bluuebunny/crossref_metadata_2025 huggingface dataset:
Writing the Grotesque in Jesmyn Ward's "Salvage the Bones"
Authors: Psilopoulou Katerina
Published: November 2021

In her work, Jesmyn Ward has revitalized the Southern Gothic tradition and its tropes to better reflect the realities of Black American life in the 21st century. This essay explores the reconfiguration of the grotesque body in Ward's sophomore novel, Salvage the Bones, which follows an impoverished Black family in Mississippi in the days leading up to Hurricane Katrina. In contrast to her literary predecessors, Ward defines the grotesque as a state of debility imposed on Black bodies and then deemed uniquely problematic to them as a class and race, rather than the result of centuries of structural oppression. As such, she understands the trope as encompassing far more than bodily or intellectual difference, the way in which it was previously utilized by Southern writers like William Faulkner and Carson McCullers. Instead, Ward theorizes the grotesque as a biopolitical state, in which populations that do not conform to the status quo, and specifically the dominant capitalist mode of production and consumption, are driven to the margins and their lives deemed expendable.
Apakah Kejujuran Pengelola Anggaran dan Jenis Penghargaan Mempengaruhi Senjangan Anggaran?
Authors: Simatupang Tio Rasmi
Published: November 2021

Penelitian ini bertujuan untuk mengetahui pengaruh kejujuran pengelola anggaran, penghargaan moneter dan non moneter terhadap senjangan anggaran. Penelitian ini menggunakan metode kuantitatif dan sumber data yang digunakan dalam penelitian ini  menggunakan data primer yang diperoleh dari kuesioner. Sampel yang digunakan sebanyak 60 responden dari perusahaan distributor yang diperoleh dengan metode purposive sampling. Uji hipotesis menggunakkan analisis regresi berganda. Hasil penelitian menunjukkan bahwa kejujuran pengelola anggaran berpengaruh signifikan terhadap senjangan anggaran. Sementara itu, penghargaan moneter dan non moneter berpengaruh signifikan terhadap senjangan anggaran. Secara simultan seluruh variabel independen dalam penelitian ini yaitu kejujuran pengelola anggaran, penghargaan moneter dan non moneter berpengaruh signifikan terhadap senjangan anggaran. Namun, ketika dilakukan uji terpisah pada penghargaan moneter dan non moneter terhadap senjangan anggaran hasil penelitian menunjukkan bahwa pengahargaan moneter berpengaruh terhadap senjangan anggaran sedangkan pengahargaan non moneter tidak berpengaruh terhadap senjangan anggaran. Penelitian ini memberikan implikasi bahwa organisasi  harus selalu meningkatkan kejujuran dalam pengelolaan anggaran dan memberikan penghargaan (reward) apabila karyawannya dapat mencapai target yang diharapkan.
Enigma of Respiratory Carriage of Kingella kingae and Neisseria meningitides in Young Jordanian Children
Authors: Khanfar Malak A , Badran Emman , Marrar Basma , Charvalos Ekatherina , Shehabi Asem A
Published: November 2021

Background:

Kingella kingae and Neisseria meningitides are gram-negative bacteria, causing several life-threatening diseases and considered as opportunistic pathogens in the upper respiratory tract of healthy carriers. The detection of these both bacteria species is difficult in routine culture methods.

Objective:

This study aimed to find the occurrence rate of K. kingae and N. meningitides colonizing upper respiratory tract of young Jordanian children, and to determine the antimicrobial susceptibility profile of the isolates.

Methods:

A total of 300 samples of throat and nasal swabs were collected from out- patients Jordanian children aged between 6 months and 5 years, who were admitted to Pediatrics' clinics department at the Jordan University Hospital and Al-Bashir Hospital over the period October 2018 through January 2019.  Samples were cultured for detection  K. kingae and Neisseria species including specially N. meningitides.    Their suspected growth was identified and tested using microbiology culture methods and polymerase chain reaction (PCR) method. Additionally, DNA was extracted directly from one 100 samples and was investigated only for K. kingae using real- time PCR assay.                                                                                             

Results:

This study showed the absence of K. kingae in all cultured samples, while Neisseriaspecies was detected in 21 (7 %)including one N. meningitides isolate(0.3%). The results of antibiotic susceptibility testing indicated presence of few percentage of Neisseria species isolates resistant 100 % to clindamycin, oxacillin and vancomycin, whereas all were susceptible for chloramphenicol (100%)levofloxacin and gentamycin , and less to ampicillin(90.6%) and erytromycin ( 85.7%), respectively.

Conclusion: This study shows the absence of K. kingae and the rare occurrence of N. meningitides colonizing the upper respiratory tract of young Jordanian children over the 4-month period of study.
The Poissonian Origin of Power Laws in Solar Flare Waiting Time Distributions
Authors: Aschwanden Markus J. , Johnson Jay R. , Nurhan Yosia I.
Published: November 2021

In this study we aim for a deeper understanding of the power-law slope, α, of waiting time distributions. Statistically independent events with linear behavior can be characterized by binomial, Gaussian, exponential, or Poissonian size distribution functions. In contrast, physical processes with nonlinear behavior exhibit spatiotemporal coherence (or memory) and “fat tails” in their size distributions that fit power-law-like functions, as a consequence of the time variability of the mean event rate, as demonstrated by means of Bayesian block decomposition in the work of Wheatland et al. In this study we conduct numerical simulations of waiting time distributions N(τ) in a large parameter space for various (polynomial, sinusoidal, Gaussian) event rate functions λ(t), parameterized with an exponent p that expresses the degree of the polynomial function λ(t) ∝ t

p
. We derive an analytical exact solution of the waiting time distribution function in terms of the incomplete gamma function, which is similar to a Pareto type II function and has a power-law slope of α = 2 + 1/p, in the asymptotic limit of large waiting times. Numerically simulated random distributions reproduce this theoretical prediction accurately. Numerical simulations in the nonlinear regime (p ≥ 2) predict power-law slopes in the range of 2.0 ≤ α ≤ 2.5. The self-organized criticality model yields a prediction of α = 2. Observations of solar flares and coronal mass ejections (over at least a half solar cycle) are found in the range of α
obs ≈ 2.1–2.4. Deviations from strict power-law functions are expected due to the variability of the flare event rate λ(t), and deviations from theoretically predicted slope values α occur due to the Poissonian weighting bias of power-law fits.
Resolving the Fastest Ejecta from Binary Neutron Star Mergers: Implications for Electromagnetic Counterparts
Authors: Dean Coleman , Fernández Rodrigo , Metzger Brian D.
Published: November 2021

We examine the effect of spatial resolution on initial mass ejection in grid-based hydrodynamic simulations of binary neutron star mergers. The subset of the dynamical ejecta with velocities greater than ∼0.6c can generate an ultraviolet precursor to the kilonova on approximately hour timescales and contribute to a years long nonthermal afterglow. Previous work has found differing amounts of this fast ejecta, by one to two orders of magnitude, when using particle-based or grid-based hydrodynamic methods. Here, we carry out a numerical experiment that models the merger as an axisymmetric collision in a corotating frame, accounting for Newtonian self-gravity, inertial forces, and gravitational wave losses. The lower computational cost allows us to reach spatial resolutions as high as 4 m, or ∼3 × 10−4 of the stellar radius. We find that fast ejecta production converges to within 10% for a cell size of 20 m. This suggests that fast ejecta quantities found in existing grid-based merger simulations are unlikely to increase to the level needed to match particle-based results upon further resolution increases. The resulting neutron-powered precursors are in principle detectable out to distances ≲200 Mpc with upcoming facilities.We also find that head-on collisions at the freefall speed, relevant for eccentric mergers, yield fast and slow ejecta quantities of order 10−2
M
⊙, with a kilonova signature distinct from that of quasi-circular mergers.
Epidemiological profile, spatial distribution, and syphilis time series: a cross-sectional study in a Brazilian municipality
Authors: Lino Carolina Matteussi , Sousa Maria da Luz Rosário de , Batista Marília Jesus
Published: November 2021

Introduction: Syphilis is an infectious disease of bacterial nature, acting on organs and/or systems. The increase in the number of cases worldwide has been of concern and the infection has been considered a public health problem. Given this scenario, this study evaluates the epidemiological profile, spatial distribution, and time series of the cases of acquired syphilis, syphilis in pregnant women, and congenital syphilis in a Brazilian municipality.

Methodology: This is a cross-sectional and descriptive study with second data of the notified cases. For the definition of the population universe, an initial survey of syphilis cases notified in the municipality was carried out, from January 1, 2013 to December 31, 2017.

Results: There was an increase in the notified cases and the detection/incidence rates of syphilis. The epidemiological profile was composed of men (76.7%), adults (24.8%), white (60.4%), with eight or more years of study (53.7%) in addition to pregnant adolescents (36.7%) and young adults (26.0%), with inadequate treatment and untreated partners. A concentration of cases was identified in the regions with the lowest monthly income and the time series showed an increasing trend (p-value < 0.001).

Conclusions: Health actions should continue to improve access to diagnosis and to notification, focusing on treatment, cure and health education actions to control and prevent new cases.
Prevalence and risk factor analysis for HIV/HTLV 1/2 coinfection in Paraíba state, Brazil
Authors: Santos de Souza Marcela , Prado Gonçales Juliana , Santos deMorais Viviane Martha , Silva Júnior José Valter Joaquim , Lopes Thaísa Regina Rocha , Costa Joanne Elizabeth Ferraz da , Côelho Maria Rosângela Cunha Duarte
Published: November 2021

Introduction: Human T-lymphotropic virus (HTLV) 1 and 2 infections can lead to neurological diseases, mainly in HIV/HTLV 1 coinfected. Furthermore, HTLV 1 infection in HIV/AIDS patients has also been associated with AIDS progression. Despite this, HTLV 1/2 infections are not of mandatory notification in Brazil. Here, we describe the prevalence of HTLV 1/2 in HIV/AIDS patients from Paraíba state, Brazil, as well as the sociodemographic characteristics of the coinfected individuals.

Methodology: Information about HIV viral load and TCD4 lymphocyte count were obtained from patients’ records. Data on the patients’ sociodemographic characteristics were obtained by interview conducted after signing the informed consent form. The serological diagnosis for HTLV 1/2 was performed by Enzyme-Linked Immunosorbent Assay (ELISA) and Western Blot (WB).

Results: A total of 401 HIV/AIDS patients participated in the study, of whom about 1.5% (6/401) were positive for antibodies against HTLV, specifically for HTLV 1, evaluated by both ELISA and WB. No risk factors were found associated with HIV/HTLV 1/2 coinfection.

Conclusions: We report a 1.5% prevalence of HTLV 1 infection in HIV/AIDS patients from Paraíba state. Although we have not identified risk factors associated with HTLV 1, we describe the most observed sociodemographic characteristics in HIV/HTLV 1 coinfection.
Perceived Barriers in Online Learning among Nursing Students during the COVID-19 Pandemic in Indonesia
Authors: Achmad Bayu Fandhi , Fitriawan Akbar Satria , Kurniawan Dedi , Kafil Raisa Farida , Retnaningsih Listyana Natalia , Setyaningsih Wiwit Ananda Wahyu
Published: November 2021

BACKGROUND: In March 2020, nursing schools in Indonesia were forced to abruptly shift from face-to-face learning to fully online learning due to the COVID-19 pandemic. Before the pandemic, fully online learning was still not widely used in Indonesian nursing education.

AIM: This study aimed to identify barriers in online learning among Indonesian nursing students during the COVID-19 pandemic.

METHODS: This study used a cross-sectional design and involved 530 undergraduate nursing students from five universities in Indonesia participated in this study. The authors sent an online self-administered questionnaire to nursing students from October to December 2020. The questionnaire consisted of four sections to obtain the following data: (1) Sociodemographic characteristic, (2) information about online learning, (3) platform used for online learning, and (4) perceived barriers in online learning. Descriptive statistics were used to analyze data with frequency distribution, percentages, means, and standard deviations.

RESULTS: Nursing students in Indonesia were confronted by various barriers during the implementation of abrupt online learning in the current pandemic situation. Most frequently barriers encountered by nursing students during online learning were high costs for online learning, poor internet connection, lack of motivation toward online learning, lack of skill in using the online learning platforms, and lack of training and assistance to use the platforms.

CONCLUSION: High cost for online learning, poor internet connection, low learning motivation, lack of skill in using the online learning platforms, and lack of training and assistance to use the platforms were identified as the most frequent barriers encountered by nursing students.
Two new species of the genus Ptychoptera Meigen, 1803 (Diptera, Ptychopteridae) from Yunnan, China with remarks on the distribution of Chinese species
Authors: Zhang Xiao , Kang Zehui
Published: November 2021

Sixteen known species of the genus Ptychoptera Meigen, 1803 have been recorded from China, of which three occur in Yunnan Province. Herein, two new species from Yunnan, P. cordatasp. nov. and P. yunnanicasp. nov., are described from China. An updated key to Ptychoptera is presented for all Chinese species.
New species of the genus Ptychoptera Meigen, 1803 (Diptera, Ptychopteridae) from Zhejiang, China with an updated key to Chinese species
Authors: Shao Jiaqi , Kang Zehui
Published: November 2021

We revise the taxonomy of the genus Ptychoptera Meigen, 1803 from Zhejiang, East China. One new species from Zhejiang, P. tianmushanasp. nov., is described and illustrated. Morphologically, the new species is most similar to P. emeica Kang, Xue & Zhang, 2019 and P. formosensis Alexander, 1924, but it can be distinguished by the coloration of the abdomen and the details of the male genitalia. In addition, P. bellula Alexander, 1937 is recorded from Zhejiang for the first time. Two known species from Zhejiang, P. longwangshana Yang & Chen, 1998 and P. gutianshana Yang & Chen, 1995, are redescribed and illustrated. A key to Chinese species of Ptychoptera is provided.
Automorphism groups of representation rings of the weak Sweedler Hopf algebras
Authors: Su Dong ,   School of Mathematics and Statistics, Henan University of Science and Technology, Luoyang 471023, China, Yang Shilin ,   Faculty of Science, Beijing University of Technology, Beijing 100124, China
Published: November 2021

Let $ \mathfrak{w}^{s}_{2, 2}(s = 0, 1) $ be two classes of weak Hopf algebras corresponding to the Sweedler Hopf algebra, and $ r(\mathfrak{w}^{s}_{2, 2}) $ be the representation rings of $ \mathfrak{w}^{s}_{2, 2} $. In this paper, we investigate the automorphism groups $ {{{\rm{Aut}}}}(r(\mathfrak{w}^{s}_{2, 2})) $ of $ r(\mathfrak{w}^{s}_{2, 2}) $, and discuss some properties of $ {{{\rm{Aut}}}}(r(\mathfrak{w}^{s}_{2, 2})) $. We obtain that $ {{{\rm{Aut}}}}(r(\mathfrak{w}^{0}_{2, 2})) $ is isomorphic to $ K_4 $, where $ K_4 $ is the Klein four-group. It is shown that $ {{{\rm{Aut}}}}(r(\mathfrak{w}^{1}_{2, 2})) $ is a non-commutative infinite solvable group, but it is not nilpotent. In addition, $ {{{\rm{Aut}}}}(r(\mathfrak{w}^{1}_{2, 2})) $ is isomorphic to $ (\mathbb{Z}\times \mathbb{Z}_{2})\rtimes \mathbb{Z}_{2} $, and its centre is isomorphic to $ \mathbb{Z}_{2} $.
Explaining the longevity characteristics in China from a geographical perspective: A multi-scale geographically weighted regression analysis
Authors: Yang Renfei , Ren Fu , Ma Xiangyuan , Zhang Hongwei , Xu Wenxuan , Jia Peng
Published: November 2021

Longevity is a near-universal human aspiration that can affect moral progress and economic development at the social level. In rapidly developing China, questions about the geographical distribution and environmental factors of longevity phenomenon need to be answered more clearly. This study calculated the longevity index (LI), longevity index for females (LIF) and longevity index for males (LIM) based on the percentage of the long-lived population among the total number of elderly people to investigate regional and gender characteristics at the county level in China. A new multi-scale geographically weighted regression (MGWR) model and four possible geographical environmental factors were applied to explore environmental effects. The results indicate that the LIs of 2838 counties ranged from 1.3% to 16.3%, and the distribution showed obvious regional and gender differences. In general, the LI was high in the East and low in the West, and the LIF was higher than the LIM in 2614 counties (92.1%). The MGWR model performed well explaining that geographical environmental factors, including topographic features, vegetation conditions, human social activity and air pollution factors have a variable influence on longevity at different spatial scales and in different regions. These findings enrich our understanding of the spatial distribution, gender differences and geographical environmental effects on longevity in China, which provides an important reference for people interested in the variations in the associations between different geographical factors.
Traditional botanical flora of medicinal plants in the treatment of kidney stones in Iran
Authors: Mordi Asaad , Teimorian Mohammad , Shakiba Behnam , Moudi Emadoddin
Published: November 2021

Medicinal plants have long been considered for the treatment of many diseases among Iranians and in recent years the use of medicinal plants has increased. In traditional Iranian medicine, many plants have been described to eliminate kidney stones, dissolve kidney stones or prevent stone formation. Based on the results Medicinal plants Cichorium intybus L. Biarum straussii Engl., Tribulus terrestris L., Nasturtium officinale R. Br., Alhagi camelorum Fisch., Adiantum Capillus-Veneris L., Anchusa italic, Alhagi maurorum, Achila mellifolium, Capsella bursa-pastoris (L.) Medicus., Adiantum capillus- Veneris L., Pistacia khinjuk, Acanthophyllum khuzistanicum Rech. F., Malva parviflora L., Allium iranicum (Wendelbo Wendelbo), Centaurea solstitialis L., Cerasus vulgaris Miller, and etc. are medicinal plants that are used in different parts of Iran used to treat kidney stones. It was found that plant families including Fabaceae (10 plants), Asteraceae (10 plants), Brassicaceae (6 plants) and Zygophyllaceae (6 plants) have the most medicinal plants in the discussion of medicinal plants affecting kidney stones and parts such as leaf (27%), fruit (15%), aerial parts (15%) and flower (14%) are the most plant organs that are used in this area for the treatment of kidney stones. The great tendency of people in the knowledge of ethno-botany and plant flora in traditional medicine is evident in the use of medicinal plants and the historical history of the use of medicinal plants. Iranian ethno-botanical knowledge can play a good role in presenting pure ideas of traditional medicine for modern medicine.
The burden of influenza and other respiratory viruses in hospitalized infants and children in a university hospital, Jordan
Authors: Al-Zayadneh Enas , Mohammad Abu Assab Dina , Adeeb Arabiat Esraa , Al-Iede Montaha , Ahmad Kayed Hanin , Daher Amirah
Published: November 2021

Background: Acute lower respiratory infection (ALRI) is a major cause of morbidity and mortality worldwide in young children and is predominately caused by viral respiratory pathogens. This study aims to identify the viral etiologies of acute ALRI in hospitalized children in Jordan University Hospital and compare the clinical characteristics of influenza virus infection with other respiratory viruses. Methods: a retrospective viral surveillance study that included 152 children below 15 years of age admitted with ALRI from December 2018  through April 2019. We recorded results of real-time reverse transcriptase-polymerase chain reaction (RT- PCR ) for common respiratory viruses. Clinical and demographic information of the study population was collected from patients’ electronic medical records. Results: 152 were identified with a median age of 1 year (mean was 2.1 years). Ninety-five patients (62.5%) were males. One or more viral respiratory pathogens were detected in 145 (95.3%) children. Respiratory syncytial virus was the most commonly detected virus in 68 patients (44.8%). Influenza virus was detected in 25 (16.4%). Children with influenza infection had more fever and less leukocyte count compared to children infected with other viruses. The severity of the ALRI correlated significantly with several factors, including age less than 6 months and the presence of neuromuscular disease (p<0.05). Conclusion: Viral detection was common among children admitted with viral ALRI. Viruses, including influenza, are recognized as major contributors to the morbidity associated with ALRI. More attention is needed on strategies for the prevention and detection of viral ALRI in developing countries.
Excercises and the tired back
Authors: Office Editorial
Published: November 2021

No abstract available.
ICP-OES analysis of heavy metal and nutrient elements of yarrow sold in Turkey
Authors: Gokcena Ummusen , Koseb Yavuz B. , Aboul-Enein Hassan Y. , Arli Goksel
Published: November 2021

Aim

The present study was to evaluate the local ‘yarrow’ drug − Millefoli herba − samples acquired from aktars, herbalists, and herbal shops.

Materials and methods

The samples were from Ankara (10 samples), Antalya (14 samples), Eskisehir (11 samples), Istanbul (10 samples), Izmir (10 samples), Mersin (10 samples), and Ordu (seven samples), which are used in the traditional medicine for various purposes. More than 70 samples were evaluated from seven different provinces.

Results

The taxonomic diagnosis of some of them is sold as Achillea millefolium L.; however, the study results show that the drugs do not belong to this species, and also five different A. L. taxa are sold as A. millefolium L. The selected heavy metals (Fe, Cd, and Co) and plant nutritional elements (Mn, Zn, Na, K, Ca, B, and Mg) were initially determined by quantitative ICP-OES analyses. Among the investigated samples, the lowest and highest results were 0.365–18.86 mg/kg for Fe; 0.007–0.294 mg/kg for Cd; 0.022–0.027 mg/kg for Co; 0.097 mg/kg–2.098 mg/kg for Mn; Zn 0.009–0.624 mg/kg; Na 1.539–15.80 mg/kg; K 39.8–390.3 mg/kg; Ca 31.24–223.1 mg/kg; B 0.046–3.970 mg/kg; Mg 7.058–43.84 mg/kg, respectively.

Conclusion

The results were compared with WHO recommended limits and daily intakes.
Behavior of hyperreflective spots noted on optical coherence tomography following intravitreal therapy in diabetic macular edema: A systematic review and meta-analysis
Authors: Ganne Pratyusha , Krishnappa Nagesha C , Karthikeyan Siddharth K , Raman Rajiv
Published: November 2021

Purpose:

Hyperreflective spots (HRS) are considered as spectral domain optical coherence tomography biomarkers in predicting response to intravitreal therapy (IVT) in diabetic macular edema (DME). We aimed to determine if there was a quantitative reduction in HRS following IVT in DME, if the response to antivascular endothelial growth factor (anti-VEGF) drugs was different from steroids, and if HRS-response was associated with improvement in visual acuity (VA) or reduction in central macular thickness (CMT).

Methods:

PubMed/MEDLINE, Scopus, ProQuest, CINAHL, Wiley online, and Web of Science were searched (between January 1, 2011 and July 1, 2020). Publication bias and heterogeneity were assessed. Meta-analysis was done using the random-effects model.

Results:

Totally, 1168 eyes from 19 studies were eligible for inclusion. IVT was associated with a reduction in quantitative HRS (z = -6.3, P < 0.0001). Studies, however, showed heterogeneity (I
2 = 93.2%). There was no difference between anti-VEGF and steroid therapies (P = 0.23). The evidence on predicting VA and CMT outcomes were limited by the number of analyzable studies, owing to the wide variation in individual study designs, and lack of randomized controlled trials.

Conclusion:

We could conclude that there is a definite reduction in quantitative HRS following either form of IVT. We highlight the lacunae in the existing literature on HRS in DME and propose goals for future studies to harness the advantage of this promising biomarker.
Situational analysis of diabetic retinopathy screening in India: How has it changed in the last three years?
Authors: Murthy GVS
Published: November 2021

Of all the eye conditions in the contemporary Indian context, diabetic retinopathy (DR) attracts the maximum attention not just of the eye care fraternity but the entire medical fraternity. Countries are at different stages of evolution in structured DR screening services. In most low and middle income countries, screening is opportunistic, while in most of the high income countries structured population-based DR screening is the established norm. To reduce inequities in access, it is important that all persons with diabetes are provided equal access to DR screening and management services. Such programs have been proven to reverse the magnitude of vision-threatening diabetic retinopathy in countries like England and Scotland. DR screening should not be considered an endpoint in itself but the starting point in a continuum of services for effective management of DR services so that the risk of vision loss can be mitigated. Till recently all DR screening programs in India were opportunistic models where persons with diabetes visiting an eye care facility were screened. Since 2016, with support from International funders, demonstration models integrating DR screening services in the public health system were initiated. These pilots showed that a systematic integrated structured DR screening program is possible in India and need to be scaled up across the country. Many DR screening and referral initiatives have been adversely impacted by the COVID-19 pandemic and advocacy with the government is critical to facilitate continuous sustainable services.
Urine protein: Urine creatinine ratio correlation with diabetic retinopathy
Authors: Mujeeb Samya , Rodrigues Gladys R , Nayak Rajesh R , Kamath Ajay R , Kamath Sumana J , Kamath Gurudutt
Published: November 2021

Purpose:

To investigate the urine protein (UP) and urine creatinine (UC) ratio in diabetes mellitus and report its influence as a risk factor for the presence and severity of diabetic retinopathy (DR).

Methods:

In total, 150 diabetic patients presenting to the outpatient department were included. Detailed history with informed consent and ophthalmic examination, including visual assessment, external ocular examination, anterior segment evaluation, dilated fundus examination by slit-lamp biomicroscopy, and indirect ophthalmoscopy, was done. The early morning spot urine sample was used to determine spot urine protein creatinine ratio. Association with hypertension, fasting blood sugar (FBS), and HBA1C (glycosylated Hb) were also noted.

Results:

Urinary PCR increased with the severity of the diabetic retinopathy (P < 0.001). HbA1c, FBS, and duration of diabetes had a direct correlation with urine PCR. ROC curve analysis showed that the optimal PCR cut-off value for predicting the risk of onset DR was 0.65. Retinopathy progressed with increasing urine PCR. Spot urine PCR strongly correlates with stages of diabetic retinopathy and proteinuria measured in 24-h urine samples.

Conclusion:

The study showed that urine PCR can be a marker for risk and progression of diabetic retinopathy.
Preferred practice pattern of physicians regarding diabetic retinopathy in diabetes mellitus patients
Authors: Moudgil Tania , Bains Barinder K , Bandhu Seema , Kanda Nancy
Published: November 2021

Purpose:

To assess the perceptions of physicians about diabetic retinopathy (DR) screening, barriers to DR screening, and change in management protocol of Diabetes Mellitus (DM) patients with DR.

Methods:

A cross-sectional descriptive study was conducted using a standard predesigned and pretested structured questionnaire through online mode in the month of April 2021 to assess the criteria used for referral of diabetic patients for DR screening, barriers to DR screening, and the management plan among physicians after the patient has been diagnosed with DR.

Results:

In total, 100 physicians participated in the study. Physicians responded that criteria used for referral for DR screening according to duration was <5 years (n = 0), 5–10 years (n = 60), >10 years (n = 10), and irrespective of the duration (n = 30). According to severity, well-controlled DM without (n = 30) and with other system involvement (n = 50) and uncontrolled DM without (20) and with other system involvement (n = 50) and irrespective of the severity of disease (n = 30) was reported. Physicians (n = 40) responded that patients who were diagnosed with DR belonged to the Type 1 DM category rather than Type 2 DM (P < 0.05). With regard to the barriers and challenges faced in ensuring DR screening, the following themes emerged: no ocular symptoms, lack of compliance, time constraint for the patient, and lack of motivation.

Conclusion:

We found that the preferred practice pattern of physicians regarding referral for DR screening was dependent on the duration of the disease (mostly 5–10 years of the disease) and severity (when other systems were involved). Noncompliance with advice was the major barrier to DR screening.
Diabetic retinopathy in pregnancy - A review
Authors: Chandrasekaran Priya R , Madanagopalan V G , Narayanan Raja
Published: November 2021

Diabetes and gestational diabetes (GD) are areas of concern worldwide. GD can eventually lead to serious development of diabetic retinopathy (DR) during pregnancy or worsening of an already existing DR. GD confers future risk of diabetes, both in the mother and fetus, further complicating their lives. DR in pregnant women has been intriguing in terms of understanding the prevalence, assessing risk factors causing pathogenesis, and problems associated with treating them. Pregnancy itself is a risk factor for progression of DR. Physiological changes such as metabolic, vascular, immunologic, and hormonal changes that occur during pregnancy can cause development as well as worsening of DR. This can eventually lead to permanent visual loss if not addressed on time. Timing of laser, choice of treatment for diabetic macular edema with laser, intravitreal anti-vascular endothelial growth factor agents (VEGF), and intravitreal steroids pose a serious challenge in managing these patients without causing damage to the mother and fetus. This review article showcases the prevalence, risk factors, and pathogenesis, outlines the management of DR in pregnancy, and recommends guidelines based on the available evidence. PubMed and MEDLINE searches were performed pertaining to the prevalence of GD in India, DR in pregnancy, risk factors for progression of DR, role of vasoactive mediators in DR, role of angiopoietic factors in DR, hormonal influence of DR, role of growth factors in DR, use of fluorescein and indocyanine green angiography, retinal lasers, anti-VEGF agents, intravitreal steroids, anesthesia, and retinal surgery, all pertaining to pregnancy and guidelines and recommendations for managing DR in pregnancy.
Using artificial intelligence for diabetic retinopathy screening: Policy implications
Authors: Raman Rajiv , Dasgupta Debarati , Ramasamy Kim , George Ronnie , Mohan Viswanathan , Ting Daniel
Published: November 2021

Artificial intelligence (AI) has evolved over the last few years; its use in DR screening has been demonstrated in multiple evidences across the globe. However, there are concerns right from the data acquisition, bias in data, difficulty in comparing between different algorithm, challenges in machine learning, its application in different group of population, and human barrier to AI adoption in health care. There are also legal and ethical concerns related to AI. The tension between risks and concerns on one hand versus potential and opportunity on the other have driven a need for authorities to implement policies for AI in DR screening to address these issues. The policy makers should support and facilitate research and development of AI in healthcare, but at the same time, it has to be ensured that the use of AI in healthcare aligns with recognized standards of safety, efficacy, and equity. It is essential to ensure that algorithms, datasets, and decisions are auditable and when applied to medical care (such as screening, diagnosis, or treatment) are clinically validated and explainable. Policy frameworks should require design of AI systems in health care that are informed by real-world workflow and human-centric design. Lastly, it should be ensured that healthcare AI solutions align with all relevant ethical obligations, from design to development to use and to be delivered properly in the real world.
Bridging the valley of death between research and implementing a systematic diabetic retinopathy screening program in low- and medium-income countries
Authors: Sivaprasad Sobha , Conroy Dolores , Das Taraprasad
Published: November 2021

Translating research findings to routine clinical practice is fraught with obstacles. The gap between the end of a research project and the implementation of its results is often termed the “valley of death.” In this perspective, we highlight the barriers and potential solutions in translating research on diabetic retinopathy care pathways to implementation in the clinic. This gap analysis applies to all countries around the world, though it predominantly applies to low- and middle-income countries.
Severity of diabetic retinopathy and its relationship with age at onset of diabetes mellitus in India: A multicentric study
Authors: Parameswarappa Deepika C , Rajalakshmi Ramachandran , Mohamed Ashik , Kavya Sanagavarapu , Munirathnam Haripriya , Manayath George , Kumar Mathangi Ashok , Raman Rajiv , Vignesh TP , Ramasamy Kim , Mani Sheena , Muralidhar Alankrita , Agarwal Manisha , Anantharaman Giridhar , Bijlani Neha , Chawla Gajendra , Sen Alok , Kulkarni Sucheta , Behera Umesh C , Sivaprasad Sobha , Das Taraprasad , Rani Padmaja Kumari ,   on behalf of India Retinal Disease Study group
Published: November 2021

Purpose:

To present clinical profile and risk factors of sight-threatening diabetic retinopathy (STDR) among people with age of onset of diabetes (AOD) <25 versus ≥25 years.

Methods:

A retrospective chart analysis of consecutive patients with diabetic retinopathy (DR) n = 654) treated at 14 eye care centers across India between 2018 and 2019 was performed. Patients were divided into two groups, Group 1: AOD <25 years and Group 2: AOD ≥25 years. DR and diabetic macular edema (DME) were classified using the International Clinical Classification of DR severity scale. STDR included severe nonproliferative DR (NPDR), proliferative DR (PDR), and moderate to severe DME. A multilevel mixed-effects model was used for comparison between two groups: 1) Patients with DR and AOD <25 years and 2) Patients with DR and AOD ≥25 years. Bivariate and multivariate regression analyses were used to evaluate risk factors between the two groups.

Results:

A total of 654 patients were included, 161 (307 eyes) in AOD <25 and 493 (927 eyes) in AOD >25 group. There was a higher prevalence of PDR with high-risk characteristics in AOD <25 group (24% vs. 12%) at baseline and 12-month follow-up (25% vs. 6%); P < 0.001. Systolic hypertension and poor glycemic control were risk factors in both groups, with no difference in these modifiable risk factors between groups.

Conclusion:

People with youth-onset DM are likely to present with severer form of STDR despite similar modifiable risk factors. Therefore, strict control of systolic blood pressure, glycemic status, and regular screening for DR are recommended to reduce the risk of STDR irrespective of the age of onset of diabetes.
Diabetic macular edema treatment guidelines in India: All India Ophthalmological Society Diabetic Retinopathy Task Force and Vitreoretinal Society of India consensus statement
Authors: Giridhar Sneha , Verma Lalit , Rajendran Anand , Bhende Muna , Goyal Mallika , Ramasamy Kim , Rajalakshmi  , R Padmaja , Natarajan Sundaram , Palanivelu Mahesh Shanmugam , Raman Rajiv , Sivaprasad Sobha
Published: November 2021

Diabetic macular edema (DME) is a common cause of moderate visual impairment among people with diabetes. Due to the rising number of people with diabetes in India, the absolute numbers of people with DME are significant. There are several treatment options for DME, and the choice of treatment is based on the availability of retinal specialists and infrastructure for the delivery of treatment. A major challenge is the out-of-pocket expenditure incurred by patients as most treatment options are costly. Treatment also varies based on the associated ocular and systemic conditions. The All India Ophthalmology Society (AIOS) and the Vitreo-Retinal Society of India (VRSI) have developed this consensus statement of the AIOS DR task force and VRSI on practice points of DME management in India. The objective is to describe the preferred practice patterns for the management of DME considering the different presentations of DME in different clinical scenarios.
Knowledge, attitude, and practice patterns and the purported reasons for delayed presentation of patients with sight-threatening diabetic retinopathy at a tertiary eye-care facility in Central India: A questionnaire-based study
Authors: Sen Alok , Pathak Parul , Shenoy Pratik , Kohli Gaurav Mohan , Bhatia Priyavrat , Shetty Sachin
Published: November 2021

Purpose:

To identify the reasons for delayed presentation among patients with sight-threatening diabetic retinopathy (STDR) and to assess their knowledge, attitude, and practice (KAP) patterns in context to diabetes mellitus (DM) and diabetic retinopathy (DR).

Methods:

Single-center, cross-sectional, questionnaire-based KAP survey. All consecutive cases of STDR who presented to our tertiary eye care facility from June 2020 to November 2020 were recruited. The KAP scoring survey tool was incorporated into the questionnaire to help evaluate and represent the patient’s disease.

Results:

170 patients with STDR were enrolled in the study. The mean age of patients was 54 ± 9.34 years (Range: 21–70 years); 110 patients (64.7%) were between 41 and 60 years; 131 patients (76%) had DM for more than 5 years. The STDR changes were more prevalent in patients with an educational qualification of high school or less (n = 142; 83.5%). Fifty-two patients (30.6%) had been informed regarding the detrimental effect of diabetes on the eyes and were recommended to consult an ophthalmologist by the treating physician. Of these, 24 (46.15%) patients were educated about retinal changes due to diabetes. Eighty-five (50%) patients in our study had good knowledge about DM; 13 (7.6%) patients had good knowledge about DR. For patients not compliant for follow-ups with the treating physician, the use of “home glucometers for self-monitoring (n = 60, 35.3%) was the most prevalent reason. The main reason for poor compliance for undergoing a dilated fundus examination by the ophthalmologist was “Had good vision, so didn’t feel the need” in 143 (90.5%) patients.

Conclusion:

The absence of visual complaints, lack of knowledge, and failure to undergo a dilated fundus examination in the past were the prevalent risk factors in patients presenting with STDR. Knowledge/practice about DR was poor among the patients with STDR. The treating physicians and ophthalmologists were the most common sources for patient education.
Asymmetric diabetic retinopathy
Authors: Azad Rajvardhan , Sinha Sony , Nishant Prateek
Published: November 2021

Increasing prevalence of diabetes mellitus warrants recognition of factors related to asymmetric diabetic retinopathy (DR). This thematic synthesis based on an iterative literature review conducted in Medline and Google Scholar pertaining to diabetes with coexistent asymmetry of retinopathy included 45 original articles, 21 case reports and series, and 18 review articles from 1965 to 2020. Asymmetric DR is defined as proliferative DR (PDR) in one eye and nonproliferative, preproliferative, background, or no DR in the other eye lasting for at least 2 years. It is observed in 5%–10% of patients with PDR. Associated factors can be divided into (i) vascular: carotid obstructive disease, ocular ischemic syndrome, and retinal vascular diseases; (ii) Inflammatory: uveitis, endophthalmitis, and Fuchs’ heterochromic cyclitis; (iii) degenerative: posterior vitreous detachment, high myopia and anisometropia, uveal coloboma, retinal detachment, retinitis pigmentosa, and chorioretinal atrophy and scarring; (iv) cataract surgery and vitrectomy; and (v) miscellaneous: elevated intraocular pressure, glaucoma, amblyopia, retinal detachment, and optic atrophy. The gamut of diagnostic modalities for asymmetric DR includes thorough ocular examination, slit-lamp biomicroscopy, fundus photography, fundus fluorescein angiography, optical coherence tomography, and newer modalities such as ultra-widefield fluorescein angiography and optical coherence tomography angiography, along with a complete systemic evaluation and carotid Doppler studies. The differential diagnosis includes other causes of retinal neovascularization that may present in an asymmetric manner, such as sickle cell retinopathy, retinal vein occlusions, and featureless retina. This review discusses in detail the aforementioned considerations and draws a comprehensive picture of asymmetric DR in order to sensitize ophthalmologists to this important condition.
Validation of choroidal hyperreflective foci in diabetic macular edema through a retrospective pilot study
Authors: Saurabh Kumar , Roy Rupak , Herekar Sujay , Mistry Suraj , Choudhari Shruti
Published: November 2021

Purpose:

Choroidal hyperreflective foci (HCF) are novel spectral-domain optical coherence tomography (SDOCT) biomarkers in diabetic macular edema (DME). The present study intended to validate HCF and assess their role in the treatment outcome.

Methods:

It was a retrospective, longitudinal, records-based pilot study recruiting consecutive patients of nonproliferative diabetic retinopathy with treatment naïve DME. Patients were treated with three intravitreal anti-vascular endothelial growth factor injections and followed by a pro re nata regimen.

Results:

A total of 43 eyes of 28 patients were included in the study. Eyes were divided into two groups. Group A (n = 19) comprised eyes with retinal hyperreflective foci (HRF) and group B (n = 24) had eyes with both HRF and HCF. The mean age of patients in group A and B was 58.5 ± 2.1 years and 55.2 ± 8.8 years, respectively. Mean best-corrected visual acuity at presentation was 0.38 ± 0.25 in group A and 0.59 ± 0.29 in group B (P = 0.01). Final BCVA was 0.35 ± 0.39 in group A and 0.47 ± 0.34 in group B (P = 0.3). External limiting membrane was intact in 19 out of 19 eyes in group A and two (8.3%) eyes in group B (P = 0).

Conclusion:

Presence of HCF meant significantly worse initial BCVA compared to the eye that had HRF alone. The final BCVA was also worse in eyes with HCF compared to those with HRF and without HCF; however, the difference did not reach a significance level, probably pointing toward the fact that HCF and HRF are pathophysiologically identical. Further studies with a larger sample size and prospective design are needed to take these findings forward.
Use of offline artificial intelligence in a smartphone-based fundus camera for community screening of diabetic retinopathy
Authors: Jain Astha , Krishnan Radhika , Rogye Ashwini , Natarajan Sundaram
Published: November 2021

Purpose:

The aim of the study was to analyse the reliability of an offline artificial intelligence (AI) algorithm for community screening of diabetic retinopathy.

Methods:

A total of 1378 patients with diabetes visiting public dispensaries under the administration of the Municipal Corporation of Greater Mumbai between August 2018 and September 2019 were enrolled for the study. Fundus images were captured by non-specialist operators using a smartphone-based camera covering the posterior pole, including the disc and macula, and the nasal and temporal fields. The offline AI algorithm on the smartphone marked the images as referable diabetic retinopathy (RDR) or non-RDR, which were then compared against the grading by two vitreoretinal surgeons to derive upon the sensitivity and specificity of the algorithm.

Results:

Out of 1378 patients, gradable fundus images were obtained and analysed for 1294 patients. The sensitivity and specificity of diagnosing RDR were 100% (95% CI: 94.72–100.00%) and 89.55% (95% CI: 87.76–91.16%), respectively; the same values for any diabetic retinopathy (DR) were 89.13% (95% CI: 82.71–93.79%) and 94.43% (95% CI: 91.89–94.74%), respectively, with no false-negative results.

Conclusion:

The robustness of the offline AI algorithm was established in this study making it a reliable tool for community-based DR screening.
Effect of sustained-release long-acting intravitreal dexamethasone implant in patients of non-proliferative diabetic retinopathy undergoing phacoemulsification: A randomized controlled trial
Authors: Gupta Parul Chawla , Ram Jagat , Kumar-M Praveen , Agarwal Aniruddha , Gupta Vishali , Singh Ramandeep , Bansal Reema , Katoch Deeksha , Dogra Mangat R , Gupta Amod
Published: November 2021

Purpose:

Cataract and diabetes, both being a major health care problem, an intervention evaluated for the combination of the two attains paramount importance. The purpose of the study was to determine the role of intraoperative intravitreal dexamethasone implant in patients with diabetic retinopathy with/without macula edema undergoing phacoemulsification.

Methods:

The study was a two-arm, single-center, randomized, assessor-blinded trial of 151 patients with type-2 diabetes mellitus and cataract. It had two groups: dexamethasone group (DEX) versus standard of care (SOC) group, i.e. phacoemulsification and intraocular lens (IOL) implantation without injection of dexamethasone drug delivery system (DDS). The number of rescue interventions required, central macular thickness by optical coherence tomography (OCT), Early Treatment Diabetic Retinopathy Study (ETDRS) score, laser flare meter (LFM) values, intraocular pressure (IOP), and grade of diabetic retinopathy (DR) were recorded until three months follow up. Macular thickness and number of rescue medications between the treatment groups were the co-primary outcomes.

Results:

A statistically significant interaction was present between treatment and time on OCT score (P < 0.001). The requirement of rescue interventions in the dexamethasone DDS group [40.2% (33/82)] was lesser as compared to the SOC group [49.3% (34/69)] at the end of 12 weeks [odds ratio (OR), 0.70 (0.36–1.33)] follow up although not statistically significant (P = 0.343). A statistically significant interaction was present between treatment and time on LFM score (P = 0.003). No statistically significant interaction was present between the treatment and time on visual acuity score (P = 0.08) and IOP score (P = 0.375).

Conclusion:

Dexamethasone implant may have potential as a valuable therapy for patients undergoing cataract surgery with DR with/without macular edema with effects lasting for at least three months.