were insignificantly elevated over storage time up to day 5 compared with day 0 (baseline sample). Throughout the storage days, the platelet count decreased significantly. Culture had no significant impact.

Conclusion

Our findings show that under standard storage conditions, platelet storage had minimal complement activation or contamination, but with a significant decrease in platelet count.
Clinical significance of serum prohibitin in chronic myeloid leukemia patients on first-line tyrosine kinase inhibitors
Authors: Yassin Heba A , Azaazi Mohamed O , Hegab Hany M , Nabih Nermine A , Rakha Nahed M , Naguib Mary G
Published: August 2023

Background

Prohibitin is a widely expressed intracellular protein that is distributed in various compartments, where they exert different biological functions accordingly. Prohibitins have displayed both protumorigenic and antitumorigenic roles in cancer formation. Depending on the type of cancer and the localization of prohibitin, studies have shown that it exerts a different biological role.

Aim

This study aims to investigate prohibitin level in Egyptian patients with chronic myeloid leukemia (CML) and to evaluate its correlation with disease activity and response to first-line tyrosysine kinase inhibitor treatment.

Patients and methods

Prohibitin level was measured using enzyme-linked immunosorbent assay in 80 CML patients in the chronic phase. They were recruited from the clinical hematology division of Internal Medicine Department, Ain Shams University Hospitals. They were matched to 10 healthy volunteers as a control group.

Results

In our study, we have demonstrated that prohibitin levels were significantly higher in patients with CML than in the control participants (P=0.002). Prohibitin levels were significantly higher in CML patients with an active disease status (P=0.001). In addition, significantly higher levels of prohibitin in CML patients were associated with poor response to first generation TKIs (P=0.001). Receiver-operating characteristic curve was applied. A serum level of prohibitin higher than 289 is a good predictor for poor response to first generation TKIs as per response assessment by PCR for BCR-ABL (area under the curve=0.67, sensitivity and specificity 58.33 and 80.56, respectively).

Conclusion

Prohibitin is overexpressed in CML patients and has a possible impact on disease activity and response to treatment in CML patients that warrants further investigations.
Extended red blood cell phenotyping among regular donors in Fayoum, Egypt. Red Blood Cell Inventory Plan
Authors: Abdelrazik Abeer M , Abdelaziz Hossam M
Published: August 2023

Background

Antibodies to clinically significant red cell antigens contribute to hemolytic transfusion reactions and hemolytic disease of fetus and newborn. The aim of the study was to estimate the prevalence of extended red cell antigen phenotypes among regular donors in Fayoum, Egypt, and to create an emergency model database for chronic transfusion patients. Similar data in Egypt is rare to find in the literature.

Patients and methods

The study was carried out over 1 year from December 2020 until November 2021in Fayoum University Hospital Blood Bank. In all, 1834 healthy known blood donor samples were analyzed for major Rh phenotypes (D, C, c, E, e) and for other clinically significant systems including Kell, Kidd, MNS, and Duffy.

Results

Phenotypic frequencies of Rh system were D+ (84.4%), e+ (79.6%), and C+ (63.9%). The K antigen frequency was 4.3%, Jka 79.4%, Jkb 62.37%, Fy a 33.2%, Fy b 44.4%, M antigen 88%, N antigen 38.6%, and the S and s antigens 48.2 and 85.3%, respectively.

Conclusion

Determination of red cell antigen phenotyping in Fayoum, Egypt, plays an important role in setting a routine phenotyping strategy for multiple transfused patients by keeping the donor database for rare phenotypes to prevent hemolytic transfusion reaction.
Study of the morphologic changes in the peripheral blood smear as a predictive tool for the early diagnosis of coronavirus disease 2019 and their relation to the clinical course severity
Authors: Abdelsalam Hadeel S , Rahman Mohamed A , Ibrahim Elsherif Amr A , Bakheet Osama H , EL-Kady Hadir
Published: August 2023

Introduction

Coronavirus disease 2019 (COVID-19) infection affects different organs of the human body, and also the blood cells.

Since the beginning of the COVID-19 pandemic, many studies have described the quantitative peripheral blood findings seen in COVID-19 patients. However, morphologic changes have been described by only a few studies.

Peripheral blood smear (PBS) is a simple and available method to investigate blood cells’ morphologic changes.

Aim

In this study, we aimed to determine the morphologic changes affecting all blood cells of COVID-19 patients and their relation to the early diagnosis and the patients’ clinical course severity.

Patients and methods

PBS of 200 COVID-19 patients and 50 non-COVID-19 controls was examined for morphological changes in the period between January 2021 and January 2022, the patients’ clinical course and blood chemistry were reported.

Results

Significant morphological changes were found. Smudge cells are the most frequent. Other findings were schistocyte, increased large granular lymphocytes, leukoerythroblastic reaction, pseudo Pelger–Huët, abnormal monocytes, and giant platelets. Our results showed significant relationship between PBS findings and the clinical course severity and outcome.
Epithelial ingrowth under LASIK flaps: tips and tricks for preventing recurrence!
Authors: Venugopal Anitha , Madkaikar Aditee , Ravindran Meenakshi
Published: August 2023

Background:

LASIK for refractive error correction has become a universal surgery. Despite its popularity, the estimated prevalence of traumatic flap dislocations in post-LASIK patients is 3.9%, and it is sometimes associated with epithelial ingrowth. The prognosis in such cases depends on the rapid surgical revision of the flap with the removal of the EI and perioperative steps to prevent Epithelial ingrowth (EI) recurrence in the future.

Purpose:

The video aims to display the steps involved in revising the flap, removing EI, and tips to prevent its recurrence.

Synopsis:

A 33-year-old post-LASIK patient presented with decreased vision, photophobia, and glare during the COVID pandemic in the right eye for 2 months. The best-corrected visual acuity was reduced to 6/60. The anterior segment revealed traumatic flap dislocation along with macro fold temporally and epithelial ingrowth. She underwent a successful flap revision surgery with no recurrence of epithelial ingrowth postoperatively.

Highlights:

A successful revision of a 2-month-old traumatic folded flap was performed along with the complete removal of EI. It explains the step-by-step approach to avoid the recurrence of EI in each step of the surgical revision of the flap. The video is self-explanatory and guides novice surgeons too.

Video link:
https://youtu.be/JuOSjhrfw0g

Key words: Epithelial ingrowth, LASIK, traumatic flap dislocation
Long-term outcomes of therapeutic corneal transplants performed in a tertiary eye care hospital in South India
Authors: Christy Josephine S , Mathews Priya , Ravisankar Rashmita , Akpek Esen K
Published: August 2023

Purpose:

This study aimed to review the demographics, clinical characteristics, and long-term outcomes of therapeutic penetrating keratoplasty (TPK) performed in a tertiary eye care hospital.

Methods:

Case records of 149 therapeutic transplants (135 patients) that were performed during the calendar year 2016 were retrospectively analyzed, and outcomes were measured until 3 years of follow-up. Information on demographics, presentation characteristics, keratoplasty indications, offending microbe, and secondary surgical interventions was studied. The final outcome was classified in terms of therapeutic, anatomical, and functional outcomes.

Results:

The median age of the recipients was 55 years with 61% men. The most common indications for TPK were perforated infectious ulcer (45.9%), nonhealing ulcers (29.9%), and graft infections (17.4%). Fungal etiology was noted in 61.2% and bacterial etiology in 17.4% of the eyes. Therapeutic success was achieved in 130 eyes (89%) at the end of 1 month. Anatomical success was achieved in 130 (98.5%) and 88 patients (86.3%) at the end of 1 and 6 months, respectively. At the 6-month time point, 78 patients (76.5%) attained functional success with vision better than light perception. Three-year follow-up data were available for 23.7% of recipients, of which only 12 patients (37.5%) retained a clear graft either after a primary therapeutic or secondary optical keratoplasty.

Conclusion:

Therapeutic keratoplasty is highly effective in eradicating infection and providing anatomical integrity. However, timely intervention can aid in achieving the best functional outcome.
Corneal blindness and eye banking: Current strategies and best practices
Authors: Anitha Venugopal , Tandon Radhika , Shah Sushmita G , Radhakrishnan Naveen , Singh Sankalp , Murugesan Vanathi , Patwardhan Veena , Ravindran Meenakshi
Published: August 2023

Corneal blindness (CB) is one of the leading causes of blindness in India and globally, affecting around 8 million population worldwide. Many of these corneal blind patients may be visually rehabilitated by corneal transplantation (CT). Eye banking plays a crucial role in facilitating CT and ocular research. Many countries have adopted regulatory frameworks, quality assurance programs, and technological advancements to enhance the efficacy and safety of CT. Various infrastructural and organizational frameworks of eye banks (EBs) in India, according to the Eye Bank Association of India (EBAI), aid in establishing guidelines and standards for EB practices. Initiatives such as the National Programme for Control of Blindness (NPCB) have significantly contributed to eye donation rates and improved access to donor corneas. This review article discusses the established eye banking networks in countries such as India, the United States (USA), and Europe, where dedicated EB organizations work collaboratively to ensure efficient procurement, processing, and distribution of corneal tissue. It also highlights specific strategies employed in India and global countries to address EBs’ challenges. These challenges include the shortage of donor corneas, improving donor screening and tissue processing techniques, ensuring timely distribution of corneal tissue, and maintaining high-quality standards. Interestingly, the comparative analysis between India and other developed countries highlights the similarities and differences in eye banking strategies. By understanding the strategies employed by different regions, EBs can learn from each other’s experiences and work toward achieving optimal outcomes in CT and ocular research worldwide. It underscores the importance of knowledge sharing and collaborative efforts in addressing common challenges and implementing best practices in eye banking.
Ten-year follow-up of corneal cross-linking and refractive surface ablation in patients with asymmetric corneal topography
Authors: Moscovici Bernardo Kaplan , Rodrigues Pablo Felipe , Dantas Marcos Paulo Suehiro , Okimoto Juliana Taemy , Naves Obidulho Sakassegawa , Taguchi Felipe Marques de Carvalho , Malta João Baptista Nigro Santiago , Campos Mauro
Published: August 2023

Purpose:

Compare the safety and efficacy of wavefront-guided photorefractive keratotomy (PRK) 6 months after cross-linking (CXL) to wavefront-guided PRK alone for refractive correction in patients with bilateral asymmetric corneal topography.

Methods:

Prospective randomized clinical trial with 16 patients (32 eyes). CXL with subsequent PRK after 6 months in one eye, and PRK alone was performed in contralateral eyes. The follow-up was 10 years. We analyzed visual outcomes, Scheimpflug topography, and corneal haze evaluation.

Results:

Eyes in the PRK group showed better results than in the CXL + PRK group. Mean postoperative CDVA was 0.044 logmar (SD, 0.073) in the PRK group and 0.1 logmar (SD, 0.21) in the CXL + PRK group, the mean sphere was + 0.21 (SD, 0.6) D in the PRK group and 0.87 (SD, 2.3) D in the CXL + PRK group, and mean SE was −0.35 (SD, 0.65) D in the PRK group and 0.62 (SD, 2.32) D in the CXL + PRK group. In one patient, a steepening of 2.5 D and a thinning of 17 µm occurred in PRK alone group. Two patients in the CXL + PRK group presented corneal haze. The overall complication rate was 18,75% (haze and ectasia).

Conclusion:

Non-simultaneous CXL and PRK procedures yielded good refractive results, but worse than those obtained with PRK alone. Although one patient in the PRK group developed corneal ectasia, the CXL + PRK group had a higher loss of vision lines, indicating less safety.
Cataract surgery following penetrating keratoplasty in children
Authors: Janani Rajendran , Sneha Pandurangan
Published: August 2023

Background:

Following penetrating keratoplasty, cataract surgery warrants certain modifications to ensure maximum survival of the graft.

Purpose:

To emphasize the intraoperative challenges and surgical manipulations to be followed.

Synopsis:

The surgeon makes a superior sclerocorneal tunnel avoiding the graft host junction. Dispersive viscoelastic is used. Continuous curvilinear capsulorhexis is done. Cataractous lens aspirated with a low flow rate. The intraocular lens is placed in the bag. Superior peripheral iridectomy and primary posterior capsulorhexis are done. The wound closed with two interrupted 10–0 nylon sutures. Graft host junction integrity is maintained.

Highlights:

Ensure 1. Good intraoperative corneal visibility, 2. Avoid graft host junction for main port incision 3. Generous dispersive viscoelastic use/soft shell technique to protect the corneal endothelium, 4. Avoid phaco energy in case of soft cataracts/low phaco energy and flow rates, 5. Phaco probe to be meticulously oriented away from corneal endothelium, 6. Primary posterior capsulorhexis to be done as in any pediatric cataract surgery, 7. Make sure of the graft host junction integrity at the end of the surgery, 8. Restrict to a single port whenever possible.

Video link:
https://youtu.be/tu4R5JangYs

Key words: Graft survival, pediatric cataract surgery, penetrating keratoplasty
Anti-fungal efficacy of combination of amphotericin B with colistin and gentamicin in McCarey-Kaufman corneal preservation medium
Authors: Kukutam Sushmasri , Chaurasia Sunita R , Joseph Joveeta , Roy Sanhita , Ramachandran Charanya , Kandibanda Srinivas
Published: August 2023

Purpose:

To curtail the potential of donor corneal tissue disseminating fungi to the recipient’s eye, we evaluated the addition of amphotericin B to McCarey-Kaufman (M-K)—corneal storage medium supplemented with colistin.

Methods:

Amphotericin B was examined for its ability to inhibit the growth of Candida albicans and Aspergillus flavus using a microbroth dilution test and checkerboard assay in combination with only gentamicin and a combination of colistin, gentamicin, and amphotericin B. The safety on epithelium and endothelium was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay.

Results:

The minimal inhibitory concentration of gentamicin was found to be >256 μg/ml against both C. albicans and A. flavus, whereas that of amphotericin B was found to be in a range of 0.25–0.5 and 1–2 μg/ml for C. albicans and A. flavus, respectively. According to the checkerboard assay, 80% (4/5) of C. albicans isolates and 100% (5/5) of A. flavus isolates responded synergistically to the combination of amphotericin B and gentamicin, but only 20% (1/5) of C. albicans isolates showed an additive effect. None of the tested isolates displayed antagonism. The combined effect of the three drugs also did not display any antagonistic effect. Additionally, the MTT assay reveals no toxic effect of the antimicrobials used on corneal epithelial and endothelial cells.

Conclusion:

In vitro experiments demonstrate that amphotericin B is not toxic to either epithelium or endothelium and is a promising additive to the M-K medium supplemented with colistin.
Prevailing practice patterns in keratoconus among Indian ophthalmologists
Authors: Deshmukh Rashmi , Shrivastava Alok Kumar , Vaddavalli Pravin Krishna
Published: August 2023

Objective:

The past few years have seen a rapid advancement in the management of keratoconus (KC). However, there is no prescribed standard of care for the management of KC. This study evaluated the prevailing practice patterns among Indian ophthalmologists in the diagnosis and treatment of KC via an online survey.

Methods:

This was a survey-based cross-sectional study in which a questionnaire (Supplement 1) was created. Questions pertaining to the practicing experience, setting of practice, and training background were asked in addition to the investigations done and decision making in KC management. Responses were collected via Survey Monkey (Survey Monkey, Palo Alto, California, USA) and statistical analysis performed using R software (4.1.3).

Results:

The survey was answered by 273 ophthalmologists. Pentacam was the most used topographer (195 users), followed by Orbscan (41 users), Sirius (34 users), and Galilei (3 users). The lowest limit of pachymetry for performing collagen crosslinking (CXL) was 400μ for most practitioners. More than half the respondents (50.55%) did not perform photorefractive keratectomy (PRK) or intracorneal ring segment (ICRS) implantation in a suitable patient. Accelerated 10-minute protocol (9 mW/cm2 for 10 minutes) was the most commonly (54.21%) used for CXL, followed by Dresden protocol (3 mW/cm2 for 30 minutes) (36.63%). When a patient was unsuitable for CXL, 55.31% surgeons advise contact lens (CL) trial, 35.16% surgeons advise keratoplasty, 26.74% surgeons perform stromal augmentation, and 7.69% surgeons advise spectacle correction. Corneal scar was the most common indication (49.45%) for performing keratoplasty.

Conclusion:

Topography remains the most used diagnostic modality for initial diagnosis. Optical coherence tomography and epithelial mapping are increasingly being used for early diagnosis of KC. Not all ophthalmologists were comfortable performing ICRS or PRK. When patients are unsuitable for CXL, CL trial remains the most frequently advised option followed by keratoplasty.
Removal and identification of a subconjunctival parasite by light and scanning electron microscopy
Authors: Jha Vikas Kumar , Verghese Amita , Basaiawmoit Priya , Janakiraman Narayanan , Raman Muthusamy , Biswas Jyotirmay
Published: August 2023

Background:

Ophthalmic dirofilariasis is an uncommon zoonotic parasitic infection caused by species of Dirofilaria, a dog tapeworm that is transmitted to human by mosquitoes. Man is a dead-end host for the parasite. Ophthalmic involvement is rare and includes periorbital, subconjunctival, subtenon, and intra-ocular involvement. We report the removal of a subconjunctival worm and identification by light microscopy (LM) and scanning electron microscopy (SEM).

Purpose:

A 62-year-old female presented with complaints of redness, discharge, and foreign body sensation with difficulty in opening eyes in the left eye for the last 3 days. The patient is a non-vegetarian. On examination, her best corrected visual acuity in both eyes was 20/20. On slit lamp examination, there was a long, thin, round, coiled white subconjunctival live worm in the left eye superiorly. The rest of anterior segment evaluation, intra-ocular pressure, and fundus was normal in both eyes. The parasite was removed under local anesthesia from subconjunctival space [Video]. External surface morphology under LM revealed fine transverse cuticular striations with tapered cephalic and caudal ends. Uterus was long and coiled with indistinguishable masses inside. The finding was also confirmed by SEM.

Synopsis:

A subconjuctival parasite was removed and identified as Dirofilaria repens by characteristic LM and SEM findings.

Highlight:

Dirofilaria species may lodge in many tissues of human bodies including eye and adnexa. Dirofilaria is a natural parasite of carnivorous animals, mostly dogs, cats, and foxes.[1] The most common mode of transmission to human is usually by bite of mosquitoes like Culex and Aedes, which are considered as vectors, and it is often thought that parasitemia is because of accidental conduction.[1] Simple surgical removal of the worm is curative. After removal, the worm should be visualized directly under LM. All the internal structures of the transparent worm could be seen and compared with those under SEM.

Video Link:
https://youtu.be/XJb90ZHCX-I

Key words: Dirofilaria repens, light microscopy, scanning electron microscopy, subconjunctival dirofilariasis
A Case of Cobra Bite Complicated with Basilar Artery Occlusion
Authors: Yahaya Siti Nasrina Binti , Khan Abdul Hanif Khan Yusof , Sankala Hairuddin Achmad
Published: August 2023

Snakebite is one of the most common complaints related to wilderness medicine. Venomous snakebite manifestation is divided into local and systemic envenomation. For the Elapidae group, the most feared complication is respiratory muscle paralysis due to neurotransmitter malfunction at the neuromuscular junction level which leads to respiratory insufficiency. However, there is a lack of evidence or case report incidence to suggest that it can potentially associate with the development of stroke disorder. We present a rare case of massive posterior circulation infarct in a middle-aged gentleman following a cobra bite. He was brought to our center few hours later following the bite and antivenom was administered. He improved shortly after receiving it. However, he had an abrupt drop in his conscious level several hours later. Noncontrast-enhanced computed tomography (NCCT) brain was performed immediately, but stroke disorder was excluded prematurely. Repeated NCCT imaging which was done 12 h apart showed massive posterior circulation infarction with hydrocephalus. He succumbed to death 3 days later. Given its rarity, the evolution of his clinical condition warrants clinician’s early suspicion of potential stroke-related complications that can occur following a cobra bite.
Evaluation of vitamin D and vitamin D-binding protein levels and vitamin D receptor expression in basal cell carcinoma
Authors: Nagui Noha A. , Saleh Marwa A. , El-Daly Sherien M. , Khater Nohha H. , El Sharkawy Dina A.
Published: August 2023

Background

Exposure to the sun is the main cause of basal cell carcinoma (BCC) development and also the main source of vitamin D in the body. Vitamin D has anticancer activities; however, its role in BCC is debatable.

Objective

To measure the level of plasma vitamin D, vitamin D-binding protein (VDBP), and vitamin D receptor (VDR) relative expression in BCC patients and healthy controls, in an attempt to evaluate their association with BCC development.

Patients and methods

Plasma vitamin D and VDBP as well as VDR relative expression levels were measured in 30 BCC patients and 30 healthy controls. VDR relative expression was also measured in nonlesional skin of patients and compared with that of lesional skin.

Results

Vitamin D, VDBP, and VDR expression levels were statistically significantly lower in BCC patients (16.8±9.65 ng/ml, 275.8±206.7 ng/ml, 0.49±0.35, respectively) than in controls (22.7±11.3 ng/ml, 429.7±248.1 ng/ml, 1.02±0.07, respectively) (P=0.027, 0.12, and 0.001, respectively). In addition, VDR relative expression was statistically significantly lower in BCC tissue than in nonlesional skin of patients (0.644±0.234) (P=0.001).

Conclusion

Decreased vitamin D, VDBP, and VDR expression levels may be associated with BCC, suggesting a possible role in the pathogenesis of the disease. Correction of vitamin D deficiency via supplementation or topical application of vitamin D analogs may have a role in the prevention or therapy of BCCs that should be evaluated.
Limitations of dermoscopy in detecting distal and lateral subungual onychomycosis among patients with severely dystrophic nail psoriasis
Authors: El-Komy Mohamed H.M. , Aboelmagd Sara H. , Khalil Haidy S. , Abdelrahman Reem M. , Bedair Nermeen I.
Published: August 2023

Background

Onychomycosis among patients with nail psoriasis is being increasingly reported in the literature. When the two conditions coexist in the same nail, it is usually difficult to clinically detect the fungal nail affection.

Objective

To study the value of dermoscopy in detecting distal and lateral subungual onychomycosis among patients with nail psoriasis.

Patients and methods

Fifty psoriasis patients with nail changes were subjected to full history and clinical examination, including targeted Nail Psoriasis Severity Index calculation, dermoscopic examination and nail scrapping for fungal culture on Sabouraud dextrose agar, and dermatophyte (DM) test medium.

Results

Twelve (24%) of the 50 patients recruited showed a positive mycological growth on culture. Nondermatophyte molds and DM were isolated from 16 and 8% of patients, respectively. Nail psoriasis severity was not affected by fungal growth on culture and no significant relation could be detected between culture results and nail dermoscopic findings.

Conclusion

Specific dermoscopic signs of distal and lateral subungual onychomycosis do not appear to be evident in severely dystrophic psoriatic nails even when culture results show growth for DM and/or nondermatophyte molds.
Association between etiologic species with CD4 count and clinical features of oral candidiasis among HIV/AIDS patients
Authors: Murtiastutik Dwi , Prakoeswa Cita R.S. , Tantular Indah S. , Listiawan Muhammad Yulianto , Hidayati Afif N. , Ervianti Evy , Bintanjoyo Lunardi
Published: August 2023

Background

Oral candidiasis (OC) is an oral mucosal disorder due toCandidagenus. Its predisposing factor among patients with HIV/AIDS is mainly decreasing CD4 count. OC is commonly caused byCandidaalbicans.As CD4 decreases, the shift toC.non-albicanshas been observed.

Objective

To evaluate the association ofCandidaspecies with CD4 count and clinical features in HIV/AIDS patients with OC.

Patients and methods

This is a cross-sectional study. A total of 114 oral rinse solution samples from HIV/AIDS patients with OC were collected.Candidaspecies identification was done by culture in Chromagar followed by VITEK 2. The association ofCandidaspecies with CD4 count and clinical features was analyzed using Pearson'sχ2and Kruskal–Wallis tests.

Results

There was growth of 149 isolates in culture from 114 patients.C. albicanswas found in 104 (69.7%) isolates.Candidanon-albicans were found in 45 (30.3%) isolates, namelyCandida kruseiin 22 (14.85%),Candida glabratain 12 (8.1%),Candida tropicalisin six (4.05%),Candida dubliniensisin two (1.3%),Candida parapsilosisin two (1.3%), andCandidalipolyticain one (0.7%) isolate.Candidaspecies was significantly associated with clinical types, episode types, pain on swallowing, CD4 count, and antiretroviral (ARV) use among all patients.

Conclusion

Among HIV/AIDS patients with OC, growth ofC. albicansonly was more common in higher CD4 count, while mixed growth ofC. albicansandC.non-albicanswas more common in lower CD4 count. Clinical features associated with growth ofC. albicansonly were pseudomembranous type, recurrent OC, absence of pain on swallowing, and patients on ARV, whereas those associated with mixed growth ofC. albicansandC.non-albicanswere cheilitis type, first-episode OC, presence of pain on swallowing, and ARV-naive patients.
Wilson–Jones angiosarcoma of the scalp associated with alopecia and chest edema
Authors: El Enany Galal , Nagui Noha , Nada Hanan , Fawzy Marwa M. , Sany Iman , Shalaby Suzan , El Ghanam Omar
Published: August 2023

Wilson–Jones angiosarcoma is one of cutaneous angiosarcomas, which is a rare aggressive tumor of blood vessels of the skin. In this case report, we present a 72-year-old female who developed multiple episodes of facial edema of 2-year duration along with partial hair loss of the scalp. Investigations, including a skin biopsy, were diagnostic of scalp angiosarcoma.
Mucocutaneous manifestations in patients with chronic kidney disease
Authors: Khatri Hitesh S. , Adhicari Pankaj , Parry Manzoor A. , Sharma Manjuri
Published: August 2023

Background

Cutaneous manifestations in chronic kidney disease (CKD) can affect quality of life and can vary across regions, races, and nutritional status of patients.

Objective

To study the prevalence of mucocutaneous manifestations in patients with CKD and compare between dialysis and nondialysis patients.

Patients and methods

This was a cross-sectional study from North-East India. A total of 210 patients with CKD were included, with 61 patients in dialysis group and 149 in the nondialysis group. A comprehensive history, detailed examination, and all the relevant investigations were done.

Results

There was a male predominance in this study, and the mean age was 49.85±12.5 years. Diabetes mellitus (42.9%) was the most common cause of CKD. Cutaneous involvement was seen in 142 (67.61%) patients, with predominance in dialysis patients (60/61) (98.36%) as compared with nondialysis patients (80/149) (55.03%). Xerosis (58.09%) was the most common skin change seen in 122 patients, being more in the dialysis group as compared with the nondialysis group (73.8 vs. 51.7%; P=0.0034). This was followed by pallor (36.19%) of the skin and mucosa. Pruritus (35.23%) was seen in 74 patients, being more in dialysis patients. Cutaneous infections were seen in 57 patients. Absent lunula (14.26%) and half-and-half nail (12.85%) were the most common nail changes. Mucosal changes were seen in 28 (13.33%) patients. Hair changes were seen in 16.67% of patients, with predominant affection in dialysis patients.

Conclusion

Xerosis, pruritus, skin pallor, absent lunula, xerostomia, macroglossia, and infections were the most common mucocutaneous manifestations in this study. Xerosis, pruritus, absent lunula, and hair changes were more common in dialysis patients.
Assessment of perception and utility regarding flip classroom among MBBS students: A descriptive study
Authors: Khan S Muhammad S , Dkhar Sabira A , Quansar Ruqia
Published: August 2023

Purpose:

A flipped classroom is a type of blended learning technique. In modern times, the teaching techniques need to be improved and changed. The aim of the study was to assess the perception of students with regard to flipped classroom.

Materials and Methods:

The study was a descriptive cross-sectional study design. A total of 152 students participated in this study.

Results:

After watching the video and before the actual interaction, about 84.2% felt confident. About 56.6% of respondents thought flipped classrooms were superior to traditional classroom instruction. The flexibility of the “flipped classroom,” according to 44.1% of respondents, makes it the most useful feature. The aspect of flipped learning that 43.4% of students liked the most was learning about new ideas before class. A total of 98.2% thought they needed to be more accountable for their education.

Conclusion:

Although the flip classroom cannot completely replace the traditional classroom but when used in conjunction, it can help students learn more effectively. It has paved the path for improvements to teaching techniques and unquestionably produced a better manner of instruction.
Clinical profile and response to treatment in chronic hepatitis C and renal disease: A prospective study from North India
Authors: Ashraf Aadil , Wajeed Ahmad Yousuf , Khan Javed , Shah Altaf Hussain , Dar Hilal
Published: August 2023

BACKGROUND AND AIMS:

Successful treatment of hepatitis C virus (HCV) infection is associated with improved outcomes in different clinical domains. The treatment of HCV infection in high-risk groups like chronic kidney disease (CKD) is challenging. We conducted a study on the efficacy of the fixed-dose combination of sofosbuvir–velpatasvir in CKD patients.

MATERIALS AND METHODS:

The study was conducted in our hospital, Sher I Kashmir Institute of Medical Sciences Soura. Patients with HCV infection (detectable RNA levels) with an estimated glomerular filtration rate (eGFR) >15 mL/min were included in the study. All the patients were evaluated for liver disease. Patients with prior exposure to a direct-acting antiviral agent, portal vein thrombosis, or hepatocellular carcinoma were excluded from the study. All the patients received an open-label combination of sofosbuvir and velpatasvir (400/100 mg). The primary endpoint was to assess sustained virological response 12 (SVR12), and the secondary endpoint was to assess the side effect profile of the patients.

RESULTS:

A total of 33 patients were enrolled in the study, with 17 in Group A (GFR 15–30 mL/min/1.73 m2) and 16 in Group B (GFR >30 mL/min/1.73 m2). In total, 142 (87.6%) achieved viral clearance at 4 weeks of therapy. Sixteen out of 17 (94.1%) in Group A and 13 out of 16 (81.25%) in Group B achieved viral clearance at 4 weeks of therapy [early virological respsone (EVR)]. All patients in both groups achieved end-of-treatment response viral clearance, and the same number of patients maintained viral clearance 12 weeks after stopping the treatment (SVR12). In Group A, no significant improvement was seen in the mean level of any parameters pre and posttreatment. In Group B, there was an improvement in all the parameters except serum creatinine after the completion of treatment. However, the difference was significant between pre and posttreatment values of serum alanine transaminase (U/L) and liver stiffness measurement levels (P value of −0.04 and 0.01, respectively).

CONCLUSION:

We conclude that treatment with sofosbuvir–velpatasvir is a safe and effective treatment option in HCV infection in CKD.
A review study on Ayurveda treatment protocol for diabetic retinopathy
Authors: Kamaliya Sangita O. , Vaghela Dharmendra S.
Published: August 2023

Background:

Diabetic retinopathy (DR) is a serious hurdle seen in diabetic patients and major problem of visual impairment in developed nations. DR is essentially a microangiopathy affecting arterioles, venules, and capillaries of the retina. Recently, available treatments for DR have some obstacles; taking this into consideration best treatments from other streams are being searched.

Materials and Methods:

The present study is aimed to review research works carried out in Shalakya Department, Jamnagar. This study is planned to establish the effect of different Ayurvedic treatment protocols, viz., Panchakarma therapy like Nasya (use of medicated drugs through nostrils) and Virechana/Koshta Shodhana (therapeutic purgation) and ocular procedures (Netra Kriya Kalpa) like Takra Shirodhara (pouring of medicine-mixed buttermilk to the head) and Takra Shirolepa (application of buttermilk-mixed paste to the head) in DR. The numbers of patients in trials 1, 2, and 3 are 33, 46, and 100, respectively. Duration of treatment in trials 1 and 2 was 2 months and in trial 3 it was 3 months. Follow-up in all the trials was 1 month.

Results:

These treatment protocols were found to be significantly effective and safe. During the treatment and follow-up period, no any adverse drug reactions were reported.

Conclusion:

It can be said that selected intervention was found to be safe, having appreciative, effective, and helpful results for DR as a conventional treatment protocol and other choice of treatment for patients’ better quality of life.