bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Simple Method for Practicing Unimanual Pars Plana Vitrectomy With the Binocular Indirect Ophthalmoscope
Authors: Bloom Steven M , S Tiedeman MD James , Wyszynski Richard E , Brucker Alexander J 
Published: April 2021

ABSTRACTBimanual vitrectomy has become the method of choice for performing closed vitrectomy. In certain situations, visualization is improved by using indirect ophthalmoscopy to see the vitrectomy instrument. A simple method using a +20.00-diopter condensing lens is described as a means of practicing the initially difficult unimanual technique, which requires working in an inverted operative field.
Subconjunctival Versus Intrascleral Mitomycin-C in Trabeculectomy
Authors: Tressler Charles S , Cyrlin Marshall N , Rosenshein Joseph S , Fazio Roselyn 
Published: April 2021

* BACKGROUND AND OBJECTIVE: A ran domized prospective comparison of sub-Tenon's administration of mitomycin-C (MMC) with intrascleral administration of MMC in trabeculectomy was performed to determine whether intrascleral application is superior to the standard sub-Tenon's application.
* PATIENTS AND METHODS: Twenty-four eyes of 23 patients were randomized to treatment with MMC (0.27 mg/ml for 5 minutes). The route of administration was subconjunctival in group A and intrascleral in group B. Preoperative and postoperative visual acuity (VA), intraocular pressure (IOP), number of medications, and complications were compared between the two groups.
* RESULTS: There was no statistically significant difference between the two groups preoperatively regarding VA, IOP, and number of medications. Postoperatively, IOP and number of medications required had decreased significandy in both groups. A significandy larger number of postoperative procedures were required in group B to control IOP (group A = 3, group B = 14, P = .002).
* CONCLUSION: Both methods of MMC application significantly decreased the IOP and the number of medicines required to control IOP after trabeculectomy. The intrascleral use of MMC resulted in the need for more surgery postoperatively (P = .002).
[Ophthalmic Surg Lasers 1996;27:661-666.]
Indications for and Complications of Mitomycin-C in Pterygium Surgery
Authors: Anduze Alfred L , Burnett Jettie M 
Published: April 2021

* BACKGROUND AND OBJECTIVE: The purposes of this study are to examine the complications and results of a novel approach to the use of mitomycin-C in pterygium surgery; to identify the lowest effective dosage required to prevent recurrence; and to select those high-risk pterygia that could benefit from mitomycin-C use.
* PATIENTS AND METHODS: One hundred thirty-five eyes of 128 patients considered at high risk for recurrence of pterygium were treated with a single, intraoperative, subconjunctival injection of mitomycin-C at the site of excision. Three different dosages-0.2, 0.1, and 0.05 ml-at a strength of 0.5 mg/ml were used. The eyes were observed for 10 months to 3 years.
* RESULTS: There were only two recurrences (1.5%); both occurred in eyes that had undergone previous pterygium surgery. One recurrence happened with the 0.2-ml dosage, and the other with the 0.1-ml dosage. These recurrences occurred in association with early wound dehiscence, which essentially became a bare sclera susceptible to pterygium regrowth. Complications included temporary and prolonged discomfort, tearing, hyperemia, subconjunctival hemorrhage, wound dehiscence, and pigment accumulation. No vision-threatening side effects were noted.
* CONCLUSIONS: The persistence and intensity of discomfort noted at the higher dosage has prompted these authors to suggest that only high-risk pterygia should receive mitomycin-C. Conjunctival flaps should always be used to cover the sclera up to the limbus and to localize the mitomycin-C to prevent its migration. A single dose of not more than 0.05 ml at a strength of 0.5 mg/ml subconjunctivally gives the same results as multiple drops, but with far less morbidity.
[Ophthalmic Surg Lasers 1996;27:667-673.]
Sustained-Release Subconjunctival 5-Fluorouracil
Authors: Smith Thomas J , Ashton Paul 
Published: April 2021

* BACKGROUND AND OBJECTIVES: The purpose of this research was to obtain preliminary safety and efficacy data on a novel sustained-release 5-fluorouracil (5-FU) implant in high-risk glaucoma surgical patients.
* PATIENTS AND METHODS: The implants were placed subconjunctivally in four patients undergoing high-risk trabeculectomy. The patients have been observed for approximately 2.5 years.
* RESULTS: In three of the four patients intraocular pressure was controlled at less than 21 mm Hg, with stabilization of the visual field. One patient had early failure. No untoward events were linked to the placement of the implant.
* CONCLUSION: Sustained-release systems for subconjunctival 5-FU may be useful in filter maintenance.
[Ophthalmic Surg Lasers 1996;27:763-767.]
Less is More
Authors: De Simone Francesco , Nardelli Pasquale , Licheri Margherita , Frau Giovanna , Redaelli Martina Baiardo , Monaco Fabrizio , Zangrillo Alberto , Landoni Giovanni 
Published: April 2021

Context:
Protamine is routinely administered to neutralize the anticlotting effects of heparin, traditionally at a dose of 1 mg for every 100 IU of heparin—a 1:1 ratio protamine sparing effects—but this is based more on experience and practice than literature evidence. The use of Hemostasis Management System (HMS) allows an individualized heparin and protamine titration. This usually results in a decreased protamine dose, thus limiting its side effects, including paradox anticoagulation.

Aims:
This study aims to assess how the use of HMS allows to reduction of protamine administration while restoring the basal activated clotting time (ACT) at the end of cardiac surgery.

Settings and Design:
A retrospective observational study in a tertiary care university hospital.

Subjects and Methods:
We analyzed data from 42 consecutive patients undergoing cardiopulmonary bypass (CPB) for cardiac surgery. For all patients HMS tests were performed before and after CPB, to determine how much heparin was needed to reach target ACT, and how much protamine was needed to reverse it.

Results:
At the end of cardiopulmonary bypass, 2.2 ± 0.5 mg/kg of protamine was sufficient to reverse heparin effects. The protamine-to-heparin ratio was 0.56:1 over heparin total dose (a 44% reduction) and 0.84:1 over heparin initial dose (a 16% reduction).

Conclusion:
A lower dose of protamine was sufficient to revert heparin effects after cardiopulmonary bypass. While larger studies are needed to confirm these findings and detect differences in clinically relevant outcomes, the administration of a lower protamine dose is endorsed by current guidelines and may help to avoid the detrimental effects of protamine overdose, including paradox bleeding.
Internship Orientation: An Essential Facilitatory Bridging Step for Medical Students
Authors: Kathrotia Rajesh , Huda Farhanul , Rao Shalinee , Bahadur Anupama , Kant Ravi , Naithani Manisha 
Published: April 2021

Abstract
Background: Internship is a facilitatory period that hones skills and helps in the evolution of a qualified medical student to a competent doctor. The feeling of a final year student joining as a fresh intern after successfully completing the final professional examination will be directionless without a bridging initiative through a buffer program. Fresh interns need to be oriented to the fundamentals of working effectively with a patient as a whole and not as a separate discipline. This study was done to evaluate the effectiveness of the internship orientation program and to assess the feedback of participants about this program. Methodology: This was a study conducted on 235 freshly joined medical interns. The process included evaluation of a well-structured seven-day orientation program by prevalidated structured Multiple Choice Questions (MCQs) and feedback. Results: All interns performed satisfactorily in the post-test with a mean score of 74.13 ± 7.18. Post-test scores were highest for procedure skills and communication skills, including medical ethics. Overall, 232 (99%) of interns responded that the program was useful and it successfully enhanced their clinical skills; 221 (94%) of interns expressed that the content of the program was excellent to good; and 228 (97%) of interns felt that the method used for training was appropriate. Interns also documented that there were a few new skills that were acquired by attending this program. Conclusion: There is an unmet need for an internship orientation program across all medical colleges to lay a strong foundation for naive interns. Based on the results, we recommend an internship orientation program for a smooth and swift transition from that of a medical student to professional life. It will orient the interns and lay the foundation for the next level of assignment in building their professional career.Key Messages: Internship orientation programs are recommended for a smooth and swift transition from that of a medical student to professional life.
Newborn screening for congenital hypothyroidism
Authors: Gupta Vinay , Sood Ashwani , Sood Mangla 
Published: April 2021

Background:
Incidence of congenital hypothyroidism (CH) varies across countries and different geographic regions.

Aims and Objectives:
This study was conducted to find prevalence of CH in iodine-deficient district of North Indian hilly state Himachal Pradesh, India.

Materiala and Methods:
A prospective analysis of cord blood thyroid-stimulating hormone (TSH) and T4 hormone values on 4057 neonates was done in the delivery hospital.

Results:
No CH was detected among 3964 neonates; with limitation of losing 93 newborns with high cord blood TSH >20 uIU/l who could not be recalled for serum testing.

Conclusion:
With known benefits of CH screening, a properly implemented neonatal screening program for CH at all levels of health care is definitely the need of the hour.
Long-term hypocalcemia prediction post thyroidectomy
Authors: Janardhan Deepak , Suresh Sandeep , Balagopal P. G. , George Nebu Abraham , Jagathnath Krishna K. M. 
Published: April 2021

Introduction:
Hypocalcemia is a common sequela of total thyroidectomy and is usually transient (30%), only a few develop permanent hypoparathyroidism. Till date, no effective risk stratification score to predict hypocalcemia is available that can predict postoperative hypocalcemia.

Materials and Methods:
This was a prospective observational study including all patients who underwent total or completion thyroidectomy with initial parathormone (PTH) within the normal range in our institution during a 1 year period. Postoperative 6th h PTH fall was noted in all patients and cutoff point for the prediction of long-term hypocalcemia (LTHP) was determined using a paired t-test.

Results:
Postoperatively, calcium supplementation was initiated in 52% of patients. In 7.6% of patients who had a fall in PTH to more than 80% of preoperative value, calcium supplementation could not be tapered even after 3 months postoperatively. About 66% of patients <20 years of age developed hypocalcemia in the postoperative period. Patients who developed delayed hypocalcemia with initial normal calcium levels had fall in PTH of at least 45%. For individuals below 20 years, a PTH fall of 56% or more required calcium supplementation. The various variables studied failed to attain statistical significance.

Conclusions:
More than 82% fall in 6th h postoperative PTH predicts long-term hypocalcemia. Post total thyroidectomy, adolescent individuals are at a higher risk of developing hypocalcemia; hence, early calcium supplementation is recommended based on fall in PTH. Weighted score to predict LTHP could not be developed, as none of the risk factors evaluated were statistically significant.
Prevalence of Diabetes, Prediabetes, and Associated Risk Factors Among Agricultural Village Residents in the Dominican Republic
Authors: Madsen Beau De Rochars Valery E. , Keys Hunter , Samuels Shenae K. , Jo Ara , Noland Gregory S. , Gonzales Manuel , Blount Stephen , Mainous Arch G. 
Published: April 2021

Abstract.This study examined the prevalence and risk factors of prediabetes and type 2 diabetes among residents of agricultural settlement villages (bateyes) in the Dominican Republic. From March to April 2016, a cross-sectional, multi-stage cluster survey was conducted across the country’s three agricultural regions (southwest, east, and north). At selected households, an adult completed a questionnaire to assess demographics, diabetes knowledge, and care, and two household residents of any age provided finger-prick blood samples that were analyzed for hemoglobin A1c (HbA1c). HbA1c was categorized as normal (< 5.7%), prediabetic (5.7–6.4%), or diabetic (≥ 6.5%). The prevalence rates of diabetes and prediabetes were 8.6% (95% confidence interval [CI], 6.2–11.8%) and 20.4% (95% CI, 17.9–23.2%), respectively, among all participants (N = 1293; median age, 35 years; range, 2–96 years), and 10.0% (95% CI, 7.2–13.8%) and 20.0% (95% CI, 17.4–23.0%), respectively, among adults 18 years or older (N = 730). The average age of participants with diabetes was 47.2 years. The average age of participants with prediabetes was 40.7 years. Among adult questionnaire respondents, 64.8% of all participants and 39.4% of patients with diabetes had not been tested for diabetes previously. Among patients with diabetes, 28.4% were previously diagnosed; 1.2% of prediabetes patients were previously diagnosed. Half (50.7%) of the respondents had heard of diabetes. The majority (94.1%) of patients previously diagnosed with diabetes reported using diabetes medication. Among both undiagnosed and previously diagnosed patients with diabetes, diabetes knowledge, previous diabetes testing, and diabetes care-seeking were lowest among Haitian-born participants. A high burden of undiagnosed diabetes and deficiencies in diabetes knowledge, access to care, and diagnosis exist among all batey inhabitants, but most acutely among Haitians. Improvements will require a multi-sectoral approach.
Case Report: Fulminant Infantile Beriberi: A Report of Six Cases
Authors: Samprathi Madhusudan , Mohammad Faisal , M Sridhar , Ramachandra Prakash , Vemgal Prakash 
Published: April 2021

Abstract.Thiamine deficiency disorders are an under-recognized public health problem in low- and middle-income countries. Infantile beriberi, the most important symptom for children, is suspected to significantly contribute to infant mortality and lifelong neurodevelopmental morbidity. Lack of awareness, varied clinical presentation, and lack of a readily available diagnostic marker lead to frequent misdiagnoses. We report six thriving infants who presented with an acute fulminant illness with varied clinical manifestations mimicking common childhood illnesses like pneumonia and sepsis. Four of them presented with the severe cardiovascular form, called Shoshin beriberi, and severe pulmonary arterial hypertension. Empirical intravenous thiamine administered to four of the six infants resulted in dramatic recovery. Awareness of the clinical definition of infantile beriberi and treatment with empirical thiamine can be lifesaving.
Pathogenesis of Pulmonary Hemorrhagic Syndrome in Human Leptospirosis
Authors: Nicodemo Antonio C. , Duarte-Neto Amaro Nunes 
Published: April 2021

Abstract.Based on a previous study and by incorporating new knowledge, the goal of our study was to understand more fully the pathogenesis of hemorrhagic pneumonia of severe human leptospirosis, highlighting the onset of capillary lesions by Leptospira itself and/or its antigenic/toxic products acting on the endothelium and binding to cadherins. Both events lead to loss of endothelial integrity, alter permeability, cause rupture, and open intercellular junctions, contributing to the hemorrhagic phenomena associated with severe leptospirosis.
Real-Time Fluorimetry Loop-Mediated Isothermal Amplification for Diagnosis of Leishmaniasis and as a Tool for Assessment of Cure for Post–Kala-Azar Dermal Leishmaniasis
Authors: Dixit Keerti Kaumudee , Ramesh Venkatesh , Gupta Ratan , Negi Narendra Singh , Singh Ruchi , Salotra Poonam 
Published: April 2021

Abstract.Despite the dwindling number of visceral leishmaniasis (VL) cases in India, there is an urgent need for early and unequivocal diagnostics for controlling and preventing the reemergence of VL. Post–kala-azar dermal leishmaniasis (PKDL), a dermal sequela of VL, serves as a reservoir of the parasite. Diagnosis of PKDL, especially the macular variant, is challenging and poses impediment toward attainment of VL elimination. In this study, a real-time fluorimetry loop-mediated isothermal amplification (RealAmp) assay has been established for the detection of different clinical manifestations of leishmaniasis. The study included 150 leishmaniasis patients (25 VL, 25 cutaneous leishmaniasis [CL], and 100-PKDL) along with 120 controls. The assay demonstrated sensitivity of 100% (95% CI: 86.68–100) for diagnosis of VL and PKDL (95% CI: 79.61–100) and 96% (95% CI: 86.68–100) for CL with 100% specificity. Moreover, considering the cardinal role of PKDL, diagnosis using minimally invasive slit aspirate was explored, which demonstrated remarkable sensitivity of 96% (95% CI: 87.64–98.47). As a test of cure for PKDL, RealAmp successfully detected parasite in two of posttreatment cases who later reported relapse on follow-up. Also, direct sample lysis using slit aspirate was attempted in a small group that yielded sensitivity of 89% (95% CI: 67.20–96.90). RealAmp depicted excellent diagnostic accuracy in the diagnosis of leishmaniasis in concordance with the established SYBR Green I–based (Molecular Probes, Eugene, OR) visual loop-mediated isothermal amplification (LAMP) and the reference comparator real-time PCR. The study endorsed the employment of LAMP either as visual-LAMP or RealAmp for an accurate and expeditious diagnosis of PKDL and as a tool for assessment of cure.
Complexities of Zika Diagnosis and Evaluation in a U.S. Congenital Zika Program
Authors: Mulkey Sarah B. , Ansusinha Emily , Cristante Caitlin , Russo Stephanie M. , Biddle Cara , Kousa Youssef A. , Pesacreta Lindsay , Jantausch Barbara , Hanisch Benjamin , Harik Nada , Hamdy Rana F. , Hahn Andrea , Chang Taeun , Jaafar Mohamad , Ambrose Tracey , Vezina Gilbert , Bulas Dorothy I. , Wessel David , du Plessis Adre J. , DeBiasi Roberta L. 
Published: April 2021

Abstract.The objective of the study was to describe the complexity of diagnosis and evaluation of Zika-exposed pregnant women/fetuses and infants in a U.S. Congenital Zika Program. Pregnant women/fetuses and/or infants referred for clinical evaluation to the Congenital Zika Program at Children’s National (Washington, DC) from January 2016 to June 2018 were included. We recorded the timing of maternal Zika-virus (ZIKV) exposure and ZIKV laboratory testing results. Based on laboratory testing, cases were either confirmed, possible, or unlikely ZIKV infection. Prenatal and postnatal imaging by ultrasound and/or magnetic resonance imaging (MRI) were categorized as normal, nonspecific, or as findings of congenital Zika syndrome (CZS). Of 81 women–fetus/infant pairs evaluated, 72 (89%) had confirmed ZIKV exposure; 18% of women were symptomatic; only a minority presented for evaluation within the time frame for laboratory detection. Zika virus could only be confirmed in 29 (40%) cases, was possible in 26 (36%) cases, and was excluded in 17 (24%) cases. Five cases (7%) had prenatal ultrasound and MRI findings of CZS, but in only three was ZIKV confirmed by laboratory testing. Because of timing of exposure to presentation, ZIKV infection could not be excluded in many cases. Neuroimaging found CZS in 7% of cases, and in many patients, there were nonspecific imaging findings that warrant long-term follow-up. Overall, adherence to postnatal recommended follow-up evaluations was modest, representing a barrier to care. These challenges may be instructive to future pediatric multidisciplinary clinics for congenital infectious/noninfectious threats to pregnant women and their infants.
Risk factors for hazardous drinking in university students from South Africa and Belgium: a cross-cultural comparison study
Authors: Inaç Yasemin , Larivière Ynke , Hoque Muhammad , Van Hal Guido 
Published: April 2021

Background: Previous studies have associated certain risk factors with hazardous drinking in students. However, big cultur- al and geographical differences exist regarding alcohol use.
Objectives: To determine whether or not there was a difference in hazardous drinking between Belgian and South African university students and to establish the risk factors that contribute to hazardous drinking in university students (calculated using the AUDIT-C) from a developing country (South Africa) and a developed country (Belgium).
Methods: An online survey assessing hazardous drinking among university students in South Africa (University of KwaZu- lu-Natal, UKZN) and Belgium (University of Antwerp, UoA) was conducted, using the shortened version of the Alcohol Use Disorder Identification Test (AUDIT-C). Risk factors in males and females for hazardous drinking were explored using multivariate logistic regression analysis.
Results: In total, 499 students were included in the study (250 UoA and 249 UKZN students). A significant higher amount of male (94.8%) as well as female (92.4%) UoA students drank alcohol in the last year compared to the male (66.2%) and female (67.8%) UKZN students (p<0.001). Additionally, a significant higher amount of UoA students were hazardous drinkers, compared to the UKZN students (p<0.001). Multivaiate analysis showed that male UoA students were almost 6 times more likely to be hazardous drinkers than male UKZN students (OR=5.611, p=0.005). Female UoA students were more than twice as likely to be hazardous drinkers than female UKZN students (OR=2.371, p=0.016).
Conclusion: This study found a significant difference in hazardous drinking between Belgian and South African university students.
Keywords: Hazardous drinking; university students; South Africa; Belgium.
User - provider perspectives to overcome the challenges of TB/HIV service integration at Mulago National Referral Hospital _ Kampala
Authors: Namakula Katende Jane , Omona Kizito 
Published: April 2021

Background: Tuberculosis and Human Immunodeficiency Virus epidemics in sub-Saharan Africa have been closely related and persistent, proving a considerable burden for healthcare provision. This has complicated utilization of services, with noted opinions on the integration of these services from both users and providers of the services.
Objectives: To establish the users and the provider’s perspectives in overcoming the challenges of TB/HIV services inte- gration at Mulago National Referral Hospital.
Methods: Descriptive cross-sectional design, with predominantly qualitative methods was used. Qualitative aspect adopted phenomenological design. Participants were randomly selected for FGDs and Key informants. An observation checklist collected quantitative data from the patients to measure level of services integration.
Findings: Level of service integration of TB/HIV services was at 68% (below the acceptable 100% level). Opinions from the users pointed to; increasing number of work-days for TB/HIV service provision, strengthening sensitisation and health education and integrating other services like reproductive health services, among others. Health care providers opinions pointed to increasing trainings for health workers, increasing staffing and need for more support from Ministry of Health.
Conclusion: Opinions from both users and providers were similar. These ranged from increasing awareness to the users and healthcare providers about the integration of services.
Keywords: User - provider perspectives; TB/HIV service integration; Mulago National Referral Hospital.