bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of an AI algorithm trained on an ethnically diverse dataset to screen a previously unseen population for diabetic retinopathy
Authors: Rao Divya P , Savoy Florian M , Sivaraman Anand , Dutt Sreetama , Shahsuvaryan Marianne , Jrbashyan Nairuhi , Hambardzumyan Narine , Yeghiazaryan Nune , Das Taraprasad 
Published: July 2024

Purpose:
This study aimed to determine the generalizability of an artificial intelligence (AI) algorithm trained on an ethnically diverse dataset to screen for referable diabetic retinopathy (RDR) in the Armenian population unseen during AI development.

Methods:
This study comprised 550 patients with diabetes mellitus visiting the polyclinics of Armenia over 10 months requiring diabetic retinopathy (DR) screening. The Medios AI-DR algorithm was developed using a robust, diverse, ethnically balanced dataset with no inherent bias and deployed offline on a smartphone-based fundus camera. The algorithm here analyzed the retinal images captured using the target device for the presence of RDR (i.e., moderate non-proliferative diabetic retinopathy (NPDR) and/or clinically significant diabetic macular edema (CSDME) or more severe disease) and sight-threatening DR (STDR, i.e., severe NPDR and/or CSDME or more severe disease). The results compared the AI output to a consensus or majority image grading of three expert graders according to the International Clinical Diabetic Retinopathy severity scale.

Results:
On 478 subjects included in the analysis, the algorithm achieved a high classification sensitivity of 95.30% (95% CI: 91.9%–98.7%) and a specificity of 83.89% (95% CI: 79.9%–87.9%) for the detection of RDR. The sensitivity for STDR detection was 100%.

Conclusion:
The study proved that Medios AI-DR algorithm yields good accuracy in screening for RDR in the Armenian population. In our literature search, this is the only smartphone-based, offline AI model validated in different populations.
Electroretinographic changes in the inner and outer retinal layers before and after intravenous chemotherapy for retinoblastoma
Authors: Kannan Kiruthika , Jethva Dishank , Parameswarappa Deepika C , Kaliki Swathi , Raval Vishal 
Published: July 2024

Purpose:
To study the inner and outer retinal functions using a full-field electroretinogram (ERG) before and after intravenous chemotherapy (IVC) in children with retinoblastoma (RB).

Methods:
Of the 11 eyes, seven had RB and four were normal. All children were examined under anesthesia using a handheld ERG machine with a standard protocol – light-adapted single-flash ERG (fERG), photopic single-flash 3.0- and 30-Hz flickers, and photopic negative response (PhNR) amplitudes at 72 ms (P72). The amplitudes and peak times were compared before and after IVC.

Results:
Post-chemotherapy tumor regressed in all seven eyes. Of the seven eyes, the fERG peak time (a-wave) was delayed in two eyes (29%), whereas the b-wave was delayed in six eyes (86%). The fERG amplitude height for a- and b-waves decreased in five eyes (71%) and six eyes (86%), respectively. In addition, photopic flicker 30-Hz b-wave peak time delayed in five eyes (71%), whereas the b-wave amplitude height decreased in six eyes (86%). Simultaneously, the P72 amplitude height decreased in six eyes (86%), whereas the P-ratio increased in all seven eyes (100%). In comparison, the ERG responses improved in three of the four contralateral normal eyes. Overall, the cone function improved in two eyes (29%), whereas cone bipolar cell and retinal ganglion cell (RGC) function improved in one eye (14%) each.

Conclusion:
Comparison of light-adapted ERG changes before and after IVC showed reduced amplitudes and delayed peak times for both a and b waveforms, as well as reduced PhNR amplitude attributable to bipolar and RGC injury.
Comparison of intraocular lens power prediction by American Society of Cataract and Refractive Surgery formulas and Barrett True-K TK in eyes with prior laser refractive surgery
Authors: Shetty Naren , Sathe Priyanka , Aishwarya  , Francis Mathew , Shetty Rohit 
Published: July 2024

Purpose:
To evaluate the prediction accuracy of various intraocular lens (IOL) power calculation formulas on American Society of Cataract and Refractive Surgery (ASCRS) calculator and Barrett True-K total keratometry (TK) in eyes with previous laser refractive surgery for myopia.

Methods:
This retrospective study included eyes with history of myopic laser refractive surgery, which have undergone clear or cataractous lens extraction by phacoemulsification followed by IOL implantation. Those who underwent uneventful crystalline lens extraction were included. Eyes with any complication of refractive surgery or those with eventful lens extraction procedure and those who were lost to follow-up were excluded. Formulas compared were Wang–Koch–Maloney, Shammas, Haigis-L, Barrett True-K no-history formula, ASCRS average power, ASCRS maximum power on the ASCRS post-refractive calculator and the IOLMaster 700 Barrett True-K TK. Prediction error was calculated as the difference between the implanted IOL power and the predicted power by various formulae available on ASCRS online calculator.

Results:
Forty post-myopic laser-refractive surgery eyes of 26 patients were included. Friedman’s test revealed that Shammas formula, Barrett True-K, and ASCRS maximum power were significantly different from all other formulas (P < 0.00001 for each). Median absolute error (MedAE) was the least for Shammas and Barrett True-K TK formulas (0.28 [0.14, 0.36] and 0.28 [0.21, 0.39], respectively) and the highest for Wang–Koch–Maloney (1.29 [0.97, 1.61]). Shammas formula had the least variance (0.14), while Wang–Koch–Maloney formula had the maximum variance (2.66).

Conclusion:
In post-myopic laser refractive surgery eyes, Shammas formula and Barrett True-K TK no-history formula on ASCRS calculator are more accurate in predicting IOL powers.
Optical coherence tomography characteristics and prognostic predictors of acute macular neuroretinopathy following SARS-CoV-2 infection
Authors: Huang Ying , Sun Zuhua , Li Yingzi , Huang Shenghai , Zhou Rong , Yang Chun , Lin Bing 
Published: July 2024

Purpose:
To analyze the characteristics of optical coherence tomography in acute macular neuroretinopathy (AMN) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and discuss the prognostic predictors.

Methods:
Patients with AMN following SARS-CoV-2 infection were divided into two groups according to the presence or absence of hyperreflective outer nuclear layer (ONL) lesion involving the fovea.

Results:
The first visit included 14 eyes in the fovea-involved group and 20 eyes in the no fovea-involved group. Ellipsoid zone (EZ) hyporeflection and interdigitation zone (IZ) interruption were detected in all eyes. Other common manifestations were myoid zone (MZ) hyperreflection (76.5%), ONL hyperreflection (73.5%), outer plexiform layer (OPL) thickening (64.7%), and EZ interruption (50%). The follow-up period was 48.4 ± 55.3 days. At the last visit, 12 eyes were in the fovea-involved group and 13 eyes in the no fovea-involved group. IZ interruption was detected in all eyes. Other common manifestations were EZ hyporeflection (92.0%), ONL atrophy (40.0%), OPL thickening (36.0%), OPL linear (32.0%), and MZ hyperreflection (32%). The improvement of visual acuity (VA) was -0.5 ± 0.5 and -0.2 ± 0.4 in the fovea-involved group and the no fovea-involved group, respectively, with a statistically significant difference between them (P = 0.045). Initial VA, initial cotton wool spot, initial ONL cyst, final ONL cyst, and final OPL linear were associated with final VA (P = 0.000, P = 0.029, P = 0.044, P = 0.049, P = 0.049, respectively).

Conclusions:
In the early stage of AMN following SARS-CoV-2 infection, IZ interruption and EZ hyporeflection were the most common manifestations, and pathology of IZ was more serious than that of EZ. Subsequently, OPL and ONL atrophied, and ONL atrophied faster. Regardless of whether hyperreflective ONL involved the fovea, VA improved, with a more noticeable improvement found in the fovea-involved group. The presence of initial ONL cyst and initial cotton wool spot, rapid atrophy of OPL, and poorer initial VA indicating poorer VA outcome.
Outcomes of keratoplasty in a cohort of Pythium insidiosum keratitis cases at a tertiary eye care center in India
Authors: Acharya Manisha , Singh Aastha , Nidhi Vatsala , Tiwari Anil , Gandhi Arpan , Chaudhari Isha 
Published: July 2024

Purpose:
To assess outcomes of keratoplasty performed in patients diagnosed with keratitis caused by Pythium insidiosum (PI).

Design:
Retrospective review.

Methods:
Preoperative, intra operative and post operative data of patients diagnosed with PI keratitis and who underwent keratoplasty for their condition from January 2020 to December 2021 were collected from the central patient database of a tertiary eye care hospital in India. The data were analyzed for anatomic success, elimination of infection, graft survival, incidence of repeat keratoplasty, final visual acuity and varied complications.

Results:
In total, 16 eyes underwent penetrating keratoplasty for PI keratitis during the study period. Mean time to keratoplasty from onset of symptoms was 31.3 days and mean graft size was 10.4 mm. Nine out of the 16 cases had recurrence of infection following surgery, seven of which required a repeat keratoplasty for elimination of infection. Mean graft size for repeat keratoplasty performed in recurrent cases was 11.7 mm. Globe was successfully salvaged in 14 out of 16 patients (87.5 %). Three grafts remained clear at 6-month follow up while 11 grafts failed. Mean improvement in uncorrected visual acuity from 2.32 to 2.04 logMAR was observed at last follow up. Endo-exudates, graft infiltration, graft dehiscence, secondary glaucoma and retinal detachment were the various complications noted after keratoplasty.

Conclusion:
PI keratitis is a tenacious and potentially blinding condition. Keratoplasty remains the choice of treatment in this condition, however recurrence of disease and graft failure are common. Large sized grafts, meticulous per-operative removal of infection, adjuvant cryotherapy, and intraoperative and post operative use of antibiotics can help in improving outcome of keratoplasty in these patients.
Tear meniscus particle analysis with anterior segment optical coherence tomography in keratoconus
Authors: Seyyar Sevim Ayca , Büyükbayram Şaban , Soysal Gizem Gürbostan , Ayla Serhat , Doğan Levent , Tokuç Ecem Önder , Mercanlı Murat , Mete Alper 
Published: July 2024

Purpose:
To perform tear meniscus particle analysis using anterior segment spectral domain-optical coherence tomography (SD-OCT) and ImageJ software in keratoconus patients.

Methods:
A total of 76 participants (76 eyes) were included in the study. A comprehensive analysis of tear meniscus parameters, including tear meniscus height (TMH), tear meniscus depth (TMD), tear meniscus turbidity (TMT), and percentage of area occupied by particles (PAOP) within the meniscus, was performed in kerataconus patients and healthy controls.

Results:
TMT was significantly higher in the keratoconus group, while PAOP was significantly lower (P < 0.05). However, TMH and TMD did not show significant differences between the two groups (P > 0.05). There was a negative correlation observed between TMT and PAOP. In binary logistic regression analysis, TMT and Schirmer score were found to be the most influential factors in predicting keratoconus (odds ratio [OR] = 0.995, P = 0.039 and OR = 1.143, P = 0.021, respectively).

Conclusion:
This study revealed novel findings on analysis of the tear film in keratoconus patients, with higher TMT and lower POAP levels in the keratoconus group compared to the healthy control group.
To compare horizontal strabismus deviation as assessed from photographs with that in the strabismus clinic using the prism bar
Authors: Bose Aparna , Amitava Abadan Khan , Gupta Yogesh , Sharma Nikita , Raza Syed Aisha , Masood Anam , Singh Ramprakash , Meena Gangasagar 
Published: July 2024

Purpose:
To compare the deviation in cases of horizontal strabismus as assessed from photographs with the measurements as obtained in the strabismus clinic.

Methods:
After obtaining informed consent, we recruited subjects with manifest horizontal strabismus. We took a frontal flash photograph from a distance of 50 cm using smart-phone-based cameras with the flash light vertically aligned with the lens. After projecting the photograph on a laptop and using a vernier caliper, we measured the horizontal corneal diameter of the non-strabismic eye and the decentration of reflex in the strabismic eye taking limbus as the reference point. We converted these values to degrees by using a conversion factor of 7.5°/mm and further to prism diopters (PD) by the standard mathematical formula 100*tanθ.

Results:
We included 74 subjects aged between 5 and 40 years with manifest horizontal deviation from 20 to 85 PD. We found a statistically significant correlation of 82.6% (P value < 0.001) between the clinic and photographic measurements. Agreement analysis suggested that the photographic measurements measured on average 7 PD less (95% confidence interval: 4.6 to 9.2) than clinical measurements along all values of misalignment, although the difference between the two methods decreased as the quantum of deviation increased. Linear regression revealed an r2 of 68% and provided a predictive equation to derive clinic equivalent measurements from photographic estimates.

Conclusion:
We believe our simple method provides robust evidence that a photographic estimation can provide the basic information of the size of the deviation to plan possible surgeries, especially in situations of a tele-consultation. This is an easy approach to both understand and master and should form the armamentarium of most orthopticians and strabismologists.
Effect of protein supplements on cardiovascular health and exercise performance of young adult males
Authors: Khandelwal Ekta , Chawali Krishna Dutt , Bhavya S 
Published: July 2024

ABSTRACT

Introduction:
The modern fitness culture, propelled by celebrity influence and media exposure, has led to widespread acceptance and consumption of protein supplements, particularly among young adult males aspiring for an ideal physique. Despite the surge in usage, limited research has explored the impact of these supplements on cardiovascular health and exercise performance. This study aims to bridge this gap by clinically examining the cardiovascular system using heart rate variability (HRV) and comparing outcomes between those using protein supplements and a control group.

Methodology:
This study was conducted at the Department of Physiology, AIIMS Raipur. The cross-sectional study involved 60 young adult males aged 18–25 years. Participants were divided into two groups: group I (n = 30), comprising individuals using commercially available protein supplements for a minimum of three months, and group II (n = 30) as age-matched controls. Cardiovascular assessments, including HRV analysis, were performed at rest and after the Harvard step test. Pre-exercise and post-exercise parameters were statistically analyzed, and participants in the test group provided information on supplement labels.

Results:
Participants in both groups exhibited comparable pre-exercise cardiovascular parameters. However, post-exercise results did not reveal significant variations in systolic blood pressure, diastolic blood pressure, mean blood pressure, low frequency/high frequency (LF/HF) ratio, Standard deviation of the successive differences between adjacent NNs (SDNN), and standard deviation of successive differences (SDSD) between the test and control groups. The average exercise duration for the control group was longer than that of the test group. Amino acid profiles and nutritional content varied among 13 different protein supplement brands.

Conclusion:
The study found no statistically significant positive influence of protein supplements on cardiovascular health or exercise performance in young adult males.
Evaluation of case based simulation teaching to improve the Family Medicine residents urgent care management skills at a teaching hospital
Authors: Bhombal Swaleha T. , Babar Shazia , Qureshi Asra , Zaki Samar , Jabeem Ismat , Farid Rubia 
Published: July 2024

ABSTRACT

Context:
Simulation based teaching is effective strategy to allow trainees to acquire skills, develop clinical judgment and to become competent in order to manage the patients in a safe environment. The Case-based simulation improves the assessment and management skills of the trainees to prepare them as a competent physician.

Aim:
Evaluation of case based simulation teaching to improve the Family Medicine residents urgent care management skills at a teaching hospital.

Setting and Design:
An Interventional study (Pre and post design) was conducted on the residents of the Family Medicine department of the Aga Khan University hospital Karachi.

Methodology:
After getting their consent, pre intervention Objectively structured clinical examination (OSCE) was conducted at the Center for Innovation in medical education, AKUH. The scenarios were based on urgent care problems presenting in the Family Medicine setting. It was followed by the case based simulation teaching intervention by the facilitators and debriefing. The post intervention OSCE was conducted in order to assess the resident’s performance. Statistical Analysis: The data was analyzed in Stata version15 software in two stages; descriptive and inferential. In descriptive analysis frequency and proportion were calculated for categorical variables. Median and inter quartile range were reported for continuous variable. Paired T-tests were applied to compare the pre and post test results.

Results:
The resident’s scores significantly improved after case based simulation in majority of the post intervention OSCE stations proving the effectiveness of the intervention.

Conclusion:
Case based simulation is an effective teaching strategy for the learning process of the Family Medicine residents regarding the urgent care management skills. It is advised to use this strategy in the teaching and learning process of other Family medicine residency programs.
Anemia and its association with glycemia and transaminitis in patients with type 2 diabetes mellitus: A cross-sectional pilot study
Authors: Agarwal Harsh , Kapoor Gautam , Sethi Prayas , Ghosh Tamoghna , Pandey Shivam , Sehgal Tushar , Meena Ved P. , Ranjan Piyush , Vikram Naval K. 
Published: July 2024

ABSTRACT

Background and Aims:
Anemia impairs glucose homeostasis, affects glycemic control, and predisposes to complications in diabetics. It correlates with oxidative stress and increases the risk of developing microvascular and macrovascular complications. However, it is an underrecognized comorbidity in diabetics. This study was conducted to assess the prevalence of anemia in diabetic patients and compare the metabolic profiles of anemic and non-anemic diabetics.

Methods:
This is a cross-sectional study, conducted among type 2 diabetes (T2DM) patients, at the outpatient clinic. Patients with chronic kidney disease (CKD), known hematological disorders, and chronic inflammatory disorders were excluded.

Results:
Of the 97 patients, 37 (38.14%) were found to be anemic (hemoglobin (Hb): male <13 g/dl, female <12 g/dl). The mean values of fasting blood sugar (FBS) in low and normal mean corpuscular volume (MCV) patients were 265.9 ± 43.7 mg/dl and 157.2 ± 7.2 mg/dl, respectively (P = 0.0026), and those of postprandial blood sugar (PPBS) were 370.3 ± 58.4 mg/dl and 226.3 ± 10.1 mg/dl, respectively (P = 0.0015). It was found that 6 (22.2%) of 27 patients with raised alanine aminotransferase (ALT) had anemia against 27 (45.8%) of 59 patients with normal ALT (P = 0.03). The mean Hb levels in patients with raised and normal ALT were 13.31 ± 2.3 gm% and 12.2 ± 2.0 gm% (P = 0.03), respectively.

Conclusions:
Blood sugar may have a direct relationship with MCV in T2DM patients. Hb tends to relate to hepatic enzymes likely due to altered dietary patterns in anemics. Further larger studies on the effect of iron supplementation and dietary habits on glycemic control and hepatic steatosis are warranted.
Epidemiological study of health profile and quality of life of postmenopausal women in the urban field practice area of a teaching medical institute in a metropolitan city
Authors: Singh Khushboo , Rawat Shalini , Dhutraj Pooja , Gokhe Seema S Bansode 
Published: July 2024

ABSTRACT

Background:
Menopause is one of the most significant phases in the life of a woman which brings about various physiological changes called postmenopausal syndrome. A health programme catering to the needs of postmenopausal women is lacking in our health system.

Methodology:
A cross-sectional study was conducted in an urban health and training centre. Sample size of 171 was taken by simple random sampling. Women of age more than or equal to 45 and having 12 months of amenorrhea were enrolled in the study after obtaining their consent.

Results:
The mean age of menopause was found to be 45.31 years. In the vasomotor domain, the most common postmenopausal symptom was hot flushes (47.95%) followed by sweating (25.73%) while in the psychological domain it was seen that the most common symptom was feeling depressed down or blue (37.43%) followed by being dissatisfied with personal life, feeling anxious or nervous (36.26%) and being impatient with other people and feelings of wanting to be alone (34.50%). In physical domain, the most common symptom was ache in muscles and joints (92.98%) followed by low backache (86.55%), feeling tired or worn out (84.80%), decrease in physical strength (83.63%) and aches in the back of neck or head (81.87%). The other domain was the sexual domain in which the most common symptom was a change in sexual desire (93.57%) followed by avoiding intimacy (92.98%).

Conclusion:
It was found that the domain, most severely affecting quality of life was sexual followed by physical and psychological domain. Awareness should be created regarding the psychosocial, physical, nutritional and sexual needs of postmenopausal women.