bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic Review and Meta-analysis of Environmental Toxic Metal Contaminants and the Risk of Ischemic Stroke
Authors: Dev Priya , Gupta Priya , Mahapatra Archisman , Cyriac Mareena , Kumar Amit , Singh Varun Kumar , Mishra Vijaya Nath , Pathak Abhishek 
Published: August 2023

Background:
Stroke is the second largest cause of mortality (WHO 2014) and long-lasting disability worldwide. Many risk factors are associated with stroke, such as age, gender, chronic illnesses, cardiovascular disease, lifestyle, and smoking. With global industrialization, the roles of environmental contaminants and their association with stroke are still unclear and have attracted much more attention.

Materials and Methods:
We conducted a systematic review on the environmental toxic metal contaminants and the risk of ischemic stroke. A comprehensive literature search was carried out till June 30, 2021 from databases such as PubMed, Science Direct, Embase, and Scopus. The quality of all the articles which met our inclusion criteria was assessed using Newcastle–Ottawa scaling, and four eligible studies were included for our systematic review.

Results:
The serum and urine cadmium concentrations were positively associated with the risk of ischemic stroke. There was an inverse association of serum and urine concentrations of mercury (Hg), serum concentration of gold and cerium with ischemic stroke, and the serum and urine concentrations of lead (Pb) had no association with ischemic stroke risk.

Conclusion:
The study showed strong associations between heavy metals and ischemic stroke, but more studies are required to prove the associations.
Familial CNS-Isolated Hemophagocytic Lymphohistiocytosis Due to a Novel PRF1 Mutation Triggered by SARS-CoV2
Authors: Caldito Natalia Gonzalez , Lorenzo Jocelyn , Wang Cynthia X. 
Published: August 2023

Background:
Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyperinflammatory condition that presents with fever, hepatosplenomegaly, and characteristic laboratory findings. Mutations in the perforin gene PRF1 have been implicated in cases of familial HLH (fHLH) and can cause isolated CNS-HLH in the absence of systemic HLH.

Results:
A five year-old boy presented with three weeks of headache, blurry vision, and emesis. He was diagnosed with acute disseminated encephalomyelitis (ADEM), thought to be triggered by SARS-CoV-2 given positive nasopharyngeal testing. He completed a five day course of high dose IV methylprednisolone and plasma exchange. In the subsequent months, he was admitted twice due to worsening clinical and radiological activity and after several courses of IV pulse steroids, plasmapheresis, and IV immunoglobulin (IVIG), his condition stabilized with rituximab and monthly IVIG. A few months later, his younger brother presented with a similar syndrome. It was discovered that his parents were second cousins, leading to concern for a genetic disorder. Genetic testing revealed a homozygous mutation for PRF1 in both siblings (variant c.4422G>A).

Conclusions:
This is the first presentation of CNS-isolated familial HLH triggered by SARS-CoV-2 in the pediatric population. Furthermore, this is the first report of this specific PRF1 mutation, the variant c.4422G>A, as pathogenic. It highlights the relevance of genetic testing in pediatric neuroinflammatory disorders that do not respond adequately to conventional treatments. It is possible that as our knowledge in neurogenetics develops, certain genes will be identified as predisposing factors to syndromes such as ADEM.
Evaluation of Vascular Cognitive Impairment Using the ICMR-Neuro Cognitive Tool Box (ICMR-NCTB) in a Stroke Cohort from India
Authors: Kaul Subhash , Goyal Sheetal , Paplikar Avanthi , Varghese Feba , Alladi Suvarna , Menon Ramshekhar , Sharma Meenakshi , Dhaliwal RS , Ghosh Amitabha , Narayanan Jwala , Nehra Ashima , Tripathi Manjari 
Published: August 2023

Background and Purpose:
Vascular cognitive impairment (VCI) presents with a spectrum of cognitive impairment due to stroke and poses a huge socioeconomic burden especially in low middle-income countries. There is a critical need for early recognition and identification of VCI patients. Therefore, we developed and validated culturally appropriate neuropsychological instruments, the ICMR-Neuro Cognitive Tool-Box (ICMR-NCTB) and Montreal Cognitive Assessment (MoCA) to diagnose vascular MCI and dementia in the Indian context.

Methods:
A total of 181 participants: 59 normal cognition, 25 stroke with normal cognition, 46 vascular MCI (VaMCI) and 51 vascular dementia (VaD) were recruited for the study. The ICMR-NCTB and MoCA were administered to patients with VCI and major cognitive domains were evaluated.

Results:
The ICMR-NCTB was found to have good internal reliability in VaMCI and VaD. The sensitivity of the ICMR-NCTB to detect VaMCI and VaD ranged from 70.8% to 72.9% and 75.9% to 79.7%, respectively, and the specificity for VaMCI and VaD ranged from 84.8% to 86.1% and 82.5% to 85.2%, respectively. The MoCA had excellent sensitivity and specificity to detect VaMCI and VaD at ideal cut-off scores.

Conclusion:
The ICMR-NCTB is a valid neuropsychological toolbox that can be used for comprehensive cognitive assessment and diagnosis of VCI in India. In addition, the Indian version of MoCA is more adept as a screening instrument to detect VCI due to its high sensitivity. The ICMR-NCTB will aid in early detection and management of many patients, thereby reducing the burden of vascular MCI and dementia in India.
Association of platelet glycoprotein IIIa polymorphism as a risk factor for acute ischemic stroke in Egyptian patients
Authors: Saad Dohaa A , Attia Fadia M , Hosney Ahmed O , El samahy Mohamed , Abdelhamid Mohamed A , Ibrahim Gehan A 
Published: August 2023

AbstractContextAssociation of genetic variants of platelet receptors and their inferences on cerebral stroke is a major concern.AimsThe current study evaluates the genetic polymorphism of platelet GPIIIa as a risk factor in Egyptian patients with ischemic cerebrovascular stroke.Settings and designA total of 50 patients with ischemic stroke were recruited from the Neurology Department, in addition to 50 control individuals matching the study group in age and sex.Patients and methodsData were collected using an interview questionnaire, clinical and neurological examination, and laboratory assessment, which included hematological assessment, biochemical assessment, and molecular assessment of genotyping of GPIIIa polymorphism by PCR-RFLP technique using endonuclease restriction alongside Msp-I enzyme.Statistical analysisTo compare control and study groups, independentttest in parametric data and Mann–Whitney for nonparametric data were used.ResultsRegarding GPIIIa (PlA2/A2) genotypic distribution of the studied groups, there was a statistically significant difference between patients with ischemic cerebrovascular stroke and controls. Dyslipidemia and platelet GPIIIa genotype showed the highest odds ratio. On binary regression analysis, the role of the platelet genotype as a risk factor of stroke development alone is maximized. In the copresence of other risk factors, its role is minimized.ConclusionsThe GPIIIa (PlA1/PlA2) polymorphism is a highly predictive and reliable biomarker for ischemic cerebrovascular stroke.
Clinical outcomes, time span for healing of various ocular surface disorders with amniotic membrane: A prospective, an Indian study
Authors: Anitha Venugopal , Ghorpade Aditya , Haridas R T , Ravindran Meenakshi , Uduman Mohammed S 
Published: August 2023

Purpose:
To study the clinical outcomes, time span of healing of various ocular surface disorders with amniotic membrane graft.

Methods:
A total of 41 patients, presenting to cornea clinic were included in the study and divided into five groups depending on the type of diagnosis: Group 1, with either >2 weeks of Persistent epithelial defect following cataract/retinal/glaucoma surgeries or Shield ulcers, Group 2 with >4 weeks of Non healing corneal ulcers, Group 3 with chemical injuries, Group 4 with Epithelial defects following keratoplasty, and Group 5 is the miscellaneous group.

Results:
The mean age of the study subjects was 50.0 years. Overall mean duration between clinical presentation and AMT was 23.59 (30.7) days, a median 16 days (IQR; 2-26 days). Failure rate was high in Group 5 (n = 3: 30.0%) and Group 2 (n = 3: 27.3%). Time taken for epithelial closure was slower in groups 1 and 5 patients. The average time taken for reabsorption of AMG was 14.98 days. The complications included repeat AMG was in four eyes (9.75%), and graft displacement was noted in four eyes (9.75%) required resuturing, three eyes required TPK (7.31%), and one eye underwent evisceration (2.43%) following severe corneal melt secondary to neurotropic ulcer. The mean log MAR visual acuity improved from 1.52 to 1.26 at the 3 months.

Conclusion:
Understanding on timespan for healing of ocular surface disorders with AMG is needed to assess the prognosis of the disease, preoperative counselling for repeat procedures, and the compliance with regard to follow up.
Outcomes of topography-guided PRK/CXL in keratoconus using the NIDEK CXIII system—”Bharat Protocol” (Pilot study)
Authors: Jain Rajat , Shuaib Yusra , Mohan Neha , Mittal Vikas 
Published: August 2023

Purpose:
Outcome of topography-guided excimer laser ablation in conjunction with accelerated, high-fluence cross-linking in corneal ecstatic disease using the NIDEK CXIII equipped with CATz algorithm from the FinalFit software—”Bharat Protocol.”

Methods:
Retrospective case record review of 30 eyes of 17 patients of stage 1-3 keratoconus who underwent the procedure was performed. Data collected were for visual acuity, distortion-induced eye pain, and keratometry. Pachymetry, lower order and higher order aberrations, spherical aberrations, and topographic cylinder were documented from by Scheimpflug imaging (Pentacam 70700: Oculus, Wetzlar, Germany).

Results:
At a minimum follow-up of 6 months (range 6.2–13 months), there was significant improvement in UCVA (P < 0.00001), BCVA (P = 0.0061), decrease in Kmax (P = 0.0349), Ksteep (P < 0.0411), Kflat (P = 0.0099), and pachymetry (P = 0.0001). Significant improvement was also seen in distortion-induced eye pain (27/30 to 2/30; P < 0.00001). A more than two-line improvement in UCVA and BCVA was seen in 23/30 and 17/30 cases, respectively. Ectasia was stabilized in all cases at the last follow-up, and no complications were seen.

Conclusions:
The “Bharat” Protocol to arrest keratectasia progression and improve corneal regularity is a safe and efficacious alternative as a keratoconus management option. This is the first such study on Nidek Platform for the same.
Comparison of intraocular lens power prediction accuracy of formulas in American Society of Cataract and Refractive Surgery post-refractive surgery calculator in eyes with prior radial keratotomy
Authors: Shetty Naren , Sathe Priyanka , Aishwarya  , Francis Mathew , Shetty Rohit 
Published: August 2023

Purpose:
To evaluate the accuracy of intraocular lens (IOL) power prediction of the formulas available on the American Society of Cataract and Refractive Surgery (ASCRS) post-refractive calculator in eyes with prior radial keratotomy (RK) for myopia.

Methods:
This retrospective study included 25 eyes of 18 patients whose status was post-RK for treatment of myopia, which had undergone cataract extraction with IOL implantation. Prediction error was calculated as the difference between implanted IOL power and predicted power by various formulae available on ASCRS post-refractive calculator. The formulas compared were Humphrey Atlas method, IOLMaster/Lenstar method, Barrett True-K no-history formula, ASCRS Average power, and ASCRS Maximum power on ASCRS post-refractive calculator.

Results:
Median absolute errors were the least for Barrett True-K and ASCRS Maximum power, that is, 0.56 (0.25, 1.04) and 0.56 (0.25, 1.06) D, respectively, and that of Atlas method was 1.60 (0.85, 2.28) D. Median arithmetic errors were positive for Atlas, Barrett True-K, ASCRS Average (0.86 [−0.17, 1.61], 0.14 [−0.22 to 0.54], and 0.23 [−0.054, 0.76] D, respectively) and negative for IOLMaster/Lenstar method and ASCRS Maximum power (−0.02 [−0.46 to 0.38] and − 0.48 [−1.06 to − 0.22] D, respectively). Multiple comparison analysis of Friedman’s test revealed that Atlas formula was significantly different from IOLMaster/Lenstar, Barrett True-K, and ASCRS Maximum power; ASCRS Maximum power was significantly different from all others (P < 0.00001).

Conclusion:
In post-RK eyes, Barrett True-K no-history formula and ASCRS Maximum power given by the ASCRS calculator were more accurate than other available formulas, with ASCRS Maximum leading to more myopic outcomes when compared to others.
Sequelae of carbide-related thermo-chemical injury: A retrospective analysis
Authors: Arora Anchal , Shanbhag Swapna S , Mishra Dilip K , Malepati Nikhila , Das Sujata , Priyadarshini Smruti R , Mohanty Amrita , Sahu Srikant K 
Published: August 2023

Purpose:
To describe the outcomes of eyes with calcium carbide (CaC2)-related thermo-chemical injury.

Methods:
This study included 28 eyes of 23 patients who presented with calcium carbide-related ocular burns. Only patients with more than three months of follow-up were included. Group A included 16 eyes with Dua’s Grade I–III burns, while Group B included 12 eyes with Grade IV–VI burns. Electronic medical records were reviewed to provide data on the etiology of burn, presenting clinical signs and visual acuity, sequelae, and surgical interventions performed, both in the acute and chronic phases.

Results:
The overall mean age was 28.48 ± 11.8 years. Fifteen patients were injured while using carbide to create an explosion to scare away animals on farms. The median presenting BCVA (best-corrected visual acuity) in Group A (20/160) was significantly better than in Group B [(20/2000) (P = 0.002)]. Five eyes in Group A and one eye in Group B underwent medical management. There was no difference in the duration of follow-up for both groups (P = 0.24). The median final BCVA in Group A (20/32) was significantly better than in Group B [(20/200) (P = 0.02)]. Two eyes in Group A and nine eyes in Group B developed LSCD. Two eyes in Group B were phthisical at the last visit.

Conclusion:
Calcium carbide-related ocular injuries can result in significant visual morbidity in young adults. Early presentation and management may improve outcomes. Prevention of these injuries by increasing awareness and increasing advocacy efforts is necessary.
Assessment of the Utility of Point-of-Care Testing Incorporating Ultrasound and Arterial Blood Gas in Patients with Acute Febrile Illness in the Emergency Department to Determine Disease Severity, Disposition, Need for Ventilation and Renal Replacement Therapy
Authors: Chaudhuri Souvik , Ravindra Prithvishree , Gupta Nitin , Rao Shwethapriya , Kudru Chandrashekar Udyavara , Saravu Kavitha 
Published: August 2023

Introduction:
Acute febrile illness (AFI) patients present to the emergency department (ED), with fever to multi-organ dysfunction. There is a lack of early point-of-care-based disposition criteria in AFI patients regarding the need for intensive care unit (ICU) or high dependency unit (HDU) care.

Methods:
We enrolled 100 patients with AFI presenting to the ED and evaluated using point-of-care ultrasound with two-dimensional echocardiography (ECHO), lung ultrasound score (LUS), renal arterial resistive index (RRI), and arterial blood gas. The need for ICU/HDU admission, ventilation (either noninvasive or invasive), and renal-replacement therapy (RRT) within 48 h of hospitalization was noted.

Results:
Ninety-five patients were included in the analysis. 72 (75.8%) patients required either ICU or HDU admission, 45 (47.4%) required ventilatory support (either noninvasive or invasive), and 32 (33.7%) required RRT. After logistic regression, LUS ≥16, and arterial lactate ≥12 mg/dL were independent predictors of the need for ICU or HDU admission. The respiratory rate (RR) ≥28/minute, LUS ≥16 and RRI ≥61 were the independent predictors of the need for ventilation. The MAP ≤73 mmHg, LUS (≥16), and RRI (≥67) were the predictors of the need for RRT.

Conclusion:
In AFI patients presenting to the ED, the MAP, LUS, and lactate are predictors of the need for ICU/HDU admission. The LUS and RRI were predictors of the need for RRT whereas the RR, LUS, and RRI were the predictors of the need for ventilation.
Transforming growth factor-beta and microRNA-21, microRNA-29b, microRNA-92, and microRNA-129 in systemic sclerosis patients
Authors: Mohammed Mohammed Hassan , Shaker Olfat G. , Abd El-Raheem Talal A. , Abdulkhaleq Alaa , Khatery Basma H. 
Published: August 2023

Background
Systemic sclerosis is characterized by extracellular matrix overproduction by activated fibroblasts. It was reported that microRNAs (miRNAs) participate in the regulation of processes that drive fibrosis, which include transforming growth factor-beta (TGF-β) signaling, fibroblast proliferation, differentiation, and deposition of extracellular matrix proteins.

Objective
To detect whether miRNA-21, miRNA-29b, miRNA-92, and miRNA-129, and TGF-β are considered as biomarkers for systemic sclerosis.

Patients and methods
The current study was a case–control study carried out on 80 Egyptian adults. Of the participants, 30 were apparently healthy controls, while the other 50 patients were classified into 58% with limited skin type, 26% with diffused skin type while 16% of the patients were with unclassified systemic sclerosis. miRNAs were quantitated by real-time PCR while TGF-β was measured by the ELISA technique.

Results
The results showed that the fold change level of miRNA-21 and miRNA-92 were upregulated compared with the control group with a P value of 0.001 each. Meanwhile, the fold change levels of miRNA-29b and miRNA-129 were downregulated compared with the control group (P=0.001, 0.048), respectively. The present study showed that the mean value of the serum level of TGF-β was 145.0±42.84 pg/ml compared with the control group 23.42±5.79 pg/ml with a P value of 0.001. There was a statistically significant negative correlation between miRNA-29 and TGF-β (r=−0.31, P=0.05) among cases. The cutoff points of miRNA-21, miRNA-29b, miRNA −92, and miRNA −129 were 2.45, 0.49, 5.38, and 0.55 fold changes. While for TGF-β, the cutoff point was 120 pg/ml. For miRNA-21, miRNA-29b, miRNA-92, and miRNA-129 sensitivities were 70.5, 41.1, 54.5, and 73.5%, respectively, and 70.5% for TGF-β. Specificity was 100% for all except 98% for miRNA-29b and 99% for miRNA-129. There was no significant relation of all these markers regarding the extent of skin involvement or duration of disease.

Conclusion
It was concluded that miRNA-21, miRNA-29b, miRNA-92, and miRNA-129 as well as TGF-β can be considered as biomarkers for the diagnosis of systemic sclerosis.
Clinical Presentation and Pattern of Cardiac Involvement in Patients with Rheumatic Heart Disease: A Prospective Observational Study
Authors: Arjun M. , Rajasekhar D. , Mohan Alladi , Chandra Abha , Devi B. Vijayalakshmi , Sangaraju Sai Lahari 
Published: August 2023

Context:
Rheumatic heart disease (RHD).

Aim:
The aim of the study was to study the clinical presentation and pattern of cardiac involvement in adult patients with RHD.

Settings and Design:
This was a prospective observational study from a tertiary care hospital in South India.

Subjects and Methods:
Consecutive adult patients diagnosed with and treated for RHD in our tertiary care teaching hospital in Tirupati were screened for inclusion. In all patients, details of appropriate laboratory and imaging investigations that have been carried out were noted.

Statistical Analysis Used:
Descriptive statistics (frequencies, mean standard deviation, and median [interquartile range (IQR)]) were reported.

Results:
A total of 120 patients were enrolled. Their mean age was 45.7–12.2 years; there were 79 females. The median (IQR) follow-up was 364 (156–702) weeks. Single-valve disease was seen in 51.7% (n = 62); others (n = 58) had multivalvular disease (mitral stenosis [MS] + aortic regurgitation [AR] [n = 47, 81%] and mitral regurgitation + AR [n = 11, 19%]). Among patients with single-valve involvement, 58 (93.5%) had mitral valve disease. Overall, 116 of 120 (96.6%) patients had mitral valve involvement. Among patients with mitral valve disease (n = 116), MS was severe in 62 (51.6%). Atrial fibrillation was evident in 59 (49.2%) patients; of these, 8 had cardioembolic strokes. Forty-four (36.7%) had undergone percutaneous transvenous mitral commissurotomy. Prosthetic mitral valve obstruction was observed in 2/20 patients who had undergone mitral valve replacement or double-valve replacement.

Conclusions:
In patients with RHD, mitral valve involvement (either alone or in combination with the aortic valve) was most common; MS was most common.
Epidemiology, Pattern, and Management of Midsagittal and Parasagittal Palatal Fractures through Placement of Intra-arch Wire
Authors: Sharma Divashree , Khan Tauseef Ahmed , Tripathi Geeta Mishra , Mishra Ambrish 
Published: August 2023

Aim:
The aim of this prospective study was to evaluate the epidemiology, pattern, and concomitant injuries associated with midsagittal and parasagittal palatal fractures and to assess the postoperative complications associated with treatment by placement of intra-arch wiring for their management.

Materials and Methods:
A prospective study was carried out on 22 patients of maxillofacial trauma who were diagnosed with midsagittal or parasagittal palatal fractures and were treated by placement of intra-arch wires during August 2020 to January 2022 in the Department of Dentistry, Shyam Shah Medical College Rewa. All the cases were treated with open reduction/closed reduction for the management of concomitant injury.

Results:
Out of a total of 31 cases diagnosed with palatal fractures during the study duration, the most common palatal fractures were parasagittal (41.93%) and sagittal fractures (29.03%), which met the inclusion criterion of the study (n = 22). Sagittal and parasagittal fractures of the palate were commonly seen in males with a male-to-female ratio of 10:1. The mean age of occurrence was 32.04 ± 11.29 years. The mean duration of surgery was 7.9 ± 2.28 min. Occlusal discrepancy requiring an orthodontic intervention for correction was seen in 1 (4.54%) patient. In 3 (13.63%) patients, occlusal discrepancy was managed by prolonging the duration of intermaxillary fixation.

Conclusion:
Intra-arch wiring is a simple, cost-effective, and quick method for the management of midsagittal and parasagittal fractures of palatal fractures. It eliminates the need of a second surgery for the removal of plates that are placed in open reduction of palatal fractures.