bluuebunny/crossref_metadata_2025_split huggingface dataset:
Closed versus open-sky Muller muscle-conjunctival resection in management of blepharoptosis
Authors: Ezzeldin Ezzeldin R. 
Published: July 2021

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Setting and Design:
The research was carried out in the COVID-19 impacted districts across Nepal.

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

Statistical Analysis Used:
The statistical tests were carried out using R programming language.

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

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

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

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

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

Conclusion:
Children’s health supplement found safe and effective in promoting growth, health, and wellbeing in healthy children.
Return to Work after Surgical Treatment for Cervical Spondylotic Myelopathy
Authors: Paul Arun John , Amritanand Rohit , David Kenny S. , Krishnan Venkatesh 
Published: July 2021

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

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

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

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

Conclusion:
In spite of functional improvement, CSM was associated with poor RTW with manual laborers being the most vulnerable group. This study will help surgeons modulate patient expectations as well as provide a platform for counseling them.
Preparation, validation, and evaluation of an information leaflet for patients undergoing day-care surgeries under general anesthesia at a busy tertiary care hospital
Authors: Panigrahi Amit Raja , Bakshi Sumitra G. 
Published: July 2021

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conclusions:
The incidence of FEA is comparable to those quoted in literature from developed countries and shows association to experience and year of training of anesthesia residents.