bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of bleb morphology by anterior segment optical coherence tomography and clinical outcome after phacotrabeculectomy with mitomycin C or Ologen implant
Authors: Chelerkar Vidya J , Agrawal Dishi , Kalyani V K S , Deshpande Madan
Published: October 2021

Purpose:

To compare the bleb morphology by Anterior Segment Optical Coherence Tomography (ASOCT) and clinical outcome after Phacotrabeculectomy with either mitomycin C or Ologen implant.

Methods:

In a prospective interventional active controlled study, 93 patients aged 18 years and above underwent phacotrabeculectomy with either mitomycin C (53 eyes) or ologen implant (40 eyes), followed up for 12 months. The primary outcome measure was to note the evolution of bleb morphology by ASOCT in the two groups over 12 months. Secondary outcome measures were mean IOP, reduction in the need for anti-glaucoma medications, and complications seen in the two groups.

Results:

All parameters in the two groups were comparable preoperatively (P>0.05). Best corrected visual acuity at 12 months was 0.38±0.27 in mitomycin group and 0.31±0.23 in ologen group (P=0.151). Post-operative IOP at 12 months was 14.09±3.1mmHg (95%CI 13.22-14.97) in mitomycin group, and 13.25±2.5 mmHg (95%CI 12.40-14.30) in ologen group (P=0.254).The mean number of medications was 0.36±0.68 in mitomycin group and 0.38+/-0.70 in ologen group at 12 months (P=0.91). Overall success was achieved in 98.1 % of patients in mitomycin group and 90 % of patients in ologen group at 12 months. No major sight-threatening complications were noted in any group. AS-OCT imaging at 12 months showed multiform reflectivity with multiple large cystic spaces in both groups, with good IOP control.

Conclusion:

Phacotrabeculectomy using Mitomycin C and Ologen implant resulted in similar morphologic and functioning blebs at one year with comparable efficacy in controlling intraocular pressure.
Multimodal imaging of eyes with metamorphopsia after vitrectomy for rhegmatogenous retinal detachment
Authors: Kumar Vinod , Naik Anand , Kumawat Devesh , Sundar Dheepak , Chawla Rohan , Chandra Parijat , Kumar Atul
Published: October 2021

Purpose:

To assess the retinal features in eyes with postoperative metamorphopsia (POM) following rhegmatogenous retinal detachment (RRD) repair using multimodal imaging (MMI).

Methods:

In this cross-sectional; case-control study, patients after successful RRD repair following 25-gauge vitrectomy, clear vitreous cavity, and corrected distance visual acuity (CDVA)>20/200 were categorized using Amsler chart: cases with POM and controls without POM. MMI was performed on swept-source platform (Triton, Topcon Inc) and the confocal scanning laser ophthalmoscope system (Spectralis HRA, Heidelberg). The measures assessed were CDVA, morphological features on optical coherence tomography, autofluorescence, and multicolor imaging (MCI).

Results:

Thirty-nine eyes were included in each group. Cases had greater number of eyes with total RRD (P = 0.029) preoperatively; abnormal foveal contour (P = 0.036), ellipsoid zone (EZ) disruption (P < 0.001) and poorer postoperative CDVA (P = 0.046) as compared to controls. Outer retinal folds and retinal shift (unintentional translocation of retina after reattachment surgery for RRD) did not differ significantly between the groups (P = 0.48 and 0.35, respectively). On MCI, the distribution of detected ERM was similar between the groups (P = 0.25). Postoperative CDVA was significantly worse in eyes with POM.

Conclusion:

POM is affected by extent of RRD, postoperative foveal contour, and EZ status but not by retinal shift.
Periorbital aesthetic concerns in patients seeking corneal refractive surgery
Authors: Naik Milind N , Khader Mohammed A , Murthy Somasheila I
Published: October 2021

Purpose:

To report the frequency of periorbital aesthetic abnormalities in patients undergoing refractive surgery and to report the ability of the patient and the refractive surgeon in picking up these findings compared to the oculoplastic surgeon.

Methods:

Single-center, prospective observational case series. All patients underwent standard pre-operative work-up for refractive surgery, answered a study questionnaire, and underwent face photographs (with and without glasses). The patient, the refractive, and the oculoplastic surgeons evaluated the photographs to categorize the concerns as none, presence of ptosis, tear trough deformity, scleral show, and others. The findings of the oculoplastic surgeon were taken as the standard of reference.

Results:

The photographs of 121 patients were analyzed. The mean age was 25.76 ± 3.75 years and 72% were males. The main indication for surgery was to eliminate dependency on glasses in a majority (76%) followed by cosmesis in 23%. The oculoplastic surgeon noted tear trough deformity in 14 (11.5%) cases, scleral show in 51 (42.1%), ptosis in 35 (28.9%), and other findings in 45 (37.1%). When the symmetrical scleral show was excluded, the patient picked up aesthetic concerns in only 8.26%, the refractive surgeon in 14% as compared to 39% by the oculoplastic surgeon (P < 0.01).

Conclusion:

Periorbital aesthetic significant findings were noted in 39% of the patients undergoing corneal refractive surgery when assessed by an oculoplastic surgeon. The refractive surgeon was able to pick up less than 50% of these. We recommend a basic aesthetic initial evaluation prior to refractive surgery and photographic documentation, especially in cosmetically aware patients.
Ophthalmic presentations and long-term outcomes of subconjunctival and atypical orbital myocysticercosis
Authors: Singh Manpreet , Sharma Manjula , Chaurasia Shweta , Grewal Aditi Mehta , Kaur Savleen , Kaur Manpreet , Yadav Deepti , Gupta Pankaj
Published: October 2021

Purpose:

To study the clinical presentation, radiological features, diagnosis, and treatment response in subconjunctival and atypical orbital myocysticercosis.

Methods:

Retrospective analysis of diagnosed subconjunctival and atypical (strabismus, diplopia, and blepharoptosis) orbital myocysticercosis was performed. A diagnostic criterion (2 of the 3) among clinical features, radiological findings, and treatment response was used in our study. A minimum of “post-treatment” follow-up of 12 months was observed.

Results:

Thirty-five patients were included with a mean age of 16 years having male predominance (n = 22, 62.8%). All had a unilateral presentation, with 24 (68.6%) patients having subconjunctival cysticercosis, of which 22 were located in close proximity of the rectus muscle insertion. At presentation, 10 patients had diplopia, 7 had strabismus, and 6 had face turn. Pseudo Duane’s and pseudo-Brown’s syndrome were noted in 5 and 4 patients, respectively. Radiologically, single muscle myositis without scolex was seen in 12 (34.3%) cases. All patients first received medical treatment, and surgical intervention (cyst removal) was attempted after treatment failure. Complete resolution of symptoms was noted in 22 (after medical treatment only) and in 8 (after surgery).

Conclusion:

In the majority, the subconjunctival cysticercosis is found in proximity to the rectus muscle insertion, as a part of orbital myocysticercosis. In atypical scenarios, a satisfactory response to medical treatment can be considered as diagnostic of cysticercosis.
Use of predictive models to identify patients who are likely to benefit from refraction at a follow-up visit after cataract surgery
Authors: Gupta Sachin , Schneider Matthew J , Vardhan S Ashok , Ravilla Thulasiraj
Published: October 2021

Purpose:

To develop predictive models to identify cataract surgery patients who are more likely to benefit from refraction at a four-week postoperative exam.

Methods:

In this retrospective study, we used data of all 86,776 cataract surgeries performed in 2015 at a large tertiary-care eye hospital in India. The outcome variable was a binary indicator of whether the difference between corrected distance visual acuity and uncorrected visual acuity at the four-week postoperative exam was at least two lines on the Snellen chart. We examined the following statistical models: logistic regression, decision tree, pruned decision tree, random forest, weighted k-nearest neighbor, and a neural network. Predictor variables included in each model were patient sex and age, source eye (left or right), preoperative visual acuity, first-day postoperative visual acuity, intraoperative and immediate postoperative complications, and combined surgeries. We compared the predictive performance of models and assessed their clinical impact in test samples.

Results:

All models demonstrated predictive accuracy better than chance based on area under the receiver operating characteristic curve. In a targeting exercise with a fixed intervention budget, we found that gains from predictive models in identifying patients who would benefit from refraction ranged from 7.8% (increase from 1500 to 1617 patients) to 74% (increase from 250 to 435 patients).

Conclusion:

The use of predictive statistical models to identify patients who are likely to benefit from refraction at follow-up can improve the economic efficiency of interventions. Simpler models like logistic regression perform almost as well as more complex machine-learning models, but are easier to implement.
Determination of surgical outcomes with a novel formulation of intrastromal natamycin in recalcitrant fungal keratitis: A pilot study
Authors: Saluja Gunjan , Sharma Namrata , Agarwal Rinky , Sharma H P , Maharana Praful , Satpathy Gita , Titiyal Jeewan Singh , Velpandian T
Published: October 2021

Purpose:

To evaluate the outcomes of water-soluble intrastromal natamycin (IS-NTM) as an adjunct therapy for recalcitrant fungal keratitis.

Methods:

This was a prospective interventional pilot study in the setting of a tertiary eye-care center. Twenty eyes of 20 consecutive patients with microbiologically proven recalcitrant fungal keratitis (ulcer size >2 mm, depth >50%, and not responding to topical NTM for 2 weeks) were recruited. The selected patients were injected with a novel composition of IS-NTM (10 ug/0.1 mL, soluble natamycin) prepared aseptically in the ocular pharmacology department. All the patients continued using topical NTM suspension 5% 4-hourly until the ulcer healed. Repeat injections were undertaken after 72 h depending on the clinical response and all the patients were followed till 6 months.

Results:

The mean age of the patients was 40.42 ± 10.09 years. The mean duration of the presentation was 20.8 ± 5.1 days. The most commonly isolated organisms were Aspergillus sp. (12/20, 60%) and Fusarium
sp. (8/20, 40%). No patient had iatrogenic perforation or precipitate formation after IS-NTM injection. The overall cure rate with IS-NTM was 95% (19/20 patients). The number of patients who healed with the 1st, 2nd, and 3rd injection was 13, 5, and 1, respectively. One (5%) had no response to treatment and was subjected to penetrating keratoplasty. The average time taken for the resolution of the epithelial defect, stromal infiltrates, and hypopyon was 34 ± 5.2 days, 35.3 ± 6.4 days, and 15 ± 2.5 days. Healing with deep vascularization and cataract was noted in 6/19 eyes (31%) and 13/19 eyes (68.42%), respectively.

Conclusion:

Intrastromal injection of a novel formulation of NTM holds a promising role as adjunctive therapy to topical NTM in the management of recalcitrant filamentous fungal keratitis. The preliminary results are encouraging and further studies are required to validate the results.
Incidence of ocular and systemic diseases affecting visual function among state bus drivers
Authors: Kohli Piyush , Babu Naresh , Mishra Chitaranjan , Damodaran Sourav , Bhavani S , Kumar Mahesh , Ramasamy Kim
Published: October 2021

Purpose:

To evaluate the incidence of ocular and systemic disease affecting visual function among state transport corporation bus drivers in a south Indian district.

Methods:

This retrospective study analysed the records of all the drivers who presented to a south Indian tertiary-care eye hospital in 2019 for their mandatory annual ocular check-up. Details reviewed included demographic details; refraction; presence of systemic and ocular diseases with vision-threatening potential; presence of ocular conditions responsible for visual loss and the treatment administered.

Results:

3042 drivers (mean age, 47.0 ± 5.7 years) were evaluated. Visual function-threatening systemic diseases were present in 25.0% drivers, out of which diabetes mellitus (18.7%) was the most common pathology. The most common ocular problem was refractive error (45.0%). Visual function-threatening ocular diseases were present in 9.5% drivers. Diabetic retinopathy, visually-significant cataract, glaucoma and central serous chorioretinopathy were noted in 4.0%, 1.9%, 1.7% and 0.8% drivers. Surgical intervention was required in 2.2% drivers. Thirteen drivers were temporarily deemed unfit for driving heavy-weight vehicles.

Conclusion:

Several bus drivers suffer from vision-threatening systemic and ocular diseases. Some of them require surgical intervention to retain fitness. A complete ocular and systemic evaluation of diseases with vision-threatening potential should be performed at the time of renewal of the driving license. The drivers should be educated about the systemic diseases which can affect their driving skills and must be encouraged to seek medical help at an early stage.
Serial swept source optical coherence tomography of a cotton wool spot following SARS CoV2 infection
Authors: Shah Mauli , Biswas Jyotirmay
Published: October 2021

A 33-year-old male presented with history of blurring of vision in the left eye for two months. He was seen by the local ophthalmologist and diagnosed as nongranulomatous anterior uveitis in the left eye with normal fundus. He had history of fever 20 days back and was diagnosed positive for COVID-19 by RT-PCR. He presented with acute anterior uveitis in the left eye. Fundus examination revealed a cotton wool spot close to the fovea, which was confirmed by swept-source optical coherence tomography (SS-OCT) of the macula. The patient after two months’ follow-up showed resolution of the cotton wool spot, which was confirmed by SS-OCT. Our case indicates that cotton wool spot can be an ocular manifestation of COVID-19 infection, and swept-source optical coherence tomography can precisely document the resolution of the lesion.
Risks assessment of Adherence to non-pharmaceutical measures towards COVID-19 among residents of Mashhad in the North-East of Iran during the awful wave of the epidemic
Authors: Abdollahzadeh Hasan , Rahmanian Vahid , Sharifi Nader , Zahedi Razieh , Bajestani Majid Jafari Nejad , GholianAval Mahdi , Esmaeilzadeh Nayereh , Hadjzadeh MousaAlReza , Ahmadian Mohammad
Published: October 2021

Background:

Since the Coronavirus disease 19 (Covid-19) rampaged in Iran, three waves of the epidemic occurred.

Objective:

In the present study, two issues are considered. First: What proportion of the people adhere to the mitigation approaches towards the disease? Second: Which are the reasons to disobey these rules?

Methods:

A cross-sectional, population-based phone survey was applied among the population aged over 16 years in Mashhad between November 5 and December 1, 2020. A valid and reliable knowledge, attitude, and performance (KAP (designed questionnaire was used and logistic regression was performed with STATA 14.

Results:

The final sample size was 776; 90.59, 89.8 and 48.1% of the participants had sufficient reliable knowledge, attitude, and practice, respectively; 20.1% of the participants did not wear masks; nearly half of them visited traditional healers for the prevention and cure; 97.8% of them believed the efficiency of the vaccine and stated that they will consume it if it is distributed. Among the sociodemographic factors, only the unemployed had low adherence to the preventive approach; 51.7% of the main worry was the weak economic situation and 69% of jobs and expenditures were poorly affected. The odds ratio (OR) for optimising attitude reduced from 4.64 to 3.22, and for good performance from 5.64 to 5.43 after adjusting for the economic, knowledge and perception factors.

Conclusion:

Despite all the health rules and probably COVID-19 vaccines global access (COVAX), it seems that the most effective way to reverse this horrific wave and its economic consequences is the improvement of the economy and livelihood of the society.
Subconjunctival cysticercosis – Is surgery always indicated? Role of medical management-literature review and report of two cases
Authors: Mehta Sonalika , Verma Prashant K. , Rana Rimpi , Bhat Nowneet K.
Published: October 2021

Ocular cysticercosis is caused by the larval form of pork tapeworm for which humans and pigs are the intermediate hosts. Intense inflammation secondary to immunological reaction is the hallmark feature of the infection, which can affect almost any tissue of the host. Orbital imaging yields specific features suggestive of the diagnosis. Although medical management is the recommended treatment for extra-ocular and retro-orbital cysticercosis, surgical removal has also been suggested by several authors. Here, we report two cases of subconjunctival cysticercosis, successfully managed with medical treatment alone using oral steroid and albendazole. Surgical excision for subconjunctival cysticercosis is associated with complications which can be observed even with the most experienced hands. Through these two cases, we wish to sensitize the practicing physicians regarding the most common ocular infestation seen in the developing countries along with brief literature review on the management protocols to be followed before any surgical reference.
Comparison of actigraphy indices among patients with depression and schizophrenia
Authors: Ransing Ramdas , Patil Pradeep , Patil Swaroopa , Agrawal Shruti
Published: October 2021

Background:

Schizophrenia (SCZ) and depression (MDD) are associated with changes in sleep and activity patterns. However, because of a lack of objective evaluation, the diagnostic or clinical value of these sleep-activity patterns is unknown. In this study, we attempted to assess and compare the sleep and activity patterns using actigraphy.

Materials and Methods:

We have recruited 35 patients with SCZ (mean age: 29.29 ± 7.54 years) and 42 patients with MDD (mean age: 27.5 ± 5.59 years) in this cross-sectional study. The actigraphy indices [Time in bed (minutes), Onset latency (minutes), Total sleep time (Minutes), Sleep efficiency (%), WASO (minutes), number of awakening, and activity duration (minutes) were compared among the two groups using unpaired t-test and Fisher exact test.

Results:

In the MDD group, the time in bed (minutes) was significantly higher than in the SCZ group (402.7 ± 41.97 vs. 379.1 ± 40.45, P = 0.01), while the sleep efficiency was lower in the SCZ group than in the MDD group (60.04 ± 9.25 vs. 65.05 ± 7.16, P = 0.0092). An increase in onset latency (minutes) was observed in the SCZ group compared to the MDD group (49.06 ± 16.09 vs. 43.6 ± 10.14, P = 0.074). The difference in WASO (minutes), the number of awakenings, and activity duration (minutes) among the two groups were insignificant.

Conclusion:

Actigraphy parameters such as sleep efficiency and time in bed may be a useful sleep process, etiological, and prognostic markers in patients with SCZ and MDD. The longitudinal studies are needed to estimate the predictive role of these parameters for therapeutic outcome in these patients.
Evaluation of nutritional status and health behaviors of patients infected with COVID-19
Authors: Karimi Saba , Tondro Amirhossein , Hematpour Behzad , Karimi Maryam , Ehyaei Parvin
Published: October 2021

Introduction:

Coronavirus disease 2019 (COVID-19) was a health emergency for the world in which started in 2019. Various factors are involved in the pathogenesis of this virus, including age, gender, body mass index (BMI), the type of diet, the degree of observance of health protocols, and the health status of people. The purpose of this study was to evaluate the nutritional status and health behaviors of patients infected with COVID-19.

Methods:

A descriptive-analytical research method was used in this study. One of the outpatient centers for the patients infected with COVID-19 in Kermanshah was selected as the research setting. The study population included all patients infected with COVID-19 and the sample size was 200 people. Data were analyzed by SPSS version 22.

Results:

Most patients (51%) were females and most of them suffered from body aches (81%) and headaches (94%). Most of the patients (76%) did not use a mask. Regarding the nutritional status, a large number of patients used all food groups such as carbohydrates, proteins, fruits, and vegetables less than the standard amount.

Conclusion:

It can be concluded that people with underlying diseases are more prone to the disease than others and adherence to social distancing and mask use helps a lot to control the disease. In addition, the appropriate intake of food groups reduces the severity of the disease by strengthening the immune system in people.
Designing a curriculum for postgraduate training in family medicine in India
Authors: Rajkumar Honest Prince Christopher , David Kirubah V. , Rahman Sajitha P.M.F. , Sankarapandian Venkatesan
Published: October 2021

Context:

Family physicians, trained in handling primary care problems through the principles of family medicine (FM), were needed in India. The training required a comprehensive and detailed curriculum that could be implemented across the country.

Aim:

The aim was to create a document that includes rationale, goals, subject-based objectives, educational methods and assessment methods that align to the objectives.

Design and Methods:

Kern's Six-Step-method was used to create a curriculum document. The six steps are (a) problem identification and general needs assessment, (b) targeted needs assessment, determining and prioritizing content, (c) writing goals and objectives, (d) selecting teaching/education strategies,(e) implementation of the curriculum and (f) evaluation and application of the lessons learnt.

Results and Conclusions:

Based on the given steps, a team of faculty identified needs, requirements and barriers, wrote goals and objectives along with aligned educational and assessment methods. The curriculum document was created for FM resident training. The first set of residents have been trained based on this curriculum and an evaluation is being planned.
Prevalence of breast imaging reporting and data system (BIRADS) categories and breast consistencies in Central India –A cross-sectional survey
Authors: Mittal Megha , Deolia Shravani , Agrawal Amit , Chaturvedi Himanshu , Agrawal Gaurav , Chhabra Kumar G.
Published: October 2021

Background:

For recognizing the initial stages of breast cancer, mammography is regarded as one of the best modalities and plays a crucial part to lessen morbidity and mortality. For collaborative studies and planning of preventive strategies, it is significant to have baseline data. Thus, in this survey, the frequency distribution of breast imaging reporting and data system (BIRADS) classification and breast consistencies was investigated during the mammographic screening program in the Gwalior region, India.

Material and Methods:

A descriptive, cross-sectional survey was conducted in the Gwalior region, India, in which 1,838 patients were screened with the aid of mammography. The mammography films were evaluated by a single radiologist who determined the BIRADS score, breast composition, and any other abnormal findings. After tabulating the data into MS Excel (MS Office version 2007 developed by Microsoft, Redmond, WA), descriptive analysis and Chi-square test were performed to determine the association between the BIRADS score and breast consistency and setting significance level at (below) 0.05.

Results:

The most commonly found BIRADS score was score 1 (53.4%), followed by score 2 (20.4%), and score 5 was of the least frequency (1.3%). Similarly, the most common consistency found was fatty (48.2%) and the least common was heterogeneously dense (3.97%). The most BIRADS category of 0 was seen in heterogeneously dense (n = 22; 26%) followed by dense breast compositions (n = 18; 25%). The most common consistency found with known breast malignancy (BIRADS 6) patients was the extremely dense breast (n = 11; 40.7%).

Conclusion:

In this study, it was observed that about 57.3% of all the cases were categorized as BIRADS 1 and 20.8% as BIRADS 2.
Evaluation of liver function in symptomatic COVID-19 patients
Authors: Singhai Abhishek , Pavan G. Sai , Panda Smritimayee
Published: October 2021

Context:

The coronavirus disease 2019 (COVID-19) is a viral respiratory illness which was first detected in Wuhan, Hubei Province, China. A few case studies demonstrated that 14–53% of the cases of COVID-19 reported abnormal levels of liver enzymes during disease progression. Patients with severe COVID-19 seem to have higher rates of hepatic dysfunction.

Aims:

Our aim was to investigate the changes in the liver function test in COVID-19 patients admitted to hospital and its association with the severity of the disease, length of hospital stay, and outcome of patients.

Settings and Design:

This was a cross-sectional study involving 678 COVID-19 patients, who were admitted at AIIMS, Bhopal.

Methods and Material:

The case records of 678 patients were evaluated by the research team from the Department of Medicine, AIIMS, Bhopal, and data were analyzed. All laboratory data were obtained. The liver function tests (LFT) including alanine aminotransferase, aspartate aminotransferase, and total bilirubin values were recorded, and liver dysfunction defined as any parameter having more than the upper limit of normal value.

Results:

From April 2020 to September 2020, a total of 678 COVID-19 patients were screened, and 600 were assessed for eligibility; 78 were excluded due to either significant alcohol history or due to prior liver disease. Among the 600 patients, 265 patients (44.16%) had liver dysfunction while 335 patients (55.83%) had a normal liver function. The patients having a severe disease were more affected by liver dysfunction than the mild disease patients. The average hospital stay was more in those patients having liver dysfunction than in those patients with normal liver function. Among the patients with normal LFT on admission, 97.9% got cured while 2.1% died. Among the patients with liver dysfunction, 80.4% got cured and 19.6% died.

Conclusions:

Hepatic injury is common in severe COVID-19 patients, which may be caused by direct injury to the bile duct cells by a virus or indirectly by a cytokine storm. The liver function should be evaluated in all symptomatic COVID-19 patients. In patients with pre-existing liver diseases, special attention should be paid to monitoring and treatment.
COVID-19 treatment in children
Authors: Panda Prateek Kumar , Sharawat Indar Kumar , Natarajan Vivekanand , Bhakat Rahul , Panda Pragnya , Dawman Lesa
Published: October 2021

Background:

Exact information about the efficacy of various medications proposed by regulatory bodies in children with COVID-19 is limited due to the lack of controlled trials in the existing literature.

Methods:

Different electronic databases (MEDLINE, EMBASE, Web of Science, COCHRANE CENTRAL, LitCovid, medRxiv, and bioRxiv) were searched for articles describing the management of COVID-19 cases in children with 18 shortlisted medications. Prospective/retrospective studies/case series (with at least 20 cases) reporting COVID-19 in patients aged ≤14 years were searched to collect information regarding clinical details and severity of participants, medications used, and outcome. The pooled estimate of these parameters across studies was performed using a random-effect or fixed-effect meta-analysis depending on the degree of heterogeneity.

Results:

From a total of 5794 records, 97 studies/case series (8243 patients) fulfilled the eligibility criteria and were included in this systematic review. A total of 21% children received at least one medication specifically used for COVID-19. While antivirals were used in 15.3% of children, remedesivir was the most commonly used antiviral drug in 6.2% of included children without many reports of serious adverse effects. There was a more prevalent use of anti-inflammatory medications including corticosteroids (27.8%, P = 0.01). Total 91% of severe cases described in literature in children received some anti-inflammatory medications. Among them, corticosteroids (17%) and Intravenous immune globulin (IVIG) (17.5%) were the most predominant followed by interferon (4.2%), tocilizumab (1.5%), and anakinra (0.8%). The most predominant therapy among multisystem inflammatory syndrome in children (MIS-C) cases were IVIG (81%), followed by aspirin (67%), corticosteroids (64%), inotropes (62%), and anticoagulation (56%, mostly low molecular weight heparin, LMWH). Overall mortality was only 1.3%, but when we analyzed separately including only cases with moderate and severe disease, the mortality rate was 4.6%.

Conclusion:

Among pharmacological modalities, anti-inflammatory agents like corticosteroids and antivirals like remdesivir have the most promising evidence for severe cases of pediatric COVID-19. Intravenous immunoglobulin and other anti-inflammatory/immunomodulatory agents like anakinra, aspirin, and anticoagulants have important therapeutic role in cases with MIS-C. Most of the mild cases recover with conservative treatment only.
A rare case of nephrotic syndrome with chylothorax
Authors: Singh Saurabh K. , Chauhan Ajay , Swain Bishakha
Published: October 2021

Chylothorax is an infrequent cause of pleural effusion that is most commonly caused by the obstruction or disruption of the thoracic duct. Chylothorax is rare in nephrotic syndrome. Unilateral chylothorax of the right side is due to the transdiaphragmatic shunting of chylous ascites. It is usually transient and self-limiting but a massive chylothorax requiring therapeutic thoracentesis can also be encountered. Here, we present a rare cause of chylous ascites–nephrotic syndrome resulting in chylothorax, where initially therapeutic thoracentesis is done followed by the management of nephrotic syndrome with modified Ponticelli regimen. This case highlights the need to consider chylous ascites as a cause of chylothorax via transdiaphragmatic shunting in patients with nephrotic syndrome to institute the appropriate treatment.
Impact of alternative strategies to improve the pool of blood donation by off-hour donation
Authors: Raghuwanshi Babita , Maheshwari Ashish
Published: October 2021

Background:

The escalating need for blood component due to increasing accidents and surgeries are always challenging for blood banks and hospitals. In this fast and busy world, collecting blood from a healthy and voluntary donor is quite challenging due to time constraints. Many blood donors who wish to donate blood were unable to go to the blood bank because of simultaneous operational timings of the blood bank and office hours of the donors. We dealt with this concern by extending the donation hours and also started collecting blood on the weekends following LAARC (Listen, Acknowledge, Assess, Respond, Confirm) methodology as a pilot project for improving blood donor convenience and satisfaction at the blood bank.

Methodology:

It was a prospective observational pilot study conducted at the government tertiary care institute in the Department of Transfusion Medicine from December 2018 to June 2019. All blood donations were made as per the guidelines laid down by the Drug and Cosmetic Act. The donation timings were divided as office-hour donations (8 am to 5 pm on weekdays) and off-hours donations (5 pm to 8 pm, weekends and holidays).

Results:

In this pilot project, over 7 months out of a total of 1,591 donations, 664 donations (41.73%) were done during the off-hours. The donor experiences were pleasing, and they felt extra cared due to the convenient donation timings.

Conclusions:

Increasing the donation base needs more donor-friendly timings for the pleasant donation experience without hampering their work. More extensive studies should be conducted to include such strategies for increasing voluntary blood donation.
Subacute measles encephalitis in a case of late presenting congenital HIV with epilepsia partialis continua as the first manifestation
Authors: Chakraborty Arka P. , Ray Adrija , Mukherjee Debaleena , Gupta Subhadeep , Pandit Alak , Dubey Souvik
Published: October 2021

We report a case of a 14-year-old non-immunised girl with a prior history of measles infection presenting with afebrile seizures progressing to epilepsia partialis continua (EPC), quadriparesis and headache. Further evaluation revealed Human immunodeficiency virus (HIV) seropositivity with elevated anti-measles antibody titres in Cerebrospinal fluid (CSF). Electroencephalography showed focal epileptiform activity and Magnetic resonance imaging (MRI) of the brain revealed bilateral, asymmetrical long repetition time MRI (TR) hyperintensities involving juxtacortical white matter in both parietal lobes, left temporal and also in the left basal ganglia without any contrast enhancement or Diffusion weighted imaging (DWI) restriction. We describe the intriguing association of EPC with subacute measles encephalitis/measles inclusion body encephalitis (SME/MIBE) in the backdrop of immunocompromised state (HIV seropositivity), thought to have been acquired by vertical transmission. Also, prolonged asymptomatic HIV infection, first unmasked by measles infection, followed by rapidly deteriorating neurological illness makes this index case worthy to be reported.
A review and case report of enigmatic superficial endometrial spread of cancer of the uterine cervix
Authors: Bagde Madhuri N. , Bagde Nilaj Kumar D. , Hussain Nighat , Thangaraju Pugazhenthan
Published: October 2021

Cervical cancer is a leading cause of cancer-related morbidity and mortality. It usually spreads via direct invasion and lymphatics. Few cases with superficial spread to the uterine endometrium, fallopian tubes, and ovaries have been observed. The staging of these cases, as well as management, is not yet clear due to limited data. The Federation of Gynecology and Obstetrics (FIGO) staging disregards uterine spread to upstage the disease, and it also fails to provide clear guidelines regarding the superficial extension to the ovaries and tubes which is not uncommon in these cases. A 63-year-old female with postmenopausal bleeding was diagnosed with squamous cell carcinoma on a pap smear. Ultrasound and magnetic resonance imaging revealed a predominant endometrial lesion. Histopathology after Wertheim's hysterectomy revealed a squamous cell carcinoma of the endocervix, stage 1B2, that had spread superficially to the endometrium. A total of 48 cases of cervical cancer with superficial spread were identified. The commonest complaint was postmenopausal bleed in 39.39%. In 50% of the cases, the disease was carcinoma in situ, and 70.45% of the women had disease of stage 1B or less. In many cases, the disease had reached the tubes, 36.66%, and ovaries 23.33%. All women with stage 2A or lesser disease except for one were alive at 6 months after surgery. Superficial spread of cervical cancer is a distinct entity. Endometrial pathology must be ruled out before planning management in these women, especially when managing early-stage disease with conservative therapy.
Mothers' role in promoting oral health in children aged 6 months to 1 year
Authors: Kabiri Bahareh , Hidarnia Ali Reza , Alavijeh Mehdi Mirzaei , Motlagh Mohammad Esmaeel
Published: October 2021

Introduction:

It is essential for parents, and especially mothers, to become aware of the factors that affect oral health-promoting behaviors in children through behavior change theories. This study aimed to determine mothers' role in improving children's oral health based on the health belief model (HBM).

Methods:

The population of this descriptive, analytical, cross-sectional study comprised 240 mothers in Ilam (Iran), selected via stratified random sampling. The data collection instrument was a self-report questionnaire with two sections, including seven demographic and contextual questions, four items for perceived severity, four items for perceived benefits, four items for perceived barriers, three items for cues to action, and five items for perceived self-efficacy. The data were analyzed in SPSS 21 by using descriptive and inferential statistics, including independent samples t-test, linear regression analysis, and Pearson correlation coefficient, at a significance level of 0.05.

Results:

The participants aged 20–47 with a mean of 31.8 ± 5.67 years. The linear regression analysis indicated that the constructs of perceived severity (B = 0.073, P < 0.001), perceived benefits (B = 0.013, P < 0.001), perceived barriers (B = 0.111, P < 0.01), cues to action (B = 0.517, P < 0.001), and perceived self-efficacy (B = 0.292, P < 0.001) explained 55% of the variance of behavioral intention.

Conclusion:

With respect to the effects of perceived barriers and perceived severity on predicting oral health behaviors, effective outcomes can be achieved by emphasizing these two constructs in educational programs based on the HBM.
Basic knowledge among GP trainees regarding HIV pre- and post-exposition-prophylaxis
Authors: Flössner Christian , Avetisyan Meri , Frese Thomas
Published: October 2021

Introduction:

Preventing human immunodeficiency virus (HIV) infection is central to containing the HIV pandemic. For pre- and post-exposure prophylaxis (PrEP and PEP), drugs approved in Germany are available. Basic information on this should be obtained from physicians in further training to become specialists in General Practice (GP) since they may have to deal with this topic of high relevance for the health of patients at risk and also the physicians' health after a possible exposure in the professional context.

Methodology:

A multiple-choice questionnaire was handed out to doctors in further training in General Practice on seminar days of the Competence Centre for General Practice Saxony-Anhalt for an immediate answer.

Results:

Of the 109 doctors, 73 completed the questionnaire. A general high relevance of the topic HIV was stated by 95%. In contrast, 71% said it was relevant for family doctor activities. The knowledge questions on the prevalence were answered correctly for all questions with less than 40%; 21% stated that they knew the indication prerequisite for a PEP; 49% answered the question about the period of the highest efficacy of PEP correctly. PrEP as a drug option for prophylaxis is known to a part of the respondents, 79% would prescribe PrEP, 69% were in favour of a health insurance benefit.

Discussion:

The results show that the necessary basic knowledge about HIV is partly available. Basic knowledge on structured action in the fields of HIV testing, PEP and PrEP should be taught in a manner appropriate to the relevance of the topic in the context of the German general practice setting. Even a basic knowledge about PEP may help to ensure that the general practice teams receive proper measures after a possible exposition.
Food consumption patterns of the urban adult population in the field practice area of a teaching hospital in Kolkata, using food frequency questionnaire
Authors: Sarkar Paramita , Mitra Sayeli , Basu Rivu
Published: October 2021

Background:

Nutrition transition has replaced homemade foods with processed items that increased the prevalence of noncommunicable disease in adult population. But we know little about the food intake pattern of adults specially in urban sector.

Aims:

The study aimed at describing the food-consumption patterns in a sample of adults residing in urban area.

Settings and Design:

An observational cross-sectional study was done from April to June, 2019 at urban field practice area of a teaching hospital of Kolkata.

Methods and Material:

A prevalidated, pretested, 51-item, food-frequency questionnaire was applied to assess the food-consumption pattern of 110 participants.

Results:

Adults reported poor dietary intakes; more than half reported no consumption of green-leafy vegetables (GLV) (66.4%), other vegetables (52.8%), and fruits (63.6%). Whereas 72.7% reported consumption of three or more servings of energy-dense foods and 90.9% reported consumption of three or more servings of energy-dense beverages on previous day. Mean intake of food varied from 0.34 (SD = 0.47) for GLV to 8.19 (SD = 2.39) for cereals. Females consumed more servings of GLV, other vegetables, roots-tubers, and fruits than males. Fruit consumption was low in all age groups. Higher socioeconomic class people strikingly consumed no GLV.

Conclusions:

Study participants reported consumption of more energy-dense snacks, beverages than healthy food like GLV, fruits. Study findings highlight to design strategies to promote nutrition education and practical application of healthy food habits in target population group.
Managing comorbidities in Covid-19 patients
Authors: Sharma Aman , Jain Manish , Yadav Rahul , Rathi Priyanka
Published: October 2021

Introduction:

In the prevailing COVID-19 pandemic, the Indian healthcare system has worked hard towards restricting the adverse outcomes to the least possible figures. The present study aims to share the experience of a COVID-dedicated tertiary care government hospital in Northern India of managing COVID-19 patients with comorbidities.

Methodology:

A retrospective, observational study was conducted in a COVID-dedicated tertiary health care government hospital in Northern India. Details on sociodemographic data, hospital admission data, and drug utilization pattern of all laboratory-confirmed COVID-19 patients of all age groups, either gender, having comorbidity (s), and admitted between April and September, 2020 were noted and evaluated.

Results:

Among the total study participants (N = 406), 2868 drugs were prescribed. Out of these, 2336 were used for the management of symptoms of COVID-19 and 532 were used for the management of coexistent comorbidity (s). For COVID-19 symptoms, the most commonly prescribed class of drugs were antimicrobials (853, 36.52%), followed by nonsteroidal antiinflammatory drugs (374, 16.01%), proton pump inhibitors (299, 12.80%), antihistamines (232, 9.93%), immunosuppressant drugs (103, 4.41%), and others. For comorbidities most commonly prescribed were antihypertensive (310, 58.60%) drugs, followed by antidiabetic drugs (166, 31.38%), bronchodilators (34, 6.43%), thyroid hormones (11, 2.08%), immunosuppressant drugs (7, 1.32%).

Conclusion:

The most frequently prescribed antihypertensives were calcium channel blockers (CCBs) and least prescribed was beta blocker+CCB. Among the antidiabetic drugs, most frequently prescribed was insulin and least prescribed was DPP-4 inhibitors and Biguanide+DPP-4 inhibitor both.
Prevention of hospital-acquired infections
Authors: Mitra Manasij , Ghosh Amrita , Pal Ranabir , Basu Maitraye
Published: October 2021

Introduction:

Hospital-acquired infection (HAI) rates were reported to have declined in healthcare settings during the Covid-19 pandemic. Needless to mention that HAI is of paramount interest and relevance to a primary care physician who need to care from womb to tomb inside pandemic.

Objectives:

This study was conducted to find the impact of Covid-19 pandemic on the four parameters of HAIs, namely, catheter-associated urinary tract infections (CAUTI), central-line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP) and surgical site infections (SSIs) with hand hygiene compliance rates among healthcare workers.

Materials and Methods:

This retrospective data mining was undertaken in a 700 bed multispecialty teaching hospital in the Eastern India which was a Government of Bihar approved speciality Covid Care Hospital. Data from the monthly routine infection control monitoring and surveillance activities was collated from January 2019 to December 2020. Control charts with upper and lower control limit set at mean ± 1 SD were used to monitor monthly trends of HAIs.

Results:

The CAUTI rates reduced by 28.01%; the CLABSI rates declined by 37.61%, the SSI rates reduced by 62.39%, while the highest VAP rates were reported in November 2019 (1.9 per 1000 ventilator days). The hand hygiene compliance rates from January 2019 to December 2020 among different healthcare staffs showed a sharply rising trend.

Conclusion:

Covid-19 pandemic highlighted paramount importance regarding compliance to hand hygiene and implementation of standard infection control practices as recommended by World Health Organisation and Centres for Diseases Control and Prevention (CDC), which can drastically reduce range of HAIs.
Food portion size educational programme in a workplace setting in Puducherry – Is it effective?
Authors: Vinayachandran Gopika , Patel Namita , Mathavaswami Vijayageetha , Subitha L
Published: October 2021

Background:

Consuming larger portion sizes, i.e., in excess of a typically recommended serving size, has been attributed to the obesity epidemic. The workplace acts as an efficient target for health promotion activities.

Aims:

To assess the effectiveness of a food portion size educational programme in increasing knowledge among the employees of a software company in Puducherry.

Methodology:

An interventional study was conducted with a pre-post design. A single group of software company employees (N = 120), age ≥30 years selected by simple random sampling was included in the study. The intervention consisted of a health education programme on the portion sizes of common food items including fruits and vegetables. A self-administered questionnaire was used to collect information on personal and sociodemographic details. Self-regulation on eating was assessed using the Self-Regulation of Eating Behaviour Questionnaire (SREBQ).

Results:

The mean age of the study participants was 27 ± 5 years. Most of the participants were males, i.e., 72 (60%). Of the total, 55 (47.8%) participants were obese and 18 (15.7%) were overweight. The median number of meals and snacks consumed by the participants was 3 (1–3) and 1 (1–2), respectively. The median (interquartile range [IQR]) knowledge scores of the food portion size significantly increased from 9 (0–16) to 14 (5–19) (P < 0.05).

Conclusions:

This study has demonstrated that an educational intervention in the workplace setting is feasible and effective in increasing the knowledge of food portion size over a short term.