bluuebunny/crossref_metadata_2025 huggingface dataset:
Deep Anterior Lamellar Keratoplasty with Large Descemet's Membrane Perforation
Authors: Goweida Mohamed Bahgat , Mahmoud Shahira , Sobhy Mohamed , Liu Christopher
Published: July 2021

Purpose:

To evaluate the outcome of eyes with large Descemet's membrane (DM) perforation during deep anterior lamellar keratoplasty (DALK).

Methods:

A retrospective, interventional case series of 12 eyes with completed DALK, despite DM perforation larger than 4 mm in its widest dimension. The main outcome measures included graft clarity, endothelial cell density (ECD), corrected distance visual acuity (CDVA), and DM detachment.

Results:

The mean age of patients was 26.8 ± 11.4 years. Preoperative pathology included keratoconus (n = 10), macular dystrophy (n = 1), and postmicrobial keratitis corneal scar (n = 1). The average size of DM perforation was 6.5 mm ± 1.3 mm. At the end of the follow-up period (median 15 months, range 6–53 months), the mean CDVA was 0.32 ± 0.09 logMAR and the mean ECD was 1830.8 ± 299.7 cells/mm2. Nine patients (75%) developed DM detachments postoperatively and was managed by intracameral air injection once in six eyes, and twice in three eyes. Other complications included persistent localized stromal edema at the site of DM defect in one eye and Urrets Zavalia syndrome in one eye.

Conclusion:

Completing DALK in eyes with large DM perforation provides good visual acuity, endothelial cell count and may be superior to penetrating keratoplasty regarding long-term graft survival if confirmed in future comparative studies.
Sarcoid-Associated Bilateral Multifocal Choroiditis Secondary to Adalimumab
Authors: Wilkins Carl Stanley , Ashourian Kristen Taylor , Sobol Ethan Kyle , Fink Matthew , Saltzman Brian , Teich Steven
Published: July 2021

Purpose:

To report a rare paradoxical development of systemic sarcoidosis in a patient taking adalimumab manifesting as multifocal choroidal infiltrates and seventh nerve palsy.

Methods:

This was a single patient case report.

Results:

A 30-year-old man with a history of psoriatic arthritis on adalimumab presented with intermittent fevers and headaches. Initial infectious serology and initial ophthalmic examination were within normal limits. Over the next month, he developed a seventh nerve palsy, unilateral decreased visual acuity, and bilateral multifocal choroidal infiltrates. The patient was diagnosed with systemic sarcoidosis secondary to tumor necrosis factor alpha (TNFα) inhibitor use after a hilar lymph node biopsy. Upon treatment with high-dose oral corticosteroids, the patient's symptoms and choroidal lesions significantly improved.

Conclusion:

This case report illustrates a rare presentation of ocular, neurologic, and systemic sarcoidosis presenting as a bilateral multifocal choroiditis and seventh nerve paresis in a patient treated with adalimumab. We highlight the importance of obtaining an ophthalmic evaluation in the management of this rare adverse effect of TNFα inhibitors.
Closed versus open-sky Muller muscle-conjunctival resection in management of blepharoptosis
Authors: Ezzeldin Ezzeldin R.
Published: July 2021

Purpose

The aim of this study was to compare the accuracy and clinical outcome of closed versus open-sky approach of Muller muscle–conjunctival resection for correction of mild and moderate ptosis with good levator function and positive phenylephrine test.

Patients and methods

A prospective comparative nonrandomized interventional study was conducted on patients attending the Outpatient Clinic of the Ophthalmology Department in Al Azhar University Hospital (Damietta branch) during the period from April 2018 to August 2019. The study was conducted on 50 eyelids of 45 patients with mild to moderate ptosis with good levator function and positive phenylephrine test. The patients were treated with either a closed or open-sky approach of Muller muscle–conjunctival resection, with 25 eyelids being treated by each approach. A total of 40 cases had unilateral ptosis and five cases were bilateral. All cases were congenital except one case that was a Pancoast tumor causing preganglionic Horner's syndrome. The eyelid elevation, marginal reflex distance 1, lid contour, dry eye, and symmetry between both eyelids were the main outcome measures.

Results

There were significant differences between the two groups regarding the postoperative marginal reflex distance 1 (3.64±0.44 mm in the open-sky approach vs. 3.18±0.53 mm in the closed approach, P=0.002). There was significantly more correction of the degree of ptosis in the open-sky approach. Undercorrection was reported in 4% of the cases in the open-sky approach versus 28% in the closed approach, whereas temporal flare was reported in only 4% of the cases in the open-sky approach (P=0.0047). There was a significant reduction in the postoperative tear film in the patients treated with the closed approach in comparison with those treated with open-sky approach (P=0.007).

Conclusion

The open-sky approach offered advantages over the closed approach, including the opportunity for adjustment of the lid height and reducing the risk of dry eye.
Changes in ophthalmological practice during the COVID-19 lockdown period
Authors: Gad Elham A. , Soliman Shaimaa S. , Wasfy Tamer
Published: July 2021

Background

To limit the spread of coronavirus disease 2019 (COVID-19), the Egyptian Government had declared a national lockdown on March 24, 2020, with reduction of all governmental medical services.

Aim

The aim of this study was to investigate the changes in ophthalmological medical and surgical practice as well as the changes in learning during the COVID-19 lockdown.

Patients and methods

This is a cross-sectional study that included 263 working ophthalmologists from all over Egypt. They were asked to fill in a questionnaire about the changes in their clinical ophthalmic practice. The questionnaire was distributed as a Google form through e-mails and different social media platforms. Young ophthalmologists (<35 years) were compared with experienced ophthalmologists (>35 years) regarding the use of technology and E-learning during the lockdown of the pandemic. Ophthalmologists with private practice were compared with ophthalmologists without regarding the changes in real-life clinical practice during the same period.

Results

The mean age of the participants was 45.6±12.96 years (range=27.0–68 years). Overall, 67.3% were males, and 52.1% had a private practice either alone or with governmental practice. Most participants (86.7%) were still seeing patients during the lockdown. However, 96.2% of them decreased the number of their working days, and 94.3% decreased the number of patients. Approximately 47% of the participants stopped all surgeries, whereas 9.9% performed only emergency surgeries and 42.6% performed any type of surgery. All participants wore facial masks, 88.6% used breath shields, 55.5% wore gloves, and 59.7% started online consultations. Experienced ophthalmologists significantly attended more scientific webinars, whereas for young ophthalmologists, webinars were very useful medically but not helpful for their surgical skills.

Conclusion

The lockdown of COVID-19 did not stop ophthalmological practice in Egypt. It reduced the number of working days and the number of patients. All participants used different personal protective equipment, and more than half of them started online consultations. E-learning was very useful for young ophthalmologists but it did not help their surgical skills.
Adult encysted dacryocystocele
Authors: Ibrahiem Mohamed Farag K. , Sabry Ahmed M. , Abdelaziz Sahar Torky A.
Published: July 2021

Purpose

The aim of this study was to detect the prevalence of adult encysted dacryocystocele among patients with lacrimal passage obstruction and to evaluate its management by canaliculo-dacryocystorhinostomy (canaliculo-DCR).

Patients and methods

This is a prospective nonrandomized study that evaluated 381 adult patients who had acquired lacrimal passage obstruction. Of 47 patients who had encysted nonexpressible dacryocystocele, 48 eyes were included in this study. Dacryocystoceles were thoroughly evaluated before performing canaliculo-DCR with bicanalicular silicone intubation to address the two sites of lacrimal passage obstruction.

Results

Of 47 patients with nonexpressible dacryocystocele, 43 completed the postoperative follow-up period. The mean age of patients was 53.23±14.89 years. Approximately 88.4% of the patients lived in rural areas. Dacryocystoceles were in the right side in 62.8% of the patients. Females represented 83.7% of all patients, and 83.3% of them regularly applied traditional eye cosmetic (kohl) for a period ranging from 5 to 35 years. Canaliculo-DCR yielded 79% (34 out of 43 patients) success rate in the management of adult encysted dacryocystocele.

Conclusion

Adult acquired encysted nonexpressible dacryocystocele represented 12.6% of cases with lacrimal passage obstruction. Overall, 79% of the patients responded well to canaliculo-DCR procedure.
Spiritual wellbeing and depression for pregnant mothers in Covid-19 crisis
Authors: Alimoradi Hadi , Nazari Mahsa , Nodoushan Reza Jafari , Ajdani Alireza
Published: July 2021

Background:

Women with high-risk pregnancies experience changes in their personal, family, and social lives that can affect their quality of life and depression. Pregnancy, along with other predisposing factors, can cause or exacerbate depression. Eventually, 15% of depressed people commit suicide. The purpose of this research was to see how COVID-19 affected the condition of pregnancy (high risk or normal), as well as well-being and depressive symptoms in pregnant women.

Methods:

This is an analytical case–control analysis that included 500 pregnant women (250 in the case group and 250 in the control group) who were pregnant during the COVID-19 timeframe for health care during pregnancy. The samples were chosen at random and then grouped into two categories based on the definitions of high-risk pregnancy and normal pregnancy: normal pregnancy (control group) and high-risk pregnancy (case group). A three-part questionnaire with demographic features, the Paloutzian and Ellison Religious Well-Being Questionnaire, and the Depression, Anxiety, and Stress Scale-42 Depression Inventory were used to gather data.

Results:

According to the findings of this report, the mean score of religious well-being of pregnant mothers with high-risk pregnancies was lower than that of pregnant women with average pregnancies, as were the mean scores of depression. The distinction between a normal pregnancy and a high-risk pregnancy is important. Furthermore, the Pearson correlation coefficient test revealed a strong association between psychological well-being and depression in all types of mothers with high-risk and average pregnancies (r = −0.7) (P = 0.001).

Conclusion:

Pregnant women with high-risk pregnancies have less psychological well-being than pregnant women with regular pregnancies. Furthermore, these mothers have a greater risk of depression than pregnant women with normal pregnancies.
Association between climatic and nonclimatic parameters and transmission of SARS-CoV-2 infection in Nepal
Authors: Tandukar Sarmila , Bhandari Dinesh , Shrestha Rajani Ghaju , Sherchan Samendra P. , Aryal Anil
Published: July 2021

Background:

Preliminary evidence suggests that environmental factors may modify the transmission of SARS-CoV-2 infection. Although the role of non-pharmaceutical interventions (NPIs) on the reduction of SARS-CoV-2 transmission rate is well explored, the role of local climate across different geographical transects on the onset and transmission of SARS-CoV-two remains unclear.

Aims and Objectives:

In this study, we explored the potential association among climatic factors, non-climatic factors and COVID-19 burden, via Pearson correlation analysis. We also investigated the association between COVID-19 cases and cumulative effect of NPIs or behavioral changes during lockdown as non-climatic factors in our analysis.

Setting and Design:

The research was carried out in the COVID-19 impacted districts across Nepal.

Material and Methods:

The meteorological/climatic factors consisting of temperature and rainfall as predictor variables and total laboratory confirmed COVID-19 cases reported between January and May 2020 were considered in the study.

Statistical Analysis Used:

The statistical tests were carried out using R programming language.

Results:

Of the total 375 confirmed positive cases until May 19, 2020, clusters of the cases were diagnosed from the Terai region, which was associated with comparatively higher temperature and open border to India. Upon time series and spatial analysis, the number of positive cases increased after the end of April, possibly due to expansion of diagnostic tests throughout the country. We found a positive correlation betweenCOVID-19, and temperature indices (mean and minimum) (P < 0.05).

Conclusions:

In the absence of an effective vaccine, these findings can inform infection control division of Nepal on the implementation of effective NPIs based on the observed variability in meteorological factors, especially in prevention of possible second wave of infection during winter.
A randomized controlled trial to assess the efficacy and safety of children’s health supplement with micronutrient fortification to promote growth, health, and wellbeing in children
Authors: Khare Priya , Kulkarni Omkar , Agrawal Anuj , Ganu Gayatri , Deodas Madhavi
Published: July 2021

Background:

Proteins are one of the strong pillars of sound physical health and cognitive abilities. Protein and micronutrient deficiency can hamper the health and growth of many children globally, delaying their physical and mental improvement and increase proneness to infections. The current research depicts the efficacy and safety of the children’s health supplement with micronutrient fortification to promote growth, health, and wellbeing in children. A multicenter randomized controlled trial.

Material and Methods:

Two centers one being a teaching institute with a hospital and the second one private hospital. Total 105 subjects visiting the out patient department (OPD) section participated of which 100 completed the trial with five being dropped out as lost to follow-up. Children’s health supplement (NRL/2019/5PNK) contains essential vitamins, minerals, herbal extracts together with a blend of whey, soy, pea, rice proteins, and milk solids. It was consumed as 90 days’ treatment in a dose of 10 g daily with 150 mL milk. Children’s health supplements improved anthropometric parameters and growth of children indicated by height-to-age and weight-to-age z-scores defined by world health organization (WHO).

Results:

There was a 45.70% increased physical endurance by children’s health supplement. Enhanced immunity status indicated by reduced illness episodes and missed school days. Children’s health supplements improved child’s eating behavior and cognitive performance better than the marketed product. It was found better in improving digestive behavior in children.

Conclusion:

Children’s health supplement found safe and effective in promoting growth, health, and wellbeing in healthy children.
Academic Writing in India
Authors: Ismail Haseena , Balasubramanian Vimala
Published: July 2021

Writing, like any art, can only be improved through practice, and not just by following the rules. India is third in line when it comes to academic writing and publishing. Yet, most of the research scholars find it very difficult to excel in academic and business writing. Here, we discuss the state of academic writing among research scholars, the various factors impacting this issue, and what the possible practices could be to overcome these from a research scholar’s perspective.
A Novel Herbal Combination Decreased Lipid Droplets Accumulation and Cytokines Levels During Adipogenesis by Regulating Leptin, PPARγ and SREBP1c Genes Expression in 3T3L1 Cells
Authors: Gorantla Vasavi Rakesh , Bolla Srinivasa Rao , Tuladhar Sunanda , Bishir Muhammed , Mahalakshmi Arehally M
Published: July 2021

The present study aims at demonstrating the anti-adipogenesis and anti-inflammatory of combination of extracts of commiphora wightti, curcuma longa, and tinospora cordifolia using mouse 3T3-L1 cells. Herbal formula (CCT) significantly suppressed the mRNA of PPARγ, leptin, and SREBP1c expression, which is reveals its significant anti-adipogenesis activity. In addition, CCT down-regulated TNFα and iNOS expression, this is an added advantage and helps to alleviate the inflammatory reactions during adipogenesis. These findings encourage for further studies using in vivo models of obesity and associated complications.
Sleep and Gonadotrophin Hormones
Authors: Shivalingaiah Sushmitha Basavapattana , Tuladhar Sunanda , Mahalakshmi Arehally M. , Muthukumar Prathibha , Yannam Sudheer Kumar , Rashan Luay , Essa Musthafa Mohamed , Mohan Surapaneni Krishna , Veeraraghavan Vishnu Priya , Bolla Srinivasa Rao , Chidambaram Saravana Babu , Qoronfleh M. Walid
Published: July 2021

Sleep plays a key role in neuroendocrine functioning and glucose metabolism. Currently existing data reveal that restriction of sleep duration results in adverse health effects. Sleep plays an imperative role in endocrine systems. Sleep causes the episodic secretion of gonadotrophin through modulation of neurotransmitters activity. Research on the significance of sex and gonadotrophic hormone in causing sleep disparities and its effects on cognition among men and women is gaining increased awareness. Epidemiologic, preclinical, and clinical studies have reported that sleep deprivation causes alteration of metabolic endocrine functions, including reduced glucose tolerance, insulin sensitivity, and leptin levels with increased cortisol and ghrelin levels. Men with lesser levels of testosterone and women with elevated levels of progesterone are more susceptible to the effects of sleep restriction on cognition and emotion processing tasks. The present integrative review highlights the effects of sleep deprivation on sex and gonadotrophin hormones and its link to cognitive function.
Return to Work after Surgical Treatment for Cervical Spondylotic Myelopathy
Authors: Paul Arun John , Amritanand Rohit , David Kenny S. , Krishnan Venkatesh
Published: July 2021

Purpose:

The purpose of the study was to determine the rate and predictors of return to work (RTW) after surgery for cervical spondylotic myelopathy (CSM).

Overview of Literature:

RTW is arguably the most important outcome following spine surgery from a patient’s perspective. But, to the best of our knowledge, there have been no reports in the English literature describing RTW among patients undergoing surgery for moderate-to-severe CSM.

Materials and Methods:

We included adult patients with CSM with Nurick grade ≥ 3 who underwent surgery. They were divided into two groups: those who returned to work within 6 months (group 1) and those who did not (group 2) and their outcomes were analyzed.

Results:

A total of 34 patients were included in the study. Baseline characteristics were comparable between the groups. Only 18 (52.9%) patients returned to work by 6 months. The nature of work had a statistically significant association with RTW by 6 months (P = 0.005) with failure to RTW specifically seen in manual laborers. Age, body mass index, symptom duration, pre-operative absenteeism, smoking, diabetes mellitus, number of levels operated, surgical approach, and post-operative complications did not have significant association with RTW. Better functional outcomes were seen in patients who returned to work as calculated using Nurick grade (P = 0.000) and modified Japanese Orthopedic Association score (P = 0.001). All the patients who returned to work and 75% of the patients who did not RTW were satisfied with the outcome of surgery (P = 0.039).

Conclusion:

In spite of functional improvement, CSM was associated with poor RTW with manual laborers being the most vulnerable group. This study will help surgeons modulate patient expectations as well as provide a platform for counseling them.
Direct Anterior Screw Fixation for a Pediatric Odontoid Fracture with Associated Skull Fracture
Authors: Dutta Dilip , Dasgupta Arjun Shankar
Published: July 2021

The upper cervical spine remains the most susceptible region for spinal trauma in children, with odontoid fractures being the most common ones in this age group. Concomitant traumatic brain injuries or skull fractures can pose therapeutic challenges in such cases. We report a case of an 11-year-old boy who presented in the semiconscious state with a deep scalp laceration in the left frontoparietal region. A computed tomography (CT) scan revealed a depressed skull fracture requiring an emergency left frontoparietal decompressive craniectomy and an associated fracture of the odontoid process at the base with anterior displacement. Odontoid fractures usually heal well after immobilization, and the use of instrumented fusion is still debated in view of skeletal immaturity. The usual management of Halo vest could not be instituted in his case owing to the skull fracture, and a single cannulated screw fixation was done under fluoroscopic guidance. Direct operative fusion of the odontoid process has been described in younger children with apophyseal fractures, but the evidence of such procedures is rare in elder children with a fused odontoid process. This case report, thus, confirms the anterior odontoid screw fixation as an effective mode of treatment in children of the 7- to 12-year age group.
Single-stage Decompression of C1–D9 Anterior Epidural Abscess by a Gas-Producing Enteric Pathogen
Authors: Nallathambi Vetri , Chander M. Atharsh
Published: July 2021

Multilevel pyogenic spinal epidural abscess is a rare presentation, and there are only a few documented cases. This is a case report of a cervicothoracic epidural abscess (C1–D9) presenting with sepsis and neurological impairment due to a gas-producing enteric organism that was managed by surgical decompression. The abscess was drained in a single-stage multilevel procedure. The patient recovered gradually in the postoperative period clinically and neurologically and is on follow-up for two years. The peculiarity of this case is the absence of any vertebral or disc involvement in the presence of such an extensive anterior epidural abscess.
Management Protocols for Functioning of Operation Theatre Complex during COVID-19 Pandemic – Perspective of a Zonal Hospital
Authors: Bhatnagar Vidhu , Honwad M. S. , Dutta Smita , Sharma Kamender
Published: July 2021

Chinese Centre for Disease Control and Prevention announced a novel coronavirus as causative pathogen of COVID-19 on 08th January 2020, after the epidemic broke in Wuhan, China. The coronavirus infection has been incontrollable since then and was given the status of pandemic by the World Health organization in March 2020. World has come to a standstill with the advent of COVID-19 pandemic and multiple changes have made way in the normal functioning of life as well as health-care system. Despite lockdown and restrictions on movement and travel, the virus has managed to seep into multiple countries and presently India is witnessing more than 50,000 new cases daily. Health-care system all over world is exhausted and struggling to handle this contagious virus. This article is an attempt to summarize essential knowledge of COVID-19, review current understanding of COVID-19, and provide recommended management protocols for functioning of operation theater complex which have been formulated and are being followed in our Armed Forces Zonal Hospital in Southern India since Mar 2020.
Transient Pancreatitis Post Laparoscopic Cholecystectomy
Authors: Kumar M. Arun , Pahwa Bhavna , Singh Dharmendra , Sharma Anupam
Published: July 2021

Acute postoperative pancreatitis is an uncommon complication following laparoscopic cholecystectomy. The common complications in the early postoperative period are usually attributable to a bile duct injury or a bleeding vessel. Pancreatitis in such a setting usually resolves by conservative management unless there is an active obstruction at the lower common bile duct. Very few cases have been documented in the literature in this contention. In this case report, a case of acute pancreatitis following laparoscopic cholecystectomy is described in terms of the clinical presentation, laboratory parameters, management strategy, and a short review of the literature.
Leprosy Presenting with Papulosquamous Skin Lesions in a Case of Human Immunodeficiency Virus Infection
Authors: Sinha Preema , Sinha Anwita , Kinra Prateek , Venugopal Ruby
Published: July 2021

Leprosy has a wide range of clinical manifestations, which sometimes imposes a clinical challenge and may lead to misdiagnosis. Interactions between leprosy and human immunodeficiency virus (HIV) have been little studied and poorly understood to date. However, coinfection still poses dilemmas in leprosy as to the occurrence of the immune reconstitution inflammatory syndrome manifesting as clinical leprosy and reversal reactions, higher chances of relapse after the successful completion of the multidrug therapy (MDT) and drug interactions between MDT and antiretroviral therapy. Furthermore, coinfection can lead to atypical clinical manifestations of leprosy. Herein, we describe a rare presentation of leprosy in a patient of HIV infection who reported with papulosquamous lesions over both upper and lower limbs histopathologically consistent with Hansen's disease.
Radiofrequency Ablation of Benign Thyroid Nodules
Authors: Ha Eun Ju , Baek Jung Hwan , Che Ying , Chou Yi-Hong , Fukunari Nobuhiro , Kim Ji-Hoon , Lin Wei-Che , My Le Thi , Na Dong Gyu , Hwee Quek Lawrence Han , Wu Ming-Hsun , Yamakado Koichiro , Zhou Jianhua
Published: July 2021

Radiofrequency ablation (RFA) is a thermal ablation technique widely used for the management of benign thyroid nodules. To date, five academic societies in various countries have reported clinical practice guidelines, opinion statements, or recommendations regarding the use of thyroid RFA. However, despite some similarities, there are also differences among the guidelines, and a consensus is required regarding safe and effective treatment in Asian countries. Therefore, a task force was organized by the guideline committee of the Asian Conference on Tumor Ablation with the goal of devising recommendations for the clinical use of thyroid RFA. The recommendations in this article are based on a comprehensive analysis of the current literature and the consensus opinion of the task force members.
The Evaluation of Palpable Thigh Nodularity in Vaccination-age Children – Differentiating Vaccination Granulomas from Other Causes
Authors: Mulholland Douglas , Joyce Eimear A. , Foran Ann , Snow Aisling
Published: July 2021

Palpable thigh nodularity is a relatively frequent indication for imaging of vaccination-age children, with patients often referred by their community physician or general practitioner. Ultrasound (US) is the imaging modality of choice to delineate the abnormality, and we present a number of characteristic findings that permit the radiologist and pediatrician to accurately identify the cause. A retrospective review was performed at the largest children's hospital in a European country between 2015 and 2017 over a 30-month period. A search was performed of the hospital's Picture Archiving and Communication System (PACS) for all children referred for a soft-tissue, upper limb, or lower limb US between January 2015 and July 2017. The findings were collated and stored in a spreadsheet. Nine patients were identified who developed subcutaneous nodules in the thigh at some point during their childhood vaccination schedule. Three of these patients had clinical histories strongly suggestive of a diagnosis of abscess or foreign body. The remaining six patients were selected for more in-depth analysis. Four of these patients had US features consistent with vaccination granuloma. Two patients were ultimately diagnosed with venolymphatic malformations. Palpable thigh nodularity in a child of vaccination age is encountered with a reasonable frequency. When encountered, granulomas tend to be located within the subcutaneous tissues, and we postulate that this is due to erroneous administration of a vaccine into the subcutis rather than into the muscle.
COVID-19 ARDS
Authors: Sasidharan Shibu , Singh Vijay , Singh Jaskanwar , Madan Gurdarshdeep Singh , Dhillon Harpreet Singh , Dash Prasanta K. , Shibu Babitha , Dhillon Gurpreet Kaur
Published: July 2021

Physicians and care providers are familiar with the management of ARDS, however, when it occurs as a sequalae of COVID-19, it has different features and there remains uncertainty on the consensus of management. To answer this question on how it compares and contrasts with ARDS from other causes, the authors reviewed the published literature and management guidelines as well as their own clinical experience while managing patients with COVID-19 ARDS. For research, a PubMed search was conducted on 01.04.2021 using the systematic review filter to identify articles that were published using MeSH terms COVID-19 and ARDS. Systematic reviews or meta-analyses were selected from a systematic search for literature containing diagnostic, prognostic and management strategies in MEDLINE/PubMed. Those were compared and reviewed to the existing practices by the various treating specialists and recommendations were made. Specifically, the COVID-19 ARDS, its risk factors and pathophysiology, lab diagnosis, radiological findings, rational of recommendation of drugs proposed so far, oxygenation and ventilation strategies and the psychological ramifications of the disease were. discussed. Because of the high mortality in mechanically ventilated patients, the above recommendations and findings direct the potential for improvement in the management of patients with COVID-19 ARDS.
Preparation, validation, and evaluation of an information leaflet for patients undergoing day-care surgeries under general anesthesia at a busy tertiary care hospital
Authors: Panigrahi Amit Raja , Bakshi Sumitra G.
Published: July 2021

Background and Aims:

It is essential that patients posted for day-care surgeries are adequately prepared preoperatively. Verbal information alone may not be always effective. This study aimed to prepare, validate, and evaluate the efficacy of a patient information leaflet (PIL) for patients undergoing day-care surgeries under general anesthesia (GA).

Material and Methods:

After approval from the hospital ethics committee a PIL was prepared in English. Readability and design of the leaflet were checked using standard tests: Flesch readability ease test (FRE), Flesch Kincaid grade level (FKGL), and Baker Able leaflet design (BALD). It was translated into three regional languages. The PIL was tested among patients using a questionnaire. Seventy-nine adult patients posted for elective day-care procedures were included while emergency surgeries were excluded. Patient knowledge pre and post-PIL was compared using paired 't' test. The influence of age, gender, and education level on the usefulness of PIL were analyzed using the Chi-square test and knowledge was compared using ANOVA.

Results:

The English leaflet had an FRE Score of 63.9 and FKGL of 6.4, which is “standard“. The BALD score for all leaflets was 25 (“above standard“). The overall knowledge scores significantly improved from 52.6% (preintervention) to 70.7% (postintervention), P < 0.001. Knowledge improvement was seen with the use of PIL in all four languages. Sixty eight percent of patients strongly recommended the PIL while 31% were willing to recommend it to others.

Conclusion:

The PILs developed in this study have standard readability, good design and validated for efficacy.
Vitamin D levels of anesthesiologists working in tertiary care hospital of South Asian country
Authors: Bishnoi Sonika , Gombar Satinder , Ahuja Vanita , Bhardwaj Neerja , Kaur Jasbinder
Published: July 2021

Background and Aims:

Vitamin D deficiency is now emerging as a major global health problem. Doctors spend most of their time indoors and hence, have very low sun exposure. With limited studies on vitamin D levels of anesthesiologists and no published study from South Asian countries, we planned to determine vitamin D levels in anesthesiologists.

Material and Methods:

One hundred twenty anesthesiologists, working in two tertiary care hospitals, were enrolled in this study. The participants were asked to complete the questionnaire and blood samples were drawn at the same sitting for measuring serum 25(OH) D and serum calcium levels. A subgroup analysis of anesthesiologists was done based on vitamin D status levels defined as per Endocrine society clinical practice guidelines 2011 on vitamin D deficiency. Vitamin D deficiency: 25(OH) D <20 ng/ml (<50 nmol/l), Vitamin D insufficiency: 25(OH) D of 21–29 ng/ml (52.5–72.5 nmol/l), Vitamin D sufficiency: 25(OH) D of ≥30 ng/ml (≥75 nmol/l).

Results:

The mean working hours in a day [mean ± standard deviation (SD)] were 10.70 ± 1.56 hours with a range of 8–15 hours. The mean ± SD level of vitamin D in anesthesiologists was 14.56 ± 9.39 ng/ml with a range of 5.30–58.00 ng/ml. Out of 120 anesthesiologists, 101 (84.2%) anesthesiologists had deficient levels of vitamin D, 10 (8.3%) had insufficient levels, and 9 (7.5%) anesthesiologists had sufficient levels of vitamin D. Majority of the anesthesiologists had normal serum calcium levels. A total of 91.5% of doctors had vitamin D deficiency who were not taking vitamin D supplement groups as compared to 28.6% in doctors who had taken vitamin D supplements in the past.

Conclusion:

Prevalence of vitamin D deficiency/insufficiency was high among anesthesiologists. However, levels were optimal in professionals taking vitamin D supplements.
Comparison of the time taken for subarachnoid block using ultrasound-guided method versus landmark technique for cesarean section – A randomized controlled study
Authors: Gayathri B , Swetha Ramani C. K , Urkavalan Karthika , Pushparani A , Rajendran A
Published: July 2021

Background and Aims:

Spinal anesthesia is the regional technique preferred for cesarean section and is usually administered using the traditional landmark technique. Ultrasonography of the spine appears to be helpful in locating the puncture site and increasing the success rate. The primary objective of this study was to assess the use of ultrasonogram in locating the lumbar interspinous space for spinal anesthesia in laboring parturients brought for elective cesarean section.

Material and Methods:

Sixty parturients scheduled to undergo elective cesarean section under spinal anesthesia were included in this prospective randomized controlled trial, after obtaining the institutional ethical clearance. In Group I, 30 patients received spinal anesthesia by landmark technique and in Group II, 30 patients underwent ultrasound-guided spinal anesthesia. The statistical analysis was done using SPSS software version 17 (SPSS Inc., Chicago, Illinois, USA) for Microsoft windows.

Results:

The time taken for spinal in Group I was longer than in Group II (62 ± 18s; 41 ± 11s; P = 0.0001). The number of attempts of needle insertion was significantly less in Group II (group I 1.86 ± 1.04: group II 1.06 ± 0.25). However, the total preparation time (28 8.30 ± 92 vs 804.73 ± 77; P = 0.0001) was more in the ultrasound-guided than in the landmark group. The patients had better satisfaction in group II.

Conclusion:

Preprocedural ultrasound is a useful tool for successful lumbar puncture in parturients as it minimizes the number of attempts of needle insertion and provides better patient satisfaction.
A randomized double-blinded controlled trial comparing ultrasound-guided versus conventional injection for caudal block in children undergoing infra-umbilical surgeries
Authors: Kollipara Navya , Kodali V. Rajesh Kumar , Parameswari Aruna
Published: July 2021

Background and Aims:

Caudal epidural block is widely used in pediatric surgeries to provide intraoperative and postoperative analgesia in infra-umbilical surgeries. The conventional technique involves the risk of multiple punctures and other complications such as dural puncture, vascular puncture, and intraosseous injection.

Material and Methods:

Around 106 children aged between 6 months to 10 years belonging to ASA class I-II scheduled for elective infra-umbilical surgeries were included after obtaining written informed consent from parents/guardians. All children were randomized into two groups: ultrasound-guided (Group U) or conventional caudal group (Group C). All were premedicated with oral midazolam and inhalational induction was done with oxygen and 6–8% sevoflurane. Caudal block of 1 mL/kg of 0.125% bupivacaine was administered in both groups. The primary outcome assessed was 1st puncture success rate and the secondary outcomes assessed were number of skin punctures, block performing time, and block success rate.

Results:

Group U had a higher first puncture success rate (P = 0.001) than Group C (90.6% v/s 64.2%) and was statistically significant. The number of punctures were significantly less (P = 0.01) in Group U (1.09 ± 0.295) than Group C (1.45 ± 0.667). Block performing time was significantly higher (P = 0.0005) in Group U (53.19 ± 10.97 s) than Group C (30.34 ± 7.34 s). There was no difference in the overall block success rate between the groups (98.1% v/s 100%).

Conclusion:

Ultrasound-guided caudal injection increases the first puncture success rate and decreases the number of punctures required compared to conventional caudal block in pediatric infra-umbilical surgeries.
Failure rate of labor epidural
Authors: Ismail Samina , Raza Amir , Munshi Kahif , Tabassum Rabia
Published: July 2021

Context:

Frequent use of labor epidural has also led to a corresponding increase in failed epidural analgesia (FEA).

Aims:

This study aims to identify the overall rate of FEA and evaluate its association with trainee anesthesiologist at different years/levels of anesthesia residency training.

Settings and Design:

Prospective observational study was conducted for one year in the labor room suit of a university hospital.

Methods and Material:

After university ethics committee approval, full-term parturient receiving labor epidurals and consenting for the study were included. FEA was identified by the presence of one or more set criteria of failure including; pain of numeric rating scale of >4 at 45 minutes after epidural placement, accidental dural puncture, need to re-site the epidural, abandoning the procedure, and maternal dissatisfaction with labor pain relief.

Statistical Analysis Used:

A binary logistic regression was used to assess the association between failure rate of labor epidural and grades of anesthesiologists. Odds ratio (OR) and 95% confidence interval (CI) were reported. P value ≤0.05 was considered significant.

Results:

Out of 500 women included, 76 (15.2%) had FEA, which was significantly high in 2nd and 3rd year residents compared to 5th year and above level anesthesiologists [OR = 2.08; 95% CI: 1.17 to 3.67; P = 0.012]. Failure rate was also high but insignificant in 4th year residents compared to senior level anesthesiologists [OR = 1.78; 95%CI: 0.89 to 3.53; P = 0.098].

Conclusions:

The incidence of FEA is comparable to those quoted in literature from developed countries and shows association to experience and year of training of anesthesia residents.
Anesthetic considerations in patients with cystic pulmonary adenomatoid malformations
Authors: Gupta Bhavna , Chaudhary Kapil , Hayaran Nitin , Neogi Sujoy
Published: July 2021

Congenital pulmonary adenomatoid malformation (CPAM) is a rare entity. The authors searched the US National Library of Medicine Database, EMBASE, Google Scholar, PubMed Central for anesthetic management in CPAM. The search was performed using the terms: congenital cystic adenomatoid malformation, congenital pulmonary adenomatoid malformation, CCAM, CPAM, anesthetic management. The prognosis of CPAM depends on timely diagnosis, presence of hydrops, degree of hypoplasia of remaining lung, and the size of the lesion. Symptomatic patients must be treated surgically and lobectomy is considered the gold standard. Anesthetic management of such cases is challenging as it involves thoracotomy or thoracoscopic lobectomy or cystectomy and can lead to sudden hemodynamic Collapse. Early extubation should be considered to avoid iatrogenic ventilator-induced bronchial stump dehiscence resulting from positive pressure ventilation.
Laryngeal mask airway protector generates higher oropharyngeal leak pressures compared to the laryngeal mask airway supreme
Authors: Acx Emilie , Van Caelenberg Els , De Baerdemaeker Luc , Coppens Marc
Published: July 2021

Background and Aims:

The Laryngeal Mask Airway (LMA) Protector™ is one of the latest introduced supraglottic airway devices. It provides access and functional separation of the respiratory and digestive tracts. Compared to the LMA Supreme™, it has two digestive ports, one to provide suction in the pharyngeal region and one for gastric tube insertion. High oropharyngeal leak pressure is a marker for safe ventilation when using LMA devices. We hypothesized that oropharyngeal leak pressure of the LMA Protector™ is 5 cm H2O higher than the oropharyngeal leak pressure of the LMA Supreme™ at various cuff volumes. Secondary outcome measures were ease of insertion of both masks, fiberoptic confirmation of correct positioning, failures of insertion, presence of blood staining, sore throat, presence of air leak and insertion time.

Material and Methods:

American Society of Anesthesiologists (ASA) I-III patients aged >18 years, scheduled for elective minor ambulatory surgery under general anesthesia with a LMA were included. Patients were randomized in the LMA Protector™ or LMA Supreme™ group based on a computer-generated random sequence table. After general anesthesia induction, oropharyngeal leak pressures were measured.

Results:

Oropharyngeal leak pressures were significantly higher (P < 0.0001) for LMA Protector™ compared to LMA Supreme™ at different cuff volumes and a cuff pressure of 65 cm H2O. Insertion time was significantly higher for the LMA Protector™ (29 sec) [interquartile range (IQR) 23, 35] compared to the LMA Supreme™ (19 sec) (IQR 16, 22) (P < 0.0001). There were no statistically significant differences in ease of insertion (number of attempts for succesful positioning), failures of insertion, presence of blood staining, sore throat or presence of air leak.

Conclusion:

Oropharyngeal leak pressures were consistently higher (>5 cm H2O) for LMA Protector™ compared to LMA Supreme™. LMA Protector™, therefore, allows effective ventilation at higher airway pressures than LMA Supreme™.

Trial Registration:

http://clinicaltrials.gov.NCT03462550.
Novel management of critically induced polyneuropathy in intensive care patients
Authors: Ahuja Vanita , Selvam Selwin Rajan , Chander Anjuman , Sawal Nishit
Published: July 2021

There has been tremendous growth in patients requiring critical care with severe infections. During a prolonged stay in the intensive care unit (ICU), patients develop critical illness polyneuropathy (CIP). The early identification of neurological involvement requires special attention during ICU care. We describe two cases who developed complete motor weakness after a prolonged stay in ICU. Patients were successfully managed with pyridostigmine and testosterone hormonal therapy initially and later with pyridostigmine only. The present case series highlights the need for early recognition, assessment, and novel management of CIP in ICU patients. However, the role of nutrition, physiotherapy, and supportive care is equally essential for the successful outcome in these patients.
A randomized control led study comparing CMAC video laryngoscope and Macintosh laryngoscope for insertion of double lumen tube in patients undergoing elective thoracotomy
Authors: Mathew Amit , Chandy Jacob , Punnoose Joseph , Gnanamuthu Birla Roy , Jeyseelan L. , Sahajanandan Raj
Published: July 2021

Background and Aims:

Double lumen tube (DLT) insertion for isolation of lung during thoracic surgery is challenging and is associated with considerable airway trauma. The advent of video laryngoscopy has revolutionized the management of difficult airway. Use of video laryngoscopy may reduce the time to intubate for DLTs even in patients with normal airway.

Material and Methods:

A total of 87 ASA 1–3 adults, scheduled to undergo elective thoracotomy, requiring a DLT were randomly allocated to videolaryngoscope (CMAC) arm or Macintosh laryngoscope arm. It was on open label study, and only the patient was blinded. The primary objective of this study was to compare the mean time taken for DLT intubation with CMAC (Mac 3) and Macintosh laryngoscope blade and the secondary objectives included the hemodynamic response to intubation, the level of difficulty using the intubation difficulty scale (IDS), and complications associated with intubation. Data was analysed using the statistical software SPSS (version 18.0).

Results:

The time taken for intubation was not significantly different (42.8 ± 14.8 s for CMAC and 42.5 ± 11.5 s for Macintosh laryngoscope P -0.908). The CMAC video laryngoscope was associated with an improved laryngoscopy grade (Grade I in 81.8% with CMAC and in 46.5% with Macintosh), less pressure applied on the tongue, and less external laryngeal pressure required. Hemodynamic responses to intubation were similar in both groups.

Conclusion:

Macintosh blade is as good as CMAC (mac 3) blade to facilitate DLT intubation in adult patients with no anticipated airway difficulty, however CMAC was superior as it offers better laryngoscopic view, needed less force, and fewer external laryngeal manipulations.
Retinal Vascular Abnormalities in Different Types of Inherited Retinal Dystrophies Assessed by Optical Coherence Tomography Angiography
Authors: Sabbaghi Hamideh , Daftarian Narsis , Hassanpour Kiana , Fekri Sahba , Nourinia Ramin , Suri Fatemeh , Kheiri Bahareh , Yaseri Mehdi , Rajabpour Mojtaba , Sheibani Kourosh , Ahmadieh Hamid
Published: July 2021

Purpose:

To investigate the retinal vascular characteristics among patients with different types of inherited retinal dystrophies (IRDs).

Methods:

This comparative cross-sectional study was conducted on 59 genetically confirmed cases of IRD including 37 patients with retinitis pigmentosa (RP) (74 eyes), 13 patients with Stargardt disease (STGD) (26 eyes), and 9 patients with cone-rod dystrophy (CRD) (18 eyes). Both eyes of 50 age- and sex-matched healthy individuals were investigated as controls. All participants underwent optical coherence tomography angiography to investigate the vascular densities (VDs) of superficial and deep capillary plexus (SCP and DCP) as well as foveal avascular zone area.

Results:

In RP, significantly lower VD in whole image (P = 0.001 for DCP), fovea (P = 0.038 for SCP), parafovea (P < 0.001 for SCP and DCP), and perifovea (P < 0.001 for SCP and DCP) was observed compared to controls. In STGD, VD of parafovea (P = 0.012 for SCP and P = 0.001 for DCP) and fovea (P = 0.016 for DCP) was significantly lower than controls. In CRD, the VD of parafovea (P = 0.025 for DCP) was significantly lower than controls. Whole image density was significantly lower in RP compared to STGD (P < 0.001 for SCP) and CRD (P = 0.037 for SCP). VD in parafovea (P = 0.005 for SCP) and perifovea (P < 0.001 for SCP and DCP) regions was significantly lower in RP compared with STGD. Also, foveal VD in STGD was significantly lower than RP (P = 0.023 for DCP).

Conclusion:

Our study demonstrated lower VDs in three different IRDs including RP, STGD, and CRD compared to healthy controls. Changes were more dominant in RP patients.