bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of pseudoexfoliation in diabetic patients with senile cataract: A hospital-based study in Kashmir, India
Authors: Thakur Sidra Javaid , Lone Imtiyaz Ahmad , Kitab Ifrah Shafat
Published: August 2023

Purpose:

To study the prevalence of pseudoexfoliation syndrome (PEX) in diabetics with senile cataracts and compare it to the prevalence in nondiabetic control group.

Methods:

Two hundred and fifty diabetics and 250 nondiabetics (age and sex matched) were evaluated for PEX deposition.

Results:

Chi-squared test was employed, and a P value < 0.05 was considered significant. In the PEX group, most patients belonged to the age group of 60–70 years (55.17%). Out of 18 patients with PEX, 11 (61.1%) showed bilaterality. There was a higher frequency of raised intraocular pressure (IOP; >20 mmHg) in PEX eyes (10.3%) than in the non-PEX eyes (5.9%). The PEX group had a higher number of eyes with cup-to-disc ratio (CDR) >0.6 (11.12%) than the non-PEX group (4.32%). Nuclear cataracts were more frequent in PEX eyes than non-PEX eyes, whereas PSC and mature cataracts were more prevalent in the non-PEX group. Most eyes had PEX deposition on the anterior lens capsule and pupillary margin. Of the 500 study eyes corresponding to the diabetic group, 418 had cataracts (rest pseudophakic), of which 28 had pseudoexfoliation, accounting for 6.7% of the total. In the nondiabetic control group comprising 500 eyes, 430 had senile cataracts (rest pseudophakic), of which 105 had PEX deposition, accounting for 24.4% of the total.

Conclusion:

According to our findings, diabetics have a lower prevalence of PEX than nondiabetics. Few such studies have been conducted so far, and none have been conducted in the Indian population.
Refractive outcomes of toric intra-ocular lens implantation in cases of high posterior corneal astigmatism
Authors: Jin Tianru , Yu Lan , Li Jingjing , Zhou Yanwen
Published: August 2023

Purpose:

To evaluate whether the toric intra-ocular lens (IOL) power calculation based on total corneal astigmatism (TCA) in eyes with high posterior corneal astigmatism (PCA) could result in a systematic over-correction or under-correction after operation.

Methods:

The present study included a mono-centric retrospective study design. The data were collected from 62 consecutive eyes during uncomplicated cataract surgery by a single surgeon with a measured PCA of 0.50 diopters (D) or higher. Toric IOL calculations were made using TCA measurements. The eyes were grouped as either “with-the-rule” (WTR) or “against-the-rule” (ATR) on the basis of the steep anterior corneal meridian. The post-operative refractive astigmatic prediction error was analyzed 1 month post-operatively using the vector analysis by the Alpins method and double-angle plots method.

Results:

The correction indexes were 1.14 ± 0.29 in the ATR eyes and 1.25 ± 0.18 for the WTR eyes, indicating a tendency toward over-correction. The mean over-correction was 0.22 ± 0.52D in the ATR group and 0.65 ± 0.60D in the WTR group. The magnitude of error (ME) values were significantly different from the ideal value of zero in both groups (ATR: P = 0.03; WTR: P = 0.00). No significant difference in mean absolute error (MAE) in predicted residual astigmatism was found between ATR and WTR groups (0.61 ± 0.42 D versus 0.64 ± 0.39 D; P = 0.54). The ATR group yielded better results, with 48% <0.50D prediction error in the main analysis.

Conclusions:

The results suggested that in cases of high PCA, the toric IOL calculation, which was performed using TCA, may cause a potential over-correction in the ATR and WTR eyes. For ATR eyes, over-correction led to slight disruption of post-operative visual quality because of the “with-the-rule” residual astigmatism after operation. Therefore, we suggested using TCA for toric IOL calculation in ATR eyes.
A comparative study of vision-related quality of life (VRQoL) among glaucoma and nonglaucoma patients at a tertiary care center of North India
Authors: Tripathi Alka , Agarwal Richa , Kharya Pradip , Dwivedi Priyanka , Khan Imran
Published: August 2023

Purpose:

Glaucoma influences vision-related quality of life (VRQoL) of an individual in various ways. There are very limited studies on the Indian population and the northern part of India. Therefore, we conducted the present study to evaluate VRQoL in glaucoma patients as well as the association between the severity of glaucoma and VRQoL.

Methods:

An institution-based, cross-sectional, analytical study was conducted from August 2022 to October 2022 involving 190 participants (95 glaucoma patients and 95 controls). The glaucoma quality of life-15 (GQL-15) questionnaire was explained in their vernacular language by the interviewer. The scoring was given according to the validated scoring algorithm for the questionnaire.

Results:

Mean GQL score in the control group was 19.66 ± 5.5 and in glaucoma cases was 32.8 ± 10.2, whereas the mean score of mild glaucoma cases was 22.3 ± 4.83, moderate glaucoma cases was 36.3 ± 4.09, and severe glaucoma cases was 47.24 ± 3.03. Therefore, as the severity of glaucoma increases, the GQL score also increases, indicating poorer quality of life. Visual field loss was strongly positively correlated (correlation coefficient = 0.759, P < 0.01) with the GQL-15 score, while a weaker positive correlation was found with best corrected visual acuity (BCVA), cup disc ratio, and duration of treatment.

Conclusion:

Besides controlling or reducing intraocular pressure (IOP) to the target level, the goal of glaucoma treatment should be to provide an individual with good functional vision to maintain an acceptable quality of life. It would also help in providing patients with the best possible treatment, not only in terms of good vision but also in maintaining or improving their overall quality of life.
Coronavirus disease 19 (COVID-19) and viral keratouveitis – unraveling the mystery
Authors: Sanjay Srinivasan , Kundu Gairik , Deshpande Vrushali , Sethu Swaminathan , Agrawal Ruchika , Ghosh Arkasubhra , Kawali Ankush , Mahendradas Padmamalini , Shetty Rohit
Published: August 2023

To demonstrate viral proteins/inflammatory cytokines in a patient with unilateral keratouveitis. Retrospective case report. A 70-year-old Asian-Indian male presented with acute onset of blurring of vision in the left eye (OS) of 2 days duration. He had was coronavirus disease 2019 (COVID-19)-positive 3 months earlier. He had undergone cataract surgery/retinal laser photocoagulation in both the eyes. The corrected distance visual acuity (CDVA) (Snellen) in the right eye (RE) (OD) and left eye (LE) (OS) was 20/20 and 20/80, respectively. OS showed decreased corneal sensation, Descemet’s folds, mild stromal edema, and fine and pigmented keratic precipitates with anterior chamber 1+ flare and 1+ cells. Fundus evaluation showed scattered laser marks in the OD and temporal sectoral laser marks in OS. He was diagnosed with viral keratouveitis in OS. Tear samples were collected on Schirmer’s strips and tear wash for mass spectrometry and cytokines, which had 368 and 451 viral proteins in the RE and LE, respectively, using nano liquid chromatography–mass spectrometry, which were more than controls. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and varicella zoster virus proteins were detected. Cytokine analysis using flow cytometer analysis showed higher inflammation in OS as compared to OD. The patient was treated with oral acyclovir and topical steroids and resulted in resolution of his keratouveitis. SARS-CoV-2 proteins were present in the tear sample 3 months after COVID-19. The presence of viral proteins does not indicate causality.
Peering into the eye: A comprehensive look at ultrasound biomicroscopy (UBM) and its diagnostic value in anterior segment disorders
Authors: Kapoor Rohan , Parameswarappa Deepika C , Dhurandhar Deven , Peguda Hari K , Rani Padmaja K
Published: August 2023

Background:

Ultrasound biomicroscopy (UBM) is a noninvasive imaging modality that enables in-vivo visualization of the structures of the anterior segment of the eye. Unlike routine ophthalmic diagnostic ultrasound which uses frequencies of 5–10 MHz, UBM utilizes ultrasound frequencies in the range of 50–100 MHz. The high-frequency probes in UBM allows for higher resolution and better visualization of subsurface ocular structures, even in the presence of anatomic or pathological obscuration. UBM has qualitative as well as quantitative applications in various disorders affecting the anterior segment of the eye. Despite its huge importance, many clinicians lack in knowledge about the technique and its clinical usefulness. The current educational video aims to address this gap in knowledge by highlighting the technique and various clinical indications of UBM.

Purpose:

The purpose of this video is to demonstrate the technique of UBM and showcase its quantitative and qualitative implications and importance through various clinical cases.

Synopsis:

UBM is an imaging technique that assesses the depth of tissue structures by measuring the time delay of the returning ultrasound signal. This modality is capable of measuring the size of various structures within the eye, such as the cornea, iris, ciliary body, sclera, and the depth of the anterior and posterior chamber. To perform a UBM, a transducer is inserted into a specially designed eye cup filled with distilled water, creating a water bath environment. Axial and longitudinal scans can be performed in a similar fashion as in routine diagnostic B-scan ultrasound. Quantitative indications for UBM depicted in this video include measurements of corneal thickness, depth of the anterior chamber, and the width of the angle. The video also showcases how UBM can aid in the diagnosis and management of various anterior segment disorders like angle-closure glaucoma, plateau iris configuration, secondary glaucoma, and anterior uveitis with complicated cataract. Qualitative indications for UBM highlighted in this video include its role in intermediate uveitis, ocular hypotony, ocular surface tumors, cystic lesions of iris, and identifying the location and type of intraocular foreign bodies in the anterior segment based on the type of artifact seen. Additionally, the video shows the applications of UBM in scleral and episcleral pathologies.

Highlights:

This video will educate clinicians about the technique of UBM and showcase a bouquet of UBM findings in various case scenarios, helping one to better understand the potential of this modality in clinical practice.

Video link:
https://youtu.be/F626TMbJXoU

Key words: Anterior segment and glaucoma, diagnostic modality, indications, ultrasound biomicroscopy
Leptospiral uveitis- “Transition ‘from epidemic to endemic form” difficulties in laboratory confirmation
Authors: Rathinam SR. , Kohila G. Jeya , Gowri P Chidambaranathan , Balagiri KS.
Published: August 2023

Purpose:

Leptospirosis is a waterborne zoonotic disease that primarily causes systemic illness, followed by uveitis. After heavy flooding in Madurai district, an epidemic outbreak of systemic and ocular leptospirosis occurred in 1994. Our data shows a transition to endemicity after each epidemic.

Aim:

The aim of this study is to report the clinical signs, epidemic outbreaks, and persistent endemicity of leptospiral uveitis, as well as the diagnostic dilemmas associated with it.

Methods:

A retrospective analysis of clinical signs was conducted using medical records of leptospiral uveitis patients over a period of 27 years (1994–2020) in a tertiary care eye hospital. The clinical workup of uveitis included a detailed clinical history, systemic, and ophthalmic examination. Microagglutination tests (MATs) was done at the Centers for Disease Control and Prevention (CDC) in Atlanta and later in our regional laboratory. Serum samples were collected from human systemic leptospirosis cases and a small group of animals in and around Madurai.

Results:

The first epidemic outbreak resulted in 200 seropositive patients. Subsequent epidemic outbreaks occurred in 1997, 1998, 2001, 2005, and 2012, with Madurai experiencing multiple outbreaks. However, the disease remained endemic, with 25–50 patients being observed per year in between the peaks. Ocular examination revealed acute non-granulomatous uveitis (94.9%), pan uveitis (59.8%), vitreous inflammatory reaction (55.4%), retinal vasculitis (29.5%), disc hyperemia (20.9%), and hypopyon. (16.2%). New serovars emerged every year, resulting in decreased sensitivity of the MAT. Over time, the MAT started to miss diagnoses.

Conclusion:

The persistent endemicity of leptospiral uveitis emphasizes the need for accessible diagnostic tests. The low performance of the MAT can be attributable to the use of an older panel. The incorporation of new isolates in the MAT by a national laboratory will improve the accuracy of diagnosis.
Prepapillary vascular loops – A new classification
Authors: Subramanian Vishnu , Govindaraj Indu , Rajendran Anand
Published: August 2023

Background:

Prepapillary vascular loops are a type of congenital vascular anomaly seen on or around the optic disk. Patients with this condition are usually asymptomatic and are detected incidentally on routine fundus examinations. Differential diagnosis for this condition includes neovascularization of the disk and collaterals on the disk. Prepapillary capillary loops are not associated with any systemic condition. They are usually unilateral in presentation, but can rarely be bilateral.

Purpose:

To discuss the new proposed classification of prepapillary capillary loops.

Synopsis:

Prepapillary capillary loops are classified based on their location around the disk, loop characteristics such as elevation, shape, and covering, and presence of vitreoretinal traction.

Highlights:

The most common vascular loops are arterial in origin and rarely venous in origin. They can sometimes be associated with spontaneous and recurrent vitreous hemorrhage, branch retinal artery or vein occlusion, and subretinal hemorrhage. It is an important differential diagnosis in spontaneous vitreous hemorrhage. Treatment is symptomatic.

Video link: https://youtu.be/gbq_oP7Y2q4

Key words: Branch retinal artery occlusion, prepapillary vascular loops, vitreous hemorrhage
Drill from Military to Operating Theater and Safe Reuse of Single-Use Items to Combat the Cost of Optical Fibers and Consumables in Endovenous Laser Ablation of Varicose Veins
Authors: Rajapaksha Keerthi
Published: August 2023

Introduction:

Can the tandem arrangement of operating theater setup to perform a surgical drill similar to military, together with safe reuse of single-use items combat the cost of consumables of endovenous laser ablation (EVLA)?

Methods:

Operation pathway of EVLA consisted of cleaning and draping of patient (step 1), access to the affected vein and infiltration of tumescent local anesthesia (step 2), endovenous ablation (step 3), ultrasound-guided microfoam sclerotherapy (step 4), and chemical sterilization of consumables (step 5). Dedicated theater lists for EVLA were arranged to treat several patients per session in a prearranged operating theater. When the step 5 is completed on the first patient, the step 1 on the next patient was performed using sterilized optical fiber (OF) as a cycle while minimizing patient changeover time. Number of patients treated with each session of OF and time taken for step 1 to step 4 was recorded and analyzed.

Results:

A total of 140 patients treated using eight OFs during December 2019 to December 2022. Average number of patients treated with a single OF and during a single session of fiber is 17.5 (9–23) and 4.2 (3–7), respectively. Average time taken for step 1 was 7.83 min, step 2 was 7.95 min, step 3 was 1.57 min, and step 4 was 6.36 min. All the procedures were performed using four chemically re-sterilized guidewires and introducer sheaths.

Conclusion:

Tandem arrangement of operating theater to perform EVLA procedure similar to military drill can optimize the utilization of OFs and consumables.
Usefulness of Off-Label Use of Coronary Drug-Eluting Stents as Bailout for Patients with Critical Limb Ischemia and Infrapopliteal Arterial Occlusive Disease
Authors: Sekar Natarajan , Jagan Jithin , Sima Rahul Ralph , Archana Rajan
Published: August 2023

Background:

Infrapopliteal arterial disease is the most common finding in patients presenting with critical limb-threatening ischemia (CLTI) majority of whom also present with tissue loss. Vein bypass has been the gold standard of treatment in these patients. Nowadays, because of high peri-operative mortality and morbidity in these high-risk patients, endovascular treatment is offered first. Vascular restenosis, caused by intimal hyperplasia due to vessel injury during percutaneous transluminal angioplasty (PTA), remains the main limitation of infrapopliteal PTA and bare metal stent with clinical relapse and reinterventions. Drug-eluting stents (DES) are considered a possible solution to the problem of restenosis by reducing neointimal hyperplasia, after promising results in coronary arteries.

Materials and Methods:

Coronary DES was used as a bail out in patients undergoing below the knee (BTK) angioplasty. Those who developed dissection or recoil were stented with coronary stents. Multiple stents were used in patients with a long segment recoil of the artery. None of the stents were placed 2 or 3 cm beyond the origin of the tibial artery. The primary patency at 6 and 12 months, defined as absence of restenosis (≥50% stenosis) or occlusion based on clinical assessment and duplex scan, limb salvage and time taken to complete wound healing were assessed.

Results:

A total of 26 patients underwent drug-eluting stenting of the infra-popliteal vessels for CLTI during a period of 32 months. Technical success was possible in 92.3% patients (n = 24), however two patients had on table thrombosis of the stent. These two patients went on to have surgical bypass and their limbs could be salvaged. Wound healing was seen in 13 of 18 (72.2%) patients at 6 months and 11/12 (91.6%) patients at 1 year. Most patients took an average of 5 months to heal. Limb salvage was 11/12 (91.6%) at 1 year. Two patients underwent below-knee amputation for severe worsening sepsis due to uncontrollable foot infection. In both these patients’ stents were patent at the time of amputation. Primary patency was 92.3% at 6 months and at 1 year. None of the patients required re-intervention. Mortality was 15.3% at 1 year.

Conclusion:

Off-label use of cardiac stents in the infra-popliteal segment seems a viable bailout option in patients undergoing revascularization. DES helps to achieve early technical success, longer patency, better wound healing, and improves limb salvage in these patients.
A Slice in the Right Direction – Novel use of Directional Atherectomy for Treatment of Upper Limb Vascular Insufficiency and Concurrent Diagnosis
Authors: Singla Animesh A , Cai Ye Tommy , Kotecha Krishna , Baillie Tina , Nguyen Daniel
Published: August 2023

Large-vessel vasculitides are well-recognized entities, affecting the aorta, supra-aortic branch vessels, cranial vessels, and less commonly, peripheral arteries. Giant cell arteritis (GCA) is one of the most frequent large-vessel vasculitides affecting elderly patients. Despite diagnostic criteria, the mainstay of definitive diagnosis has been temporal artery biopsies. More recently, adjuvant ultrasound has been used to identify skip lesions before the biopsy. Downstream ischemia affecting branch vessels has traditionally been managed by open revascularization due to patient age and risk of disease recurrence. Experience with endovascular strategies for the management of acute or chronic vasculitides has been steadily increasing. We present an unusual case of acute giant cell vasculitis, diagnosed and treated with the use of an endovascular atherectomy device. The patient was a 74-year-old woman, with prior history of polymyalgia rheumatica, long-standing immunosuppression, and new onset of significant left arm claudication and rest pain. She underwent treatment for a high-grade left axillary artery lesion with directional atherectomy and drug-coated angioplasty. She had a good angiographic result. The intraoperative atherectomy specimen revealed the presence of acute GCA which prompted treatment with an acute vasculitis regimen. She had good patency of the treated segment at 3-month follow-up with complete resolution of her symptoms.
A Rare Case of Anterior Abdominal Wall Arteriovenous Malformation
Authors: Patel Jayesh , Akhani Alisha , Chhabhaya Nirav , Patel Arya
Published: August 2023

Arteriovenous malformation most commonly affects the central nervous system but can involve any organ. A 28 year old woman presented with complaints of on and off pain in epigastric region since 3 month.skin lesion in epigastric region since one month. local examination, there was multiple clear to hemorrhagic fluid filled blister present in epigastric region. An ill defined mass in the epigastric region, soft to firm in consistency and immobile. On leg raising test, the swelling became prominent. MDCT scan of whole abdomen showed a single lobulated hypodense lesion in anterior abdominal wall. Arterial supply was from superior epigastric artery from both sides and inferior epigastric artery from left side. There was no involvement of rectus sheath or evidence of intra-peritoneal extension. Excision of the epigastric AVM was performed after ligating all the feeders. To our best knowledge, this is the first case of epigastric subcutaneous AVM and such an entity has not been reported in the literature so far. Epigastric AVMs can easily be misdiagnosed as lipoma or epigastric hernia. Ultrasonography is useful as an initial imaging modality, however a CT scan is required to determine the peritoneal and visceral involvement of an epigastric mass.
An Intriguing Case of Popliteal Vein Aneurysm Presenting as Foot Drop
Authors: Komatreddy Gagandeep Reddy , Gangam Venkat Poojitha Reddy
Published: August 2023

Neurological deficits with peripheral venous aneurysm are extremely rare. We report this rare event in an elderly female presenting with difficulty in walk for 2 months, a swelling in the right popliteal fossa, and inability to dorsiflex the right foot. She was successfully managed with surgical intervention.
Evaluation and Identification of Macrovascular Complications in Patients with COVID-19 – Original Study
Authors: Hassani Mohammad , Khanabadi Binazir , Tavallaei Mehdi , Mehdizadeh Mahshid , Mahmoud Abadi Farzad Dehghani , Mirabootalebi Fatemeh Sadat
Published: August 2023

Background:

Coronavirus disease 2019 (COVID-19) is a pandemic that has affected many patients worldwide. Infection with this virus appears to be associated with a high risk of macrovascular complications.

Methods:

In this descriptive study, we examined the clinical and demographic information of 67 patients in whom COVID-19 was confirmed in terms of vascular complications.

Results:

The results of this study showed that 65.6% of COVID-19 patients had venous complications and 34.4% had arterial complications. In the patients who had more severe symptoms caused by COVID-19 such as fever, cough, sore throat, nausea and vomiting, diarrhea, anorexia, shortness of breath, joint pain, and fatigue, they had more severe venous complications.

Conclusions:

Better and more accurate understanding of the pathophysiological mechanisms causing severe disease of COVID-19, as well as identifying the prevalence of macrovascular complications and possible disorders resulting from them in patients with COVID-19 in different ethnicities and populations to develop new treatment, is needed.
Prognostic Value of the Pre-Procedural Six Minute Walk Test in Patients Undergoing Open Abdominal Aortic Aneurysm Repair – A Prospective Observational Study
Authors: Pandey Ashutosh Kumar , Manchikanti Sriram , Sun Neelamjingbha , Gupta Aditya , Pitchai Shivanesan , Pillai Vivek
Published: August 2023

Objective:

Open surgery for aortic aneurysm is associated with significant morbidity and mortality. Preoperative functional status is one of the key predictors of adverse outcomes in the postoperative period. This study investigated the role of 6-min walk test (6MWT) in predicting the outcomes after open surgery in abdominal aortic aneurysm (AAA).

Methods:

A prospective cohort study was conducted in patients scheduled to undergo open repair of AAA. The preoperative 6-min walk distance (6MWD) was calculated for patients, followed by postoperative monitoring of all patients who underwent surgery. Walking performance was classified with 300 m as a cutoff, and patients were divided into two groups with 6MWD- <300 m and >300 m. The results of 6MWT were analyzed with respect to cardiopulmonary complications, intensive care unit (ICU) stay, ventilatory or inotropic support, length of hospital stay, and mortality.

Results:

A total of 52 patients were included in the study, and 49 patients were able to complete the 6MWT. The patients with <300 m 6MWD had a longer stay in the ICU and an increased duration of ventilatory and inotropic support (P < 0.001). The <300-m group had an increased incidence of cardiopulmonary complications (47%, P = 0.001). The <300-m group had a higher duration of hospital stay (10.6 vs. 8.4 days; P = 0.01). All the patients who died in the perioperative period had a 6MWD <300 m (n = 3, P = 0.03). The 6MWD was the only strong predictor of adverse outcomes in the cohort.

Conclusion:

6MWT can be safely performed in patients with AAA. A low walking distance correlates directly with increased perioperative morbidity and length of hospital stay. A distance of <300 m in patients with aortic aneurysm is predictive of perioperative morbidity and mortality.
A Study of Treatment Outcomes on the Basis of Revised Venous Clinical Severity Score in Patients of Varicose Veins Undergoing Surgical Management
Authors: Chowdhry Shreyansh , Jaiswal Shyam Sunder , Dwivedi Surjeet
Published: August 2023

Background:

Chronic venous disease is a prevalent and progressive disease. There has been a tremendous increase in venous technologies and procedural volumes over the past decade, but still, there is a great deficiency in available clinical data. Reporting of clinical outcomes in a standard fashion is the need of the hour required to compare devices and other therapeutic methods intended to improve clinical outcomes.

Materials and Methods:

This is a prospective observational study carried out between November 2016 and October 2018 on 200 consecutive cases that underwent surgical management for varicose veins.

Results:

Revised venous clinical severity score (RVCSS) scores reduced significantly after surgical intervention and subsequent follow-up; however, when comparing the scores between the two groups, there was no significant statistical difference.

Conclusion:

RVCSS coupled with Clinical-Etiology-Anatomy-Pathophysiology provides a standard clinical language to report and compare different approaches to cardiovascular diseases management. Ligation and stripping (L and S) are the gold standard for the treatment of varicose veins, endovascular procedures are expensive and have similar efficacy as L and S, however, are preferred in the present era due to better cosmetic and faster recovery.
The effect of symbiotic in the treatment of infantile colic
Authors: Khoshnevisasl Parisa , Sadeghzadeh Mansour , Kamali Koorosh , Hasanlo Masoumeh
Published: August 2023

Background:

This study aims to evaluate the effect of symbiotic (Pedilact) on the treatment of infantile colic.

Materials and Methods:

In this randomized clinical trial in Zanjan, Iran, 76 infants with infantile colic were assigned to two groups of 38 cases using block randomization. The intervention group received 5 drops of Pedilact, a symbiotic containing Lactobacillus reuteri and simethicone (20 mg twice daily), and the control group received placebo in addition to simethicone for 4 weeks. Daily crying time, number of crying attacks per day, and sleep duration were recorded on days 1, 7, 14, 21, and 28, and the results were compared.

Results:

Thirty-three infants in the intervention group and 35 infants in the control group were enrolled. There was no significant difference between the two groups in terms of age, gender, gestational age, maternal age, type of delivery, type of feeding, and weight at the beginning and the end of the study (all P > 0.05). Daily crying time in the control and intervention groups decreased from 240 and 210 min/day, respectively, to 0 min/day in both the groups. Daily crying attacks decreased from 5 and 4/day in the control and intervention groups, respectively, to 0/day. Sleep duration in both the groups increased from 720 to 840 and 930 min/day in the control and intervention groups, respectively, but the changes were not significant (P = 0.56, P = 0.52, and P = 0.13, respectively).

Conclusion

We did not find a significant improvement in colic symptoms in infants receiving symbiotic compared to placebo.
Ventilator Mode Finder
Authors: Saghaei Mahmoud
Published: August 2023

There are hundreds of ventilator modes on different ventilators. Despite different names, many are similar in functions and options. Educational institutions only teach a limited collection of ventilator modes of a few numbers of models; therefore, graduates may have substantial difficulties encountering new ventilator models with unfamiliar mode names on them. In this article, an Android application for finding similar modes on different ventilators is presented. The aim is to help an intensive care practitioner to easily find a familiar mode on a new ventilator.
Interleukin-6 and tumor necrosis factor-α levels in tear film of Keratoconus patients
Authors: Peyman Alireza , Namgar Mohammad , Feizi Awat , Hakemi Mazdak Ganjalikhani , Nasab Fahimeh Hosseini , Pourazizi Mohsen
Published: August 2023

Background:

It is hypothesized that increased inflammatory markers in keratoconus (KC) may be one of the causes of corneal damage. The aim of our study was to the measurement of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL)-6 in tear of patients with KC and investigate their relationship with the severity of KC.

Materials and Methods:

The current study was performed on KC patients and healthy controls with a case-control setting. Tear levels of TNF-α and IL-6 were measured after collecting the tears from the tear lake using a filter paper via Schirmer I method without anesthesia.

Results:

Eighty-one KC patients (mean age 29.45 ± 5.06 years) and 85 controls (mean age 28.01 ± 5.14 years) were enrolled. The mean levels of IL-6 and TNF-α were 26.77 ± 8.16, and 34.58 ± 9.82 pg/ml in the healthy group and 103.22 ± 51.94, and 183.76 ± 54.61 pg/ml in the KC group, respectively (P < 0.001). There was a significant relationship between the severity of the KC and the mean levels of IL-6 TNF-α in the case group (P < 0.001).

Conclusion:

Our results indicated that the mean levels of IL-6 and TNF-α are significantly higher in KC than the healthy group, and the disease severity was significantly associated with TNF-α and IL-6.
T-cell immunophenotyping in COVID-19 pneumonia
Authors: Nematollahi Pardis , Ashrafi Farzaneh , Darakhshandeh Ali , Salmasi Mehrzad
Published: August 2023

The COVID-19 epidemic is currently a global threat that has affected many parts of the world. Some patients require intensive care unit admission due to severe symptoms in the course of the disease. The severity of symptoms in this disease varies from person to person. The effectiveness of the immune response against viral infections depends on the number and activity of T-cells, which play an important role in eliminating virus-infected cells. In this study, we report two patients with COVID-19 pneumonia, one with moderate symptoms and the other with severe symptoms. Although a decrease of absolute lymphocyte count was seen in both patients, a more significant decline reported in the ICU-admitted patient. Expression of activated markers, HLA-DR, CD38, on CD8-positive T-cells was shown in a patient with more severe disease. On the other hand, partial loss of CD7 in the severe case was also observed. Hence, besides of the above parameters that already mentioned in other studies, loss of pan T-markers could be considered as a potentially valuable test for predicting disease severity. We suggest evaluating the predictability of these tests in COVID-19 in larger studies. This study was approved by the Ethics Committee of Isfahan University of Medical Sciences (IR.MUI.MED.REC.1399.238).
Quality of life and its determinants in patients with noncystic fibrosis bronchiectasis
Authors: Sami Ramin , Zohal Mohammadali , Khanali Fatemeh , Esmailzadehha Neda
Published: August 2023

Background:

Promoting quality of life (QoL) in patients with bronchiectasis, as a chronic disease, is a part of therapeutic principles. This study aimed to investigate QoL and its determinants in patients with noncystic fibrosis (CF) bronchiectasis.

Materials and Methods:

This cross-sectional study was conducted on 62 patients (38.7% male, mean age: 44) with non-CF bronchiectasis and involvement of ≥2 lobes in Qazvin, Iran. QoL was evaluated using the St. George's Respiratory Questionnaire (SGRQ). The relationships of QoL subscales with clinical (cough, dyspnea, and sputum volume) and paraclinical (spirometry, computerized tomography scan, sputum microbiology, and 6-min walk test [6-MWT]) were assessed using Pearson's correlation coefficient and multiple linear regression analyses.

Results:

The mean SGRQ total score was 53.1 (standard deviation 19.8) out of 100. The level of dyspnea (r = 0.543, P < 0.001), cough (r = −0.594, P < 0.001), 6-MWT (r = −0.520, P < 0.001), sputum volume (r = 0.423, P = 0.002), and number of exacerbations (r = 0.446, P = 0.009) had significant correlation with SGRQ total score. In multiple regression analysis, forced expiratory volume in 1 s was an independent predictor of the symptom (β = −0.22, P = 0.048) and activity (β = −0.43, P = 0.03) subscales, whereas cough was an independent predictor of the symptom subscale (β = −2.1, P = 0.002).

Conclusion:

In patients with non-CF bronchiectasis, the extent of lung impairment has a lower effect on the QoL than clinical symptoms. It seems that the QoL can be improved through the proper treatment of clinical symptoms and rehabilitation for promoting 6-MWT.
Successful treatment of plasmapheresis followed by interferon beta-1a in a child with severe COVID-19
Authors: Saleh Rana , Rahimi Hamid , Dehghan Amin , Sadeghizadeh Atefeh , Gheisari Alaleh , Saeidi Shima , Pourmoghaddas Zahra
Published: August 2023

COVID-19 outbreak has become a global health concern due to challenges in treatment and high mortality rate; therefore, its therapeutic approaches play an important role in reducing the mortality rate and resolving this concern. Different therapies have been introduced, including interferon beta-1a and purification methods, for instance, plasmapheresis. In this article, we reported a child with severe COVID-19 who fully recovered after receiving plasmapheresis and interferon beta-1a.
A narrative review of psychomotor abilities in medical sciences
Authors: Changiz Tahereh , Amouzeshi Zahra , Najimi Arash , Adibi Peyman
Published: August 2023

Extensive research in the past decades has evidenced differences in the psychomotor ability of individuals resulting from varying levels of experience, age, gender, response precision, compatibility, performance, and ability. Many studies have called for the need to identify psychomotor ability and appropriate tests that can assess it. This review article surveys the definition, categorization, and tests of psychomotor ability as well as training based on psychomotor ability in medical sciences. We searched the literature with no time limit, using the ProQuest, PubMed, and Eric databases, as well as the Google Scholar search engine. The keywords for the search involved psychomotor, psychomotor performance, assessment, psychomotor ability, motor learning, education, training, psychomotor ability testing, and psychomotor skills. Other relevant papers found through hand searching and snowballing were also included in the review. The EndNote X8 was employed as a reference manager tool. Only abstracts of the papers whose full texts were accessible were reviewed after repetitious papers were excluded. The documents were categorized into five groups: definition of psychomotor skills and ability, psychomotor ability components, psychomotor ability tests, identification of psychomotor ability (task analysis), and training. This review article revealed that there is not a single definition for psychomotor ability and its components. However, it can be said that motor abilities are the foundation for the rapid acquisition of skills and according to the neuroplasticity process are learned through training and practice. Given psychomotor abilities vary among individuals, training courses should also provide different levels of psychomotor training for learners. The literature introduces psychomotor tests as a selection tool, a predictor of future professional behavior, and a means to evaluate progress in performance, academic guidance (ability-oriented medical specialty), and curriculum implementation tailored to the needs of learners of varying graduate disciplines. The tests should be profession-specific because each profession entails its peculiar characteristics and abilities. On the other hand, the major problem in studying and analyzing underlying psychomotor skills and abilities is that the components are being investigated by researchers from varying, and usually unrelated, scientific fields. Therefore, it is necessary to have a holistic view through close interaction between the researchers of different sciences to better understand this area.
Pattern of Metastasis of Head and Neck Cancer in Nigeria: A 10 Year Review
Authors: Okwor VC , Folasire A , Ntekim AI , Okwor CJ , Nwankwo KC , Arua SC
Published: August 2023

ABSTRACT

Introduction:

Head and neck cancer is a common and aggressive malignancy with a high morbidity and mortality profile that occur in several anatomical sites in the head and neck region. They constitute the tenth most common cancer in the world. Metastatic head and neck cancers are associated with severe morbidities and its treatment is mainly palliative. This study examined the patterns of metastases of head and neck cancer in patients in a tertiary hospital in Nigeria.

Method:

The data extraction form was used to obtain information from the Radiotherapy treatments records and the case notes of patients with histological diagnosis of Head and Neck Cancers between 2002 and 2011 at the Radiotherapy department, University College Hospital, Ibadan. Analyses was done using statistical Package for Social Sciences (SPSS) Version 20.0.

Results:

A total of 481 patients were seen in this study. The age of the patients ranged from 11 years to 80 years with mean age of 42 years. The male to female ratio was 2:1. The peak age of incidence was between 40-49 years. Most patients presented with stage III and IV. Nasopharyngeal carcinoma had the highest proportion of occurrence 205 (42.6%) followed by paranasal sinuses. Lung had the commonest site of metastasis followed by bones.

Conclusion:

More than half of the patients presented late with the commonest cancer being nasopharyngeal carcinoma. Lung was the commonest site of distant metastasis with nasopharyngeal carcinoma having the highest proportion of metastasis to the lungs at two years follow up.
The Feasibility of Introducing Early Pregnancy Assessment Unit in Nigerian Hospitals: A Pilot Study from a Private Hospital in Enugu, Southeast Nigeria
Authors: Ugwu GO , Iyoke CA , Nnagbo JE
Published: August 2023

ABSTRACT

Background:

Early pregnancy assessment unit (EPAU) is a dedicated unit that provides specialist care such as definitive ultrasonographic and biochemical assessment to women who have or have had vaginal bleeding or pain before 16 weeks of pregnancy. Such patients usually have a positive pregnancy test with a scan showing pregnancy of an unknown location, previous ectopic pregnancy, recurrent miscarriages, or previous molar pregnancy. Such a holistic and prompt approach leads to better outcome in the management of women with early pregnancy and other complications.

Aim:

This study aimed to describe the diagnosis and outcome of early pregnancy pain and bleeding, managed by rapid ultrasonographic and biochemical assessments by a dedicated gynecological team in a private hospital to determine the feasibility of establishing early pregnancy assessment units (EPAUs) in Nigeria.

Materials and Methods:

This is a cross-sectional study of eligible cases of early pregnancy bleeding and pain in a private gynecological hospital in Enugu, Nigeria.

Results:

During the 9-year study period, 160 women with early pregnancy pain or bleeding were analyzed. The mean age of the participants was 32.3 ± 7.2 years, and they were mostly multipara (68.7%) and Christians and of the Igbo tribe (91.3%). The final diagnosis after clinical and radiological evaluations showed that the majority had miscarriages (82.5%), while 17.5% had ectopic gestations. All the participants had their definitive diagnosis and treatment within 24 hours of presentation. There was no recorded case of maternal death.

Conclusion:

EPAUs are feasible in a Nigerian setting provided that trained, dedicated staff and equipment are provided.
Prognostic Role of Optic Nerve Sheath Diameter in Stroke in Emergency Department, A Case Control Study
Authors: Batur A , Karaca MA , Arslan V , Boz M , Ibrahimov Z , Erbil B , Onur MR
Published: August 2023

ABSTRACT

Background:

Sonographic measurement of optic nerve sheath diameter (ONSD) can reflect intracranial pressure (ICP) indirectly and determine the neurology intensive care unit (NICU) requirement and mortality in acute ischemic stroke (AIS).

Aim:

To demonstrate the effectiveness of ONSD to determine mortality, morbidity, and NICU requirement on patients with the AIS.

Methods:

The sonographic ONSD measurements were performed on each patient with AIS, over 18 years old. All patients were categorized according to the Oxfordshire Community Stroke Project (OCSP) classification system. MRI images were examined for increased ICP, and the patients were categorized into two groups as increased ICP (i-ICP) and normal ICP. The ONSD results were evaluated in terms of classifications, outcomes, and prognosis of the patients.

Results:

One hundred and five patients were included and 31 (35.2%) were in the i-ICP group. The median ONSDs were 5.26 mm in the i-ICP group and 4.62 mm in the normal ICP group (P < 0.001). The median ONSDs were 5.13 mm in the NICU group and 4.69 mm in the neurology ward (NW) group (P = 0.001). The total anterior circulation infarction (TACI) subgroup had higher ONSDs than the others (TACI: 5.27 mm; PACI: 4.73 mm; POCI: 4.77 mm; and LACI: 4.64 mm, P < 0.001). The NICU requirements were higher in the TACI subgroup. The median ONSD was 5.42 mm in the deceased group (survived: 4.77 mm, P < 0.001).

Conclusion:

ONSD may be favorable for predicting the increased ICP and the NICU requirement in OCSP subgroups. Moreover, ONSD can be used to foresee the mortality of AIS.
Is Endometrial Sampler SAP-1 a Good Way to Diagnose the Common Intrauterine Occupying Lesions?—A Diagnostic Study
Authors: Hong Y
Published: August 2023

ABSTRACT

Background:

Intrauterine occupying lesion is clinically common in the female reproductive organs. Endometrial cancer is the most critical one among intrauterine occupying lesions, which accordingly is considered as the main indication for endometrial cancer screening, for which endometrial sampler SAP-1 was recommended as an effective sampling tool.

Objective:

This study aimed to evaluate the diagnostic efficacy of SAP-1 for endometrial polyp and uterine submucous myoma.

Materials and Methods:

From August 2018 to June 2022, patients who were hospitalized for undergoing hysteroscopy examination were enrolled in this study. Before the procedure, endometrial samples were collected by the method of SAP-1. The histological results were compared with those by hysteroscopy sampling to analyze the diagnostic efficacy of SAP-1.

Results:

The qualified rate for the SAP-1 sampling was 92.1%, which is a bit lower than that by method of hysteroscopy (95.3%). And the difference was not statistically significant (P > 0.05). Endometrial polyp (47.5%) and uterine submucous myoma (7.1%) accounted for the majority of endometrial lesions, while only 11.3% endometrial polyps (17/151) and 0% submucous myomas (0/23) were detected by SAP-1 sampling.

Conclusion:

Endometrial sampler SAP-1 is not effective in detection of solid intrauterine lesions indicated by the imaging examination. Hysteroscopy is recommended for definite diagnosis.
Changing Pattern of Cancer Distribution: Experience From a Tertiary Health Institution in Nigeria and Review of Literature
Authors: Adeniji KA , Folaranmi OO , Odetunde OA , Adegboye O , Ibiyeye KM , Ighodalo JE , Olayiwola IO , Suleiman KA , Abubakar-Akanbi SK
Published: August 2023

ABSTRACT

Background:

Over the years, epidemiological surveys have established that the five leading cancers in Africa (in descending order of prevalence) are cancers of the breast, cervix, prostate, liver, and colorectum.[1] However, a 10-year retrospective review of cases performed at the University of Ilorin Teaching Hospital (UITH) revealed some changes in the cancer incidence pattern in this region.

Aims:

The aim of the study was to determine the distribution of cancers managed at the UITH, a tertiary health care center in North Central Nigeria, in the past 10 years and create awareness of changing cancer prevalence patterns in this region.

Materials and Method:

This was a retrospective review of cancer epidemiology at UITH over a period of 10 years. Confirmed cancer cases within this period were extracted from the data in the Department of Anatomic Pathology and the Cancer registry. Descriptive and inferential statistics were applied to obtain rates and proportions for both sexes.

Results:

There were 2430 confirmed cases of cancer during the study period from January 2011 to December 2020. Out of these cases, 1310 (54%) were seen in females and 1120 (46%) were seen in males. The most common cancer recorded (in total) was prostate cancer, which accounted for 18% of all cases, constituting approximately one in six of all cancer cases. This was followed closely by breast cancer (16.6%). The most commonly diagnosed cancer in males was prostate cancer (four in ten cancer cases in males), whereas in females, it was breast cancer (approximately three in ten cancer cases in females). Cancers of the lungs and liver were rare in both sexes in this study. In children, the most common malignancies were retinoblastoma (38.3%), non-Hodgkin lymphomas (16.8%), and nephroblastoma (12.8%).

Conclusion:

There is a changing trend in cancer cases with some cancer cases now predominating compared to previous years. This may be because of increased awareness and/or better medical screening and diagnostic techniques.