bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic mutational analysis of epitope-grafted ED3 immunogenicity reveals a DENV3-DENV4 bi-serospecific ED3 mutant
Authors: Sultana Mamtaz , Hasan Nazmul , Mahib Mamunur R. , Islam Mohammad M. 
Published: February 2022

Objective:
To identify the residue determinants of the serospecificity and sero-cross-reactivity of dengue virus (DENV) envelope protein domain 3 (ED3), which contains two major putative epitopes of DENV.

Methods:
We constructed ED3 from DENV3 (3ED3) and DENV4 (4ED3), and six epitope-grafted variants, where we transferred epitope 1 (L304I, K305D, V309M, and S310A) and/or epitope 2 (D383N, K384S, K387T, and N389H) of 4ED3 onto 3ED3 and vice-versa. Swiss albino mice aged 3-4 weeks were immunized against wildtype and epitope-grafted ED3 variants and anti-ED3 IgG antibody responses were determined using ELISA.

Results:
Mouse immunization using 3ED3 and 4ED3 generated serotype-specific antisera, as expected. Similarly, most epitope- grafted ED3s produced antisera serospecific to the template ED3 with little or no cross-recognition of ED3 of the serotype from which the epitopes were taken. These indicated that a mere grafting of the epitope was not sufficient to transfer serospecificity, contrary to our expectations. However, one epitope-grafted ED3 mutant, where epitope 1 of 3ED3 was grafted onto 4ED3 (4ED3epi1), generated antisera that was serospecific to both 4ED3 and 3ED3.

Conclusions:
The 4ED3epi1 is a chimeric ED3 that produces antisera possessing serospecificity to both 3ED3 and 4ED3 onto a common 4ED3 scaffold. The 4ED3epi1, therefore, provides a unique tool for analyzing serospecificity and sero-cross-reactivity in dengue. We believe that chimeric ED3 may provide a template for future recombinant ED3 possessing serospecificity of multiple DENVs onto a single scaffold and may pave a way developing tri-and/or tetravalent anti-DENV antisera.
Furuncular myiasis by Wohlfahrtia magnifica (Diptera
Authors: Wakid Majed Hamdi , Almakki Angham Ahmed , Alsahaf Nouf Saleh , Almatrafi Mohammed Ali 
Published: February 2022

Rationale:
Human myiasis is the invasion of tissue or organs by fly larvae. This could be obligatory, facultative, or accidental.

Patient concerns:
A 4-year-old Saudi boy complained of fever over the past three days with multiple inflamed painful dermal furuncles and worms-like discharge.

Diagnosis:
Furuncular obligatory myiasis caused by Wohlfahrtia magnifica.

Interventions:
Maggots were removed for identification. The wounds were cleaned with antiseptic dressings. Topical and oral antibiotics were applied.

Outcomes:
Seven days later, the wounds completely healed.

Lessons:
Although several reports correlated human myiasis with old age, low health status, mental retardation, and low socioeconomic status, but the patient in our case was a healthy child from a family with good socioeconomic status, good hygiene, no history of diseases or mental disability, but traveled to a village where the climate is suitable for fly breeding.
Epidemic retinitis - Factors associated with poor visual outcomes
Authors: Kawali Ankush , Sanjay Srinivasan , Mahendradas Padmamalini , Mohan Ashwin , Shetty Bhujang 
Published: February 2022

Purpose:
To identify factors other than macular edema and retinitis location responsible for poor visual outcomes in epidemic retinitis (ER).

Methods:
A retrospective, observational, comparative study. Eyes with corrected distant visual acuity (CDVA) 20/200 or worse at resolution formed Group A. Eyes with central macular thickness (CMT) 600 μm or worse and retinitis within 1500 μm to foveal center at the presentation, but improved to CDVA 20/200 or better at the resolution formed Group B. The patient’s history, clinical presentation, imaging, and treatment outcomes were studied and the factors responsible for the final visual outcomes were compared in both groups.

Results:
Groups A and B included 25 eyes each. The mean CDVA at the presentation was 20/400 (range: 20/125–20000) and 20/320 (range: 20/80–20000), and mean CMT at the presentation was 948.5 μm (range: 520–1553) and 912.2 μm (range: 615–1250) in Groups A and B, respectively. All eyes except 1 (Group A) had retinitis lesions within 1500 μm of foveal center. The mean CDVA at the resolution was 20/400 (range: 20/200–20/20000) and 20/40 (range: 20/20–20/80) in Groups A and B, respectively. Older age, male gender, diabetic status, delayed presentation, poor presenting CDVA, bilaterality, presence of keratic precipitates, disk pallor, retinal thinning, and subfoveal deposits had a statistically significant association, whereas the absence of skin rash, ellipsoid zone loss, negative WIDAL, Weil-Felix test, and delayed doxycycline therapy or use of steroids without doxycycline had a statistically insignificant association with poor visual outcomes.

Conclusion:
Apart from presenting CMT and location of retinitis, multiple demographic, clinical, and imaging factors can be implicated for poor visual outcomes.
Correlation of vitreous chamber depth with ocular biometry in high axial myopia
Authors: Paritala Anusha , Takkar Brijesh , Gaur Nripen , Soni Deepak , Ali Mohammad Hasnat , Rathi Anubha 
Published: February 2022

Purpose:
The proportion of axial length (AL) occupied by vitreous chamber depth (VCD), or VCD:AL, consistently correlates to ocular biometry in the general population. Relation of VCD:AL to ocular biometry in high myopia is not known. The purpose of this study is to evaluate the relation of VCD and VCD:AL to ocular biometry of highly myopic eyes.

Methods:
This was a cross-sectional retrospective study of records of 214 myopic eyes (<−1 D SE, aged 20–40 years) attending the refractive surgery services. High axial myopia was defined as AL >26.5 mm. Eyes with posterior staphyloma and myopic maculopathy were excluded. Records were assessed for measurements of AL, central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), white to white diameter (WTW), and vitreous chamber depth (VCD). Groups were formed based on increasing AL, while the sum of CCT, ACD, and LT was recorded as anterior segment depth (AS). The main outcome measure was the correlation of VCD and VCD:AL to ocular biometry. A comparison was also performed based on of degree of axial myopia.

Results:
Mean age of the patients was 27.0 ± 5.2 years. VCD showed a very strong correlation with AL (R = 0.98, P < 0.001) but did not correlate to any anterior parameter. VCD:AL showed moderate negative relation with AS (R = −0.43, P < 0.001) and ACD (R = −0.3, P < 0.001), while it had a weakly negative relation with LT (R = −0.18, P = 0.006). VCD:AL showed strong negative relation (R > ~0.7) with AS in all individual groups of AL. Among anterior parameters, WTW showed the most consistent relation with ocular biometry.

Conclusion:
VCD:AL is a better correlate of ocular biometry in high myopia as compared to VCD. However, the correlation is weaker than that noted by previous studies done on the general population. Longitudinal studies of VCD:AL in the younger age group is recommended.
Comparison of long-term outcomes of trabeculectomy and risk factors for failure in eyes post penetrating keratoplasty or Descemet’s stripping endothelial keratoplasty
Authors: Ramyashri S , Mohamed Ashik , Chaurasia Sunita , Senthil Sirisha 
Published: February 2022

Purpose:
To evaluate the outcomes of trabeculectomy, graft survival, and risk factors for failure in post penetrating keratoplasty (PK) and Descemet’s stripping endothelial keratoplasty (DSEK) eyes.

Methods:
We reviewed charts of eyes that underwent trabeculectomy for post keratoplasty glaucoma PK [25 eyes] and DSEK [14 eyes] between 1993 and 2019. The demographics, clinical features, and surgical outcomes were evaluated. Success of trabeculectomy was defined as complete when the intraocular pressure (IOP) was >5 and ≤21 mmHg without antiglaucoma medications (AGM) and qualified with AGM. Clear and compact graft was considered for graft success.

Results:
Median (interquartile range [IQR] preoperative IOP in post-PK eyes and post-DSEK eyes was comparable, 32 (28–38) vs. 31.5 (25–36) mmHg, P = 0.38). Median number of preoperative AGMs was comparable (P = 0.78). Median postoperative follow-up was longer in post-PK, compared with post-DSEK, 2.5 (1.3–3.3) vs. 1 (0.3–2.9) years (P = 0.05). Kaplan–Meier survival estimates for complete and qualified success of trabeculectomy at 3 years were 23.7% and 73.3%, respectively, for PK and 45.8% and 71.6%, respectively, for DSEK. Kaplan–Meier survival estimates for graft survival were 91.8% up to 3 years for PK and 100% until 2 years and 77.8% at 3 years for DSEK. Higher IOP prior to trabeculectomy was a risk factor for failure of trabeculectomy (P = 0.03) and older age was a risk factor for graft failure (P = 0.05) in PK eyes. Number of prior corneal surgeries (P = 0.05) was associated with failure of trabeculectomy and graft failure in post-DSEK eyes.

Conclusion:
Trabeculectomy had moderate qualified success in post-PK and DSEK eyes at 3 years. Higher pretrabeculectomy IOP and higher number of prior corneal surgeries were significantly associated with failure of trabeculectomy in PK and DSEK eyes, respectively.
Secondary developmental glaucoma in eyes with congenital aphakia
Authors: Badakere Swathi Vallabh , Aulakh Simranjeet , Achanta Divya Sree Ramya , Chary Raghava , Senthil Sirisha , Chaurasia Sunita , Ramappa Muralidhar , Edward Deepak P 
Published: February 2022

Purpose:
To describe the clinical spectrum and management of glaucoma in congenital aphakia.

Methods:
The demographics and clinical spectrum of eyes with congenital aphakia with and without glaucoma were compared, and management outcomes of congenital aphakia cases with glaucoma were studied retrospectively between April 2000 and June 2020.

Results:
There were a total of 168 eyes (84 subjects) with a diagnosis of congenital aphakia, of which 29 eyes of 18 subjects were diagnosed with glaucoma. Corneal opacity was the presenting complaint in 26/29 eyes with glaucoma and 139/139 eyes without glaucoma. The (interquartile range (IQR)) horizontal corneal diameter was 10.5mm (IQR, 9.0-12.5) and 8mm (IQR, 5-10) in eyes with and without glaucoma (P = 0.01), respectively. The median (IQR) axial length was 17.5mm (IQR, 13.5-19.5) and 15mm (IQR, 14-16) mm in eyes with and without glaucoma (P = 0.03), respectively. Nineteen eyes with glaucoma had adequate intraocular pressure (IOP) control with one medication. Three eyes underwent transscleral diode cyclophotocoagulation and maintained IOP without medications. Three eyes underwent trabeculectomy and trabeculotomy, trabeculectomy followed by penetrating keratoplasty, and trabeculectomy, respectively, of which two eyes became phthisical. At the last follow-up, the median (IQR) IOP was 14 mm Hg (IQR, 14-17) Hg. The median (IQR) follow-up duration was 4.53 months (IQR, 2.03- 48.06).

Conclusion:
One-fifth of the eyes with congenital aphakia had secondary developmental glaucoma. The corneal diameter and axial lengths were higher in the eyes with glaucoma compared to eyes without glaucoma. Medical management is the preferred short-term mode of IOP control. Transscleral cyclophotocoagulation may be preferred over surgical intervention.
Tribal Odisha Eye Disease Study (TOES). Report # 10. Disability inclusive eye health survey in a tribal district (Rayagada) in Odisha, India
Authors: Rathi Varsha M , Williams Jachin D , Rajshekar Varda , Khanna Rohit C , Das Taraprasad 
Published: February 2022

Purpose:
To estimate seeing and other disabilities in a population cohort in a tribal district, Rayagada, in the Indian state of Orissa.

Methods:
A door-to-door survey was conducted to identify the disabilities. The vision was measured at the residence of the subject, and other disabilities were documented from the history obtained from the subject/household/neighbor. All people with seeing disabilities were reexamined in the community eye center (primary or secondary), and required treatment was given at no cost to the patients. People with other disabilities were transported to the public health facility for appropriate care and disability certification. The results were compared with the 2011 national census data.

Results:
A total of 147,699 people were enumerated, and 106,339 (72%) were examined over one year period, 2016–17. In this cohort, 47.3% (n = 50,320) were male and 27.5% (n = 29,215) were 40 years or older. We recorded systemic disease in 0.6% (n = 689) people; hypertension was two times higher than diabetes mellitus. Disability was identified in 2.8% (n = 3022). Common disabilities were seeing (46.7%; n = 1411), hearing (36.8%; n = 1112), mobility (10.4%; n = 315), and mental retardation (3.2%; n = 98). Dual sensory disability (seeing and hearing) was seen in 6.4% (n = 251), and it was higher in the older age group. Seeing and hearing disabilities were higher than the 2011 state (P =< 0.001) and national (P =< 0.001) disability census.

Conclusion:
The first population-based survey in Rayagada, Odisha (India) in 2017 showed a higher proportion of people with seeing and hearing disabilities. It calls for an appropriate service strategy.
Transconjunctival flap sutures: A novel technique to combat hypotony
Authors: Maheshwari Devendra , Shyam Priyanka , Pawar Neelam , Ramakrishnan Rengappa 
Published: February 2022

Background:
Hypotony secondary to overfiltration is a recognized complication following trabeculectomy. Persistent hypotony requires intervention .

Purpose:
We describe a modified version of placing conjunctival compression sutures directly over the scleral flap.

Synopsis:
A 70-year-old male patient diagnosed with primary open angle glaucoma in both eyes underwent combined surgery in the right eye. On the tenth post-operative day, the patient presented with severe hypotony with 360° choroidal detachment. He was treated with corticosteroids and cycloplegics but developed hypotony maculopathy on the subsequent follow-up. Hence, he was further managed surgically by trans-conjunctival flap sutures to which he responded favorably with resolution of choroidal detachment and improvement in intraocular pressure and visual acuity.

Highlights:
Transconjunctival suturing of the scleral flap is an effective and minimally invasive treatment to prevent visual loss from hypotony maculopathy for an overfiltering bleb following trabeculectomy.

Online Video Link:

https://youtu.be/BJtUZcyQZ-w
Relationship between optical coherence tomography angiography and visual evoked potential in patients with multiple sclerosis
Authors: Ava Sedat , Tamam Yusuf , Hazar Leyla , Karahan Mine , Erdem Seyfettin , Dursun Mehmet Emin , Keklikçi Ugur 
Published: February 2022

Purpose:
This study aimed to identify an easy-to-apply biomarker by correlating visual evoked potential (VEP) with optical coherence tomography angiography (OCTA) results in multiple sclerosis (MS).

Methods:
Our study was planned prospectively. Patients with MS were divided into two groups, VEP prolonged group 1 and VEP normal group 2. Age-matched and gender-matched healthy individuals (group 3) were included as the control group. Vascular density (VD) of the optic nerve head (ONH) and radial peripapillary capillaries (RPCs) were measured and recorded by OCTA. The optic nerve damage of patients was measured and recorded with a VEP device.

Results:
Thirty-two eyes were included in group 1, 50 eyes were included in group 2, and 51 healthy eyes were included in group 3. In terms of visual acuity, group 1 was significantly lower than the other groups (P < 0.001). Regardless of the prolongation of p100 latency in patients with MS, whole image, inside disc ONH VD and in the same sectors in RPC VD were found to be significantly lower than the control group (P < 0.05). Retinal nerve fiber layer thickness was found to be significantly lower in group 1 than in group 2 and group 3 (P < 0.05). There was a significant correlation between low ONH VD and RPC VD and prolonged VEP P100 (P < 0.05).

Conclusion:
VEP measurements can be correlated with OCTA measurements in patients with MS and can be used as a biomarker to determine the degree of optic nerve damage.
Clinical profile and treatment outcomes of Fusarium keratitis
Authors: Khurana Ashi , Kumar Ajit , Chauhan Lokesh 
Published: February 2022

Purpose:
To determine the seasonality, clinical profile, and treatment outcome of Fusarium keratitis.

Methods:
A retrospective medical chart review of 97 patients with culture-proven Fusarium keratitis at a tertiary eye care institution from January 2018 to December 2019.

Results:
The median (SD) age at enrollment was 44.6 (16) years; 75 (79.8%) of them were male. Presence of infiltrate less than 4 mm2 at baseline indicated 4.4 times the odds of achieving final BCVA more than 20/60 (95% CI: 1.4–13.3; P = 0.008). The absence of surgical management indicated 8.1 times the odds of achieving final BCVA of more than 20/60 (95% CI: 0.9–71.5; P = 0.06). The visual acuity at presentation, duration between symptoms and presentation, history of ocular trauma, previous use of topical medications, and presence of hypopyon were not identified as significant predictors of final BCVA in the multivariable regression analysis.

Conclusion:
Smaller infiltrate size and absence of surgical management are the significant predictors of good visual outcome. Visual outcome of Fusarium keratitis is poor, and a significant number of patients did not respond to anti-fungal therapy and had to undergo surgeries. To the best of our knowledge, this is the largest case series on Fusarium keratitis to date.
Biotin Supplementation in Children with Symptomatic Profound Biotinidase Deficiency and their Pregnant Mothers
Authors: Mishra Ranjana , Gupta Meenakshi Bothra , Mukherjee Sharmila B. , Lomash Avinash , Gupta Sangeeta , Kapoor Seema 
Published: February 2022

Background:
Biotin is the coenzyme of multiple carboxylases involved in gluconeogenesis, fatty acid synthesis, and amino acid catabolism. Biotinidase (BTD) deficiency is an autosomal recessive disorder affecting the biotin cycle. It disrupts endogenous biotin recycling and results in multiple carboxylase deficiency depending upon the level of enzyme activity. Children with profound deficiency often present in infancy with neurocutaneous manifestations. Management of symptomatic children or screen-positive newborns is lifelong oral supplementation with biotin. There may be partial or complete resolution of symptoms in the former.

Clinical Description:
We describe two unrelated families diagnosed as profound BTD deficiency, with three affected children in each family. The first family had two symptomatic surviving children, a 2-year-old boy with seizures, developmental delay, and hearing loss, and a 1.5-month-old boy with seizures. Diagnosis was established while ascertaining etiology for seizures refractory to multiple anticonvulsant therapy. The second family was referred for postconceptional counseling following two infantile deaths with similar phenotype, early-onset seizures, encephalopathy, and acute metabolic decompensation.

Management:
The affected children in the first family showed a dramatic response in seizure controls with oral biotin though the other symptoms such as developmental delay and hearing loss remained unaffected. Mother was advised regarding prenatal diagnosis in the next pregnancy but was unwilling. In the second family, stored genetic material from the earlier affected infant revealed a pathogenic homozygous indel in the BTD gene, which was confirmed in utero in the subsequent pregnancy. Both women were started on oral biotin on the lines of antenatal management of holocarboxylase synthetase deficiency. After birth, therapy was continued on the confirmation of profound BTD deficiency in both babies. They have remained asymptomatic on follow-up; the first baby till a year and the second till 3 months.

Conclusion:
There is a considerable phenotypic variability in profound BTD deficiency. Early detection and prompt treatment with biotin may result in complete resolution of some symptoms and ameliorate others. Antenatal biotin supplementation in families at high risk or with prenatal diagnosis of BTD deficiency may have a favorable outcome in affected progeny.
Acute Salpingitis Presenting with Acute Abdomen in a Pre-pubertal Girl
Authors: Babu Thirunavukkarasu Arun , Balakrishnan Padmapriya , Sharmila Vijayan Arun 
Published: February 2022

Background:
An acute abdomen in children is often a challenging scenario for clinicians as it is caused by various medical and surgical conditions. Although symptomatology and specific clinical findings point directly to few causes, thorough history and in-depth clinical examination help to systematically narrow down the differential diagnosis.

Clinical Description:
We report a rare case of acute salpingitis in an 8-year-old prepubertal female child presenting with acute abdominal pain and fever for 3 days. Examination revealed diffuse abdominal tenderness with guarding and rigidity along with an ill-defined, tender mass in the right iliac fossa.

Management:
Abdominal ultrasound showed a hyperechoic mass in the right iliac fossa and the appendix was not visualized. The child was kept nil oral and started on broad-spectrum antibiotics. However, the child developed abdominal distension and worsening of pain over the next 24 h. The child was taken up for emergency laparotomy, and a complex mass in the right iliac fossa adherent to small bowel and covered by omentum was noted. Histopathological examination of the excised right iliac fossa mass showed acutely inflamed right fallopian tube. Normal appendix was noted in the postoperative ultrasonogram.

Conclusion:
It is important to differentiate surgical causes from nonsurgical ones to avoid unnecessary surgery and its complications. Salpingitis may mimic acute appendicitis because of nonspecific symptomatology and radiological signs and should be considered as a differential diagnosis for acute abdomen, even in a prepubertal female child.
An Integrative Approach to Detect Protein–Energy Wasting Among Chronic Kidney Disease Maintenance Hemodialysis Patients
Authors: Premalatha Sunitha , Shivani Namratha , Yadav Vaishnavi , Anandh Urmila 
Published: February 2022

Background:
Malnutrition is a major predictor of overall outcome in patients on hemodialysis. Regular and frequent evaluation of the nutritional status of these patients is advisable.

Aims and Objectives:
This study aimed to look at nutritional status of a hemodialysis cohort and to evaluate whether multiple assessment tools improve the detection of malnutrition in this cohort.

Materials and Methods:
A prospective study in two outpatient hemodialysis centers was conducted over 6 months. Stable patients without any irreversible organ damage and preserved cognitive function were included in the study. Data collected included demographics, comorbid conditions, and baseline laboratory investigations. The nutritional assessment tools included body mass index (BMI), 7-point Subjective Global Assessment, Global Leadership In Malnutrition (GLIM), handgrip strength, and body composition analysis.

Results:
A total of 121 subjects (77 males, 44 females) participated in the study. Based on BMI, only 14% were underweight. 7-point SGA detected 77 malnourished subjects, whereas according to GLIM criteria, all patients had some degree of malnutrition. Body composition analysis showed depleted total body protein mass in majority of patients. There was a correlation between total body protein mass and handgrip strength. The assessment tools showed some degree of correlation in patients who were malnourished.

Conclusions:
Use of a single assessment tool often underdiagnoses malnutrition in hemodialysis patients. An integrative approach using multiple evaluation tools may be beneficial in these groups of patients.