bluuebunny/crossref_metadata_2025_split huggingface dataset:
Normative Value of Accommodative Convergence to Accommodation in Indian Population Measured by Heterophoria Method
Authors: Singh Archana Dharmdeo , Vannadil Harikrishnan , Bhatta Sunandan 
Published: March 2024

Abstract

Introduction:
Near response is a complex synkinesis required for a good binocular vision. accommodative convergence per diopter of accommodation (AC/A ratio) is a value of significance in this synkinetic movement. In addition, the value is used to classify and treat ocular movement abnormalities. The two commonly used methods for determining the AC/A ratio are Gradient Method and Heterophoria method. The normative data for Indian population by gradient method was described in two studies. However, the normative data for heterophoria method is lacking in Indian population.

Objective:
The purpose of this cross-sectional study is to generate the normative value for AC/A ratio for the Indian population by heterophoria method. One hundred healthy ophthalmologically normal adults with no presbyopia or refractive error were chosen consecutively among the attendants of patients visiting the center.

Materials and Methods:
After thorough ophthalmic evaluation, the participants were subjected to AC/A ratio calculation by heterophoria method using 6/9 fixation target and PMMA Prism bar.

Results:
One hundred healthy adults with no refractive error or ocular abnormality were selected with a mean age of 25.70 years (standard deviation [SD] = 4.92) and equal gender distribution. The mean Inter Pupillary Distance (IPD) was found to be 62.88 mm with a SD of 3.91 mm. The average phoria at distance was 1.82 prism diopters (SD = 2.03pd) of exophoria and for near at 33 cm was 4.20pd (SD = 1.92pd). The mean AC/A ratio by heterophoria method was found to be 5.49PD/D with an SD of 0.54PD/D. The highest being 6.90PD/D and the lowest being 4.27PD/D with no statistically significant difference between genders.

Conclusion and Relevance:
According to the previous studies, the normative data arrived is lesser than the value reached in the current study for similar population groups when considering both methodologies of testing. This variation between the gradient method and heterophoria method accounted for by the involvement of proximal convergence during the heterophoria method.
A Study of Nailfold Capillaroscopy in Different Morphological Variants of Psoriasis in a Tertiary Care Hospital
Authors: Kamboj Parul , Vij Vineet , Prashantha G. B. , Sinha Preema , Raj Choudhary Sampoorna , Janardnan Nidheesh Mohan 
Published: March 2024

Abstract

Background:
Psoriasis is a chronic skin disease. Nailfold capillaroscopy (NFC) is a method to analyze nail changes in autoimmune disorders and is gaining popularity as a bedside tool for studying the capillaroscopic changes of psoriasis.

Aim:
The aim was to assess the nail fold capillaroscopic parameters in controls versus psoriasis patients and to assess the nail fold capillaroscopic parameters in various morphological types of psoriasis patients.

Materials and Methods:
A cross-sectional observational study of NFC was conducted on 100 patients and 100 controls who attended the outpatient department of dermatology of a tertiary care hospital in Central India from June 2022 to October 2022. Nail fold of little fingers of both hands was studied by the Universal Serial Bus (USB) Digital Microscope and photographed.

Results:
This study was conducted on 100 patients of psoriasis and 100 controls. The mean age of patients was 50.77 ± 11.33 years with a male-to-female ratio of 1.27. The most common type of psoriasis was chronic plaque psoriasis, and erythrodermic psoriasis was the least common. Majority of 51 patients were having a Psoriasis Area and Severity Index score of >3–15 suggestive of moderate psoriasis. Capillary morphology in 89% of psoriasis cases was inverse U-shape, while remaining 11% had bizarre morphology. There was a significant difference (P < 0.011) in capillary density between psoriasis patients and controls. Only 6% of patients had irregular and haphazard capillary distribution, compared to 94% of patients who had regular and parallel capillary distribution. Other parameters of NFC such as subpapillary plexus, ramified/bushy capillaries, and hemorrhage were also studied.

Conclusion:
Psoriasis is characterized by microvascular abnormalities which can be studied by a novel technique of nailfold capillaroscopy.
Late Postpartum Posterior Reversible Encephalopathy Syndrome: Case Series and Literature Review
Authors: Thakur Vaidehi , Kamal Deep , Kashiviswanathan M. , Chawla Sushil , Ramaraju H.E. 
Published: March 2024

Abstract
Posterior reversible encephalopathy syndrome (PRES) is a reversible neurological entity characterized by seizures, headache, visual symptoms and other focal neurological findings. It is caused by wide variety of causes ultimately leading to vasogenic cerebral edema of occipital and parietal lobes of the brain. Prompt and early diagnosis of PRES is key in reducing the risk of permanent neurological sequelae. Occurrence of PRES during pregnancy or early postpartum period is well known. However, occurrence of PRES between 48 hours and one month postpartum in women who had normal pregnancy and delivery and no signs of preeclampsia is rare. In this case series we present three cases of PRES that occurred in young women during late postpartum period. All these three patients were normotensive during antenatal and early puerperal period but developed hypertension and vision loss in late puerperium. The prompt diagnosis and management of symptoms resulted in complete reversal of the symptoms with no permanent neurological deficit. Posterior reversible encephalopathy syndrome (PRES) is a reversible neurological entity characterized by the presence of white matter edema affecting the occipital and parietal lobes. The predominantly affected area of the cerebral cortex determines presentation in the patient. The reversibility of these symptoms is one of the hallmarks of the disease. Diffusion-weighted MRI is the gold standard in diagnosis of PRES as it helps to distinguish between vasogenic edema from cytotoxic edema. Prompt diagnosis and initiation of early treatment may lead to complete recovery with no residual neurological deficit.
Knowledge, Attitude, and Practices of Diabetic Patients toward Diabetic Retinopathy in a Tertiary Care Hospital of Eastern India: A Cross-Sectional Study
Authors: Rana Vipin , Sharma Neeraj , Bandopadhyay S. , Sharma Vijay K. , Kakati Kalpamoi , Rao B. V. , Patra Vinod K. , Dhole Kunal 
Published: March 2024

Abstract

Background:
To document knowledge, attitude, and practice (KAP) patterns of diabetic patients regarding diabetic retinopathy (DR), to determine associations between them, and to identify barriers to compliance with follow up and treatment regimes.

Method:
This is a cross-sectional study including 504 participants who attended the outpatient department (OPD) of a tertiary care hospital in eastern India. The participants included diabetic patients and questionnaires were completed to collect information about their sociodemographic and healthcare characteristics. A Chi-square test and Pearson correlation test were performed to analyze the data.

Results:
A total of 504 participants were enrolled in the study, with a mean age of 62.84 ± 7.62 years and a mean diabetes duration of 12 ± 4.42 years. The majority (65.07%) of the participants had higher secondary education or above. Good knowledge, a positive attitude, and poor DR practices were observed in 56.34%, 68%, and 66.6% of participants, respectively. The most common barrier to complying with regular follow-up despite having knowledge were domestic issues (no family support, lack of transport).

Conclusion:
The study reported good knowledge and attitude about DR among type 2 diabetics with relatively poor eye-care practices. Therefore, it is recommended that a collaborative approach amongst primary care providers, ophthalmologists, diabetologists, and health policy makers is necessary to transform this good knowledge and attitude into good practices.
Changing Paradigms of Disaster Management in Pandemic: An Experiential Learning
Authors: Patnaik Saroj Kumar , Tyagi Lavneesh , Manjunath S. R. , Kapoor Umesh 
Published: March 2024

Abstract

Background:
Disasters are ubiquitous in nature, and more importantly, disasters do not happen in a staggered manner nor in succession. It may erupt, attack, and happen altogether in one frame of time, abruptly, or cascade. Owing to coronavirus disease 2019 (COVID-19) pandemic, the existing human race has metamorphosed its culture from offices to work from home, cash to cashless transactions, direct retail shopping to e-commerce, socialization to social distancing, hospital-based care to domiciliary care, and much more to register. This necessitated evolution of our disaster management practices established in the pre-COVID era to be reconfigured and be made implementable in the ongoing pandemic scenario, to ensure appropriate management of disasters without bargaining the management of pandemic.

Aim and Objectives:
With this intent, the authors of this study participated in a multinational full-scale exercise to study, identify, and recommend changes in medical preparedness during disaster management while handling pandemic.

Methodology and Results:
The authors have identified key focus areas such as prehospital care and hospital-based care, which further include site and size identification, command and control, patient reception and holding areas, advanced treatment area, laboratory facilities, heating, ventilation and air conditioning systems, medical gas pipeline systems, electric supply and lighting, and transportation. At all these places, COVID-19 best practices, public health aspects along with telemedicine, and communication have been emphasized.

Conclusion:
The authors have tried to decipher the findings to utilize them during the impact of another disaster. The authors have also tried to expand the horizon of the environment by bringing out the fundamentals being faced during such events for the betterment of society.
Spectrum of Glomerular Diseases in North India and its Clinicopathological Correlation – An Observational Study
Authors: Sharma Raj Kumar , Singh Vishal , Sood Vivek , Dogra Pavitra Manu 
Published: March 2024

Abstract

Introduction:
Glomerular diseases (GDs) have varied presentations in adults. The spectrum varies from benign to aggressive presentations.

Materials and Methods:
We conducted an observational prospective study at a tertiary care teaching hospital in North India from July 2020 to June 2022 to evaluate GD’s spectrum and clinicopathological correlation. All kidney biopsies conducted during this period were considered as per inclusion and exclusion criteria, and detailed history and clinical examination were done.

Results:
One hundred and twenty-six kidney biopsies were evaluated as per inclusion and exclusion criteria. The mean age was 37.77 ± 17.73 years. Overall, the male-to-female ratio was 2.3:1 while the male-to-female ratio in lupus nephritis (LN) is 0.37:1. Primary GD (PGD) dominated among males whereas secondary GD (SGD) was more common in females. Nephrotic syndrome (NS, 44.5%) and acute kidney injury 27% were the most common clinical syndromes. The most common symptoms were edema and frothuria in NS (70%), and hematuria in acute nephritic syndrome 59%, whereas fatigue and gastrointestinal symptoms (44%) dominated in SGDs. The PGD-to-SGD ratio was 61.1:38.9. The most common PGD was immunoglobulin A nephropathy (IgAN, 22.1%), followed by minimal change disease (MCD, 20.8%), whereas LN (22.5%) was the prominent SGD, with Class IV + V (36.4%) being most common.

Conclusion:
GDs have a multitude of presentations – from asymptomatic urinary abnormalities to crescentic ones. IgAN and MCD were the most common of PGD whereas LN was the most common SGD.
Correlation of Intraoperative Frozen Section Reporting with Histopathological Diagnosis in Central Nervous System Tumors – A Study of 30 Cases
Authors: Mohanty Supreet Kumar , Singh Amandeep , Das Amit Kumar , Shelly Divya 
Published: March 2024

Abstract

Introduction:
Central Nervous System (CNS) tumors, though relatively less common (approx 2% of all tumors), display a gamut of clinical and histological presentations. Frozen section analysis in CNS tumors in a known modality which can be a beneficial tool with potential to guide intra-operative management and a likelihood of bettering outcomes. Our study aims to ascertain the correlation and concordance between intra-operative frozen section diagnosis with final histopathological diagnosis in CNS tumors.

Methods:
We studied a total of 30 cases of CNS tumors for which frozen section was carried out and the same were compared with the diagnosis after final histopathological examination. For statistical analysis SPSS software version 20.0 (IBM, Armonk, New York, USA), Pearsons’s correlation coefficient Test and Chi square test were used.

Results:
Out of the 30 cases studied, 24 cases (80%) were completely concordant, 05 cases (16.7%) were partially concordant and 01 case (3.3%) was discordant. Considering the concordant and partially concordant cases, the sensitivity was estimated to be 96.7%.

Conclusion:
Intraoperative frozen section diagnosis encompasses certain limitations in layered diagnosis. Despite the limitations of retrospective studies, this study highlights its diagnostic value as a rapid and reliable method for accurate diagnosis of CNS tumors.
Maternal and Fetal Outcome Following Post In vitro Fertilization and Embryo Transfer Pregnancy: A Prospective Observational Study
Authors: Gouru Prathyusha , Dubbewar Avinash P , Hiremat Ravishekar N. , Dey Madhusudan , Yadav Preeti , Ghodke Sandhya 
Published: March 2024

Abstract

Background:
While the majority of in vitro fertilization (IVF)-conceived children are healthy, IVF has been associated with an increased risk of adverse obstetric and perinatal outcomes including hypertensive disorders of pregnancy, preterm labor and preterm delivery, and low birth weight (LBW).

Objective:
The objective of the study is to assess pregnancy, maternal, and perinatal outcomes in patients undergoing IVF embryo transfer (IVF-ET) at tertiary care center in North India.

Methodology:
It was a prospective observational study carried out for duration of 20 months among women who conceived following an IVF-ET. The sample size was 107 consecutive mothers and data were collected using a predesigned semi-structured study pro forma. Detailed menstrual, obstetric, and medical histories of each patient were noted. Findings of the general, physical, systemic, and obstetrical and gynecological examination were noted for all patients.

Results:
One hundred and seven mothers who fulfilled the study criteria were included. Of these, 4 had an abortion. Rest of the 103 mothers were included in the final analysis. The mean age of the mothers was 30.39 ± 4.7, ranging from 22 to 50 years. Twin pregnancy rate was 45.7%. All were dichorionic-diamniotic twins. Based on gestational age, 5% were extreme preterm births, 14% were very preterm births, 32% were late preterm births, and 48% were early-term births. Normal vaginal delivery (NVD) occurred in 26.2% of the mothers, elective lower-segment cesarean section (LSCS) in 21.4%, emergency LSCS in 51.4%, and one case had vacuum delivery. Hence, NVD occurred in 27% and 73% had LSCS. With respect to neonates born to study participants, 8% were extremely LBW, 7.3% were very LBW, 46% were LBW, and the rest 38.7% weighed 2.5 kg or more at birth.

Conclusion:
IVF-ET is a safe and highly successful treatment for infertility. Many of adverse outcomes are largely due to an increased risk of multiple gestations in IVF. Patients with infertility are likely to be older and have preexisting comorbid conditions such as hypertension, diabetes, insulin resistance, or other endocrinopathies which may predispose them to adverse obstetric and perinatal outcomes. It is also recommended that patients should be given adequate preconception counseling regarding increased maternal as well as neonatal risk.
Can Increased Carbon Dioxide Gradient be Used as a Sensitive Bio-marker for COVID-19 Pneumonia Severity: An Indian Study
Authors: Patel Barun Bhai , Goje Harinder Kumar , Singhal Anuj , Patra Arun Kumar , Das Bhaskar , Mishra Satish Kumar , Choudhury Ipsita 
Published: March 2024

Abstract

Background:
Acute respiratory distress syndrome caused by severe acute respiratory syndrome coronavirus 2, is a challenge to health-care system in the recent times. The nonavailability of specific treatment and rapid spread through aerosols has impacted the countries worldwide. Research on the subject is continuous, to understand the pathology and pathophysiology of the condition. In this regard, diagnosis of the disease, severity stratification and clinical prognostication helps the clinician to plan the management. Literature is silent on clinical biomarkers for this novel disease. Hence, a study was carried out to find out a suitable clinical biomarker for the disease.

Methodology:
The author carried out a retrospective analysis of the fatal case records of a tertiary center COVID intensive care unit to evaluate whether Carbon dioxide gradient can be used as an end-stage marker of COVID pneumonia. A record-based observational study was conducted and data were collected from the fatal case documents after an institutional ethical committee clearance.

Results:
A total of 42 fatal cases were analyzed. Carbon dioxide retention was found in more than 90% of cases and raised carbon dioxide gradient (>5 mmHg) was found in more than 50% of cases. The average days of mechanical ventilation was 9 days and on average, after 5 days of ventilation patients developed raised carbon dioxide gradient.

Conclusion:
We conclude that raised carbon dioxide gradient may be chosen as an end-stage marker for COVID pneumonia though large group studies are recommended.
Breast Reduction as a Modality for Treatment of Recurrent Intertrigo: A Study of Ten Cases
Authors: Agarwal Reetu , Sharma Loknandini , Srinivasan Padmapriya , Langer Vijay 
Published: March 2024

Abstract

Introduction:
Macromastia is associated with physical and psychosocial comorbidities. One such entity which presents to dermatologists is intertrigo which is the infection of intertriginous areas caused by various species of bacteria and fungi. This is the most common presentation in females with large ptotic breasts with involvement of the inframammary region. After exhausting all possible modalities including antibiotics, antifungals, and even anti-inflammatory drugs to exclude secondary eczema, these patients can be offered breast reduction surgery as a last resort.

Aim:
The aim was to study the efficacy of breast reduction surgery in the management of recalcitrant intertrigo.

Methodology:
Ten such patients who presented to us with recalcitrant intertrigo in the setting of macromastia and consented to breast reduction surgery were recruited, and after obtaining informed consent, breast reduction was performed by vertical mammoplasty and liposuction. The patients were followed up 3 months for 1 year postsurgery. The treatment outcome was measured by physician assessment by checking the presence of visible dermatitis in the intertriginous region and patient assessment with the help of a novel questionnaire to assess the quality of life with responses on a 4-point Likert scale from 0 to 3. However, due to the small sample size, the questionnaire could not be validated.

Results:
None of the patients in this study reported recurrence of intertrigo. Furthermore, there was a significant functional improvement with minimal complication rates. A novel questionnaire was devised to assess the quality of life of these patients which showed a significant improvement postsurgery. However, due to the relatively small sample size, the questionnaire could not be validated.

Conclusion:
There is evidence that reduction mammoplasty is not only effective at decreasing breast-related symptoms such as pain and discomfort but also improves functional limitations and clinical conditions like intertrigo. In our study, we conclusively demonstrate an intent to point out to dermatologists that breast reduction can be a treatment for resistant/ intractable intertrigo only as a last resort in patients with large breast size, as would help in reducing the constant predisposing factors of moisture and friction.
Insulin: The Journey Continues
Authors: Bansal Naresh , Kotwal Narendra , Singhal Anuj , Kumar Ashish 
Published: March 2024

Abstract
In the history of medicine, the discovery of insulin marked a turning point. At first, the only form of insulin that could be administered to humans was this secretion from animal pancreas. Since its conception, technologies for purifying and altering insulin have been developed, although they are still a long way from simulating pancreatic-cells’ natural production. The precise structure of the insulin molecule had been uncovered by the late 1950s, and with the development of molecular biology and recombinant DNA techniques, it is now feasible to manipulate genes to produce recombinant human insulins. This opened the door for the creation of short-acting analogs to mimic postprandial insulin secretion and long-acting analogs to mimic basal or background insulin secretion. The patients can more closely mimic pancreatic insulin secretion thanks to the characteristics of the new basal and bolus analogs than they could with the earlier insulins. However, there are still issues with the absence of portal delivery, night-time dip, morning surge, and responsiveness to ambient blood glucose. There are a number of noninvasive methods being researched for the delivery of insulin, including transdermal, buccal, oral, and pulmonary routes. The hunt for insulin that precisely mirrors the physiological profile and has improved stability, less variability, and perhaps selective action, is still ongoing.