bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immunoglobulin deficiency among children with severe overwhelming sepsis admitted to Alexandria University Pediatric Intensive Care Unit
Authors: El Sawy Ihab H. , EL-Nawawy Ahmed A. , El Deriny Ghada F. , Elkaim Amal A K. 
Published: February 2022

Background
Worldwide, severe overwhelming sepsis is still a major cause of morbidity and mortality, especially among infants and children. Most severe sepsis and septic shock deaths are due to dysregulated immune response, resulting in multiple organ dysfunction, a part of which is low immunoglobulin (Ig) levels. Hypogammaglobulinemia is a frequent finding in patients with severe sepsis and septic shock, although it is not clear whether it is a cause or a consequence of sepsis.

Aim
The purpose of this study was to evaluate the incidence of Igs deficiency and its relation to mortality among children with severe overwhelming sepsis admitted to Alexandria University Pediatric Intensive Care Unit.

Patients and methods
A cross-sectional study was conducted on 40 patients with severe sepsis and/or septic shock during an 18-month period at Pediatric Intensive Care Unit of Alexandria University Children’s Hospital and 40 age-matched control group admitted to the ward with an infectious process. Their age ranged from 12 months to 12 years. All patients were subjected to history taking and routine investigations done at admission. Serum from the initial blood draw was collected and stored at −70°C to measure the level of total IgG, IgM, and IgA by immunoturbidimetric assay.

Results
In the severe sepsis/septic shock group, 55.26% of the patients had a deficiency in total Igs (low IgG, IgM, and IgA in 55.26, 5.26, and 21.05%, respectively) versus 17.5% in controls (low IgG, IgM, and IgA in 12.5, 0, and 7.5%, respectively). The overall mortality among the patients with severe sepsis/septic shock was high (34.21%), and the likelihood of death for Igs-deficient patients was 3.916 times more than the Igs-normal patients (P=0.048), whereas all patients in the control group survived. Survival curve analysis revealed the significant predictive ability of IgG to detect early mortality. Receiver operating characteristic curve analysis revealed the significant predictive ability of the relative concentrations of IgG, IgM, and IgA (P=0.0019, P<0.0001, and P=0.0217, respectively) at day 1 to detect mortality.

Conclusion
We documented relatively high frequencies of low IgG, IgM, and IgA in patients with severe sepsis and septic shock, and also low levels of IgG and IgM were an independent risk factor of mortality. The role of hypogammaglobulinemia in patients with severe sepsis and septic shock clearly warrants future controlled clinical trials with intravenous immunoglobulin use in this disease category.
Prolactinoma Outcome After Pregnancy and Lactation: A Cohort Study
Authors: Laway Bashir A. , Baba Mohammad S. , Bansiwal Sailesh K. , Choh Naseer A. 
Published: February 2022

Context:
Prolactinoma is the most frequent pituitary tumor among women of childbearing age. Fewer studies have addressed the outcome of prolactinomas after gestation.

Objective:
The aim was to study the spontaneous remission rate and change in tumor size after pregnancy and/or lactation in women with prolactinomas.

Patients and Methods:
Retrospective study conducted at a tertiary care center of north India. Records of 25 women with 31 pregnancies (20 microprolactinomas and 11 macroprolactinomas), who conceived on dopamine agonist (cabergoline) were studied. Cabergoline was stopped at conception in 24 pregnancies and continued in 7. Serum prolactin was noted 3 months after delivery and/or lactation. Magnetic resonance imaging available at last visit after delivery and/or lactation was also noted. Remission was defined as normal serum prolactin after pregnancy and/or lactation without use of cabergoline.

Results:
Among patients in whom cabergoline was stopped during pregnancy (n = 24), 41.6% (n = 10) had prolactin in normal range (achieved remission) after pregnancy and/or lactation. In 25% (n = 6) of women, adenoma size decreased by more than 50%, in 33%(n = 8), there was no change in adenoma size, and in 42% (n = 10), decrease in adenoma size was less than 50% after pregnancy and/or lactation. The median duration of cabergoline treatment before pregnancy among patients who achieved remission was 60 months against 24 months in those who did not achieve remission. The median pre-pregnancy adenoma size was 5.5 mm in women with remission against 8 mm in women who did not achieve remission.

Conclusion:
Pregnancy-induced remission of hyperprolactinemia was seen in 41.6% prolactinomas. Longer duration of dopamine agonist treatment before pregnancy, small pre-pregnancy adenoma size, and lower baseline prolactin were associated with high likelihood of remission, though not statistically significant.
Effect of mHealth Interventions on Glycemic Control and HbA1c Improvement among Type II Diabetes Patients in Asian Population: A Systematic Review and Meta-Analysis
Authors: Verma Divya , Bahurupi Yogesh , Kant Ravi , Singh Mahendra , Aggarwal Pradeep , Saxena Vartika 
Published: February 2022

Introduction:
Due to the high prevalence of diabetes mellitus, it is pertinent to educate and inform diabetes patients about their self-management. It can be done effectively using innovative methods like mobile health (mHealth), which includes mobile applications, phone calls, and text messages. Thus, this meta-analysis was conducted to summarize the effectiveness of mHealth interventions for the management of diabetes compared with usual care in the Asian population.

Materials and Methods:
Searches were performed in electronic databases, namely PubMed, Scopus, Embase, and Cochrane Library, in August and September 2020. Search terms used were “Diabetes Mellitus,” “mHealth,” “glycemic control”, “HbA1c levels,” and “Blood glucose levels.” The primary outcome was glycated hemoglobin and blood glucose levels. Trials were pooled, and heterogeneity was quantified using the I2 statistic.

Results:
The search yielded 3980 abstracts, of which 18 trials met the inclusion criteria. Lowering of Hba1c levels was reported in the majority of trials, which aided in Glycemic control. For post prandial blood glucose (PPBG) levels, a statistically significant reduction of value –20.13 (95%CI –35.16 to –5.10, P = 0.009, I2 = 59%) was seen in the mean in the intervention group, whereas for HbA1c levels the mean reduction in the intervention group was –0.44 (95%CI, –0.79 to 0.10, P = 0.01, I2 = 87%). Although these interventions proved beneficial for these outcomes, there was a difference in the amount of effects caused by different mHealth interventions.

Conclusion:
This study acknowledged the effects of different mHealth interventions as per their accessibility and availability in recent years. There is a need to include more studies in future reviews to generate a larger body of evidence for the reported outcomes. The researchers should give the utmost priority to the transparency while reporting the interventions for effective interpretation of the retrieved data.
Comparing the effectiveness of different postoperative counseling methods for post-keratoplasty patients
Authors: Anitha Venugopal , Nair Shobita , Ravindran Meenakshi , Uduman Mohammed Sithiq 
Published: February 2022

Purpose:
To compare various counseling methods for improving patient education, compliance, and administration of eye drops prescribed for post-optical keratoplasty patients and assess the most efficient counseling method.

Methods:
A prospective, questionnaire-based pilot study was conducted among 60 post-optical keratoplasty patients who were randomly assigned into three groups for postoperative eye drop counseling, namely group 1 (video counseling), group 2 (chart counseling), and group 3 (verbal counseling at Cornea department). The questionnaire was answered by the patients/attendants applying the eye drops on the first 3 consecutive visits. McNemar–Bowker test was used to compare responses in each group and the Kruskal–Wallis test was used to compare responses among the three groups. The Institutional Ethics Committee of Aravind Eye Hospital, Tirunelveli (Registration number ECR 816/Inst/Tn/2016) approved this study.

Results:
Results demonstrated improvement in various categories assessed regarding drop administration in all three groups, which assessed patients’ knowledge, attitude, and hygiene. Although all three groups showed improvements during subsequent follow-up visits, the video-counseling method was found to be an effective means of communication.

Conclusion:
Our study emphasizes that the nonverbal and noncontact means of communication by video demonstration would be an effective way of counseling. It can be considered in the present scenario of the pandemic as well.
Utilization rate of corneal tissue obtained from donors over 75 years of age in Western India for keratoplasty
Authors: Shah Rakesh , Hirwe Supriya , Ashar Jatin , Sengupta Sabyasachi 
Published: February 2022

Purpose:
To examine the utilization patterns of cornea procured from diseased individuals ≥75 years of age at an eye bank in western India.

Methods:
In this retrospective study, data from 1,217 eyes of 653 donors with age ≥75 years were reviewed from October 2008 to December 2019. Donor age, lens status, endothelial cell count (ECD), utilization of the tissue for transplantation or non-clinical purposes (e.g., research, training/discarded), and causes of non-utilization were noted.

Results:
The mean age of the donors was 80.9 ± 4.6 years and the tissue utilization rate was 36.5% (445 out of 1,217 eyes). The eyes used for keratoplasty procedures had a lower donor age (79.6 ± 5.7 vs. 81.5 ± 5.1; P < 0.001), a higher endothelial cell count (2493 ± 531 vs. 2034 ± 581; P < 0.001), and were more often phakic (61% vs. 36.6%) compared to the unused group. A multivariable logistic regression analysis showed that the likelihood of tissue utilization for keratoplasty was 13% higher with every 100-cell increment in donor ECD (odds ratio [OR] = 1.13, 95% CI = 1.10–1.16, P < 0.001) and 33% lower with having a pseudophakic status in the donor eye (OR = 0.67, 95% CI = 0.52–0.87, P = 0.03). Age was not a significant determinant of tissue utilization when used in the same multivariable model.

Conclusion:
More than one-third of the eyes (36.5%) can be utilized even when the donors are above 75 years of age. Eyes that were more likely to be utilized for keratoplasty were phakic and had a significantly higher ECD; age was not a determinant in tissue utilization.
Landmark trials in ophthalmology: The age-related eye diseases studies
Authors: Kumar Annapurna 
Published: February 2022

Background:
There are many landmark clinical trials in ophthalmology, the context of which provide a more relevant understanding of their results. The Age-related Eye Diseases (AREDS) studies were conducted in a large population to understand the effect of nutritional supplements on the progress of age-related macular degeneration.

Purpose:
This instructional video is being presented to familiarize the postgraduate residents as well as interested researchers of the details of the landmark AREDS studies.

Synopsis:
The video describes the enrollment of participants, their demographics, the protocols of the studies, and the key results.

Highlights:
The AREDS formulations, the specific effects of key components of the formulations, and results of the trials that guide present day treatment guidelines are discussed. Video link: https://youtu.be/SPsikgx8SCI
Localized surgical debridement for the management of orbital mucormycosis
Authors: Murthy Ramesh , Gote Yogita S , Bagchi Aadhyaa 
Published: February 2022

Purpose:
To describe the role of localized debridement and instillation of amphotericin B for the management of orbital mucormycosis post COVID-19 infection with a view to avoid exenteration.

Methods:
The records of all patients with orbital mucormycosis post COVID-19 infection in the last 6 months from December 2020 to June 2021 were evaluated, and ten patients were identified who were successfully managed with localized debridement, that is, removing the fungal tissue and necrotic material and amphotericin B gel instillation locally. MRI scan was used to identify the area of fungal infiltration and presence of necrotic material. Early surgery in the form of transconjunctival orbitotomy was performed for disease in the infraorbital fissure area, and superior transcutaneous lid crease approach was employed for disease in the superomedial orbit or medial orbit. Most patients had lid edema, ptosis, and proptosis; this resolved with the medication. Systemic antifungals were given and the follow-up ranged from 1 to 5 months.

Results:
The ptosis, proptosis, and lid edema subsided in all, except in one patient who had residual ptosis and in one who had residual ophthalmoplegia. Vision deficit did not occur in any patient. All patients were successfully discharged on oral antifungal medication.

Conclusion:
Localized clearance of the fungal tissue and the necrotic material is a good option to avoid exenteration in cases of orbital mucormycosis, avoiding disfigurement and mental trauma to the patient.
Comparing IOLM700 TK, Berdahl and Hardten astigmatism fix calculator and Barrett Rx formula in managing residual astigmatism due to toric intraocular lens misalignment
Authors: Sharma Ajay C , Khetan Avani 
Published: February 2022

Purpose:
To compare the accuracy in astigmatism reduction by using IOLM 700 steep total keratometry (TK) axis, Berdahl and Hardten astigmatism fix, and Barrett Rx formula following misaligned toric intraocular lens (IOL).

Methods:
Ten patients with residual refractive astigmatism due to misalignment following toric IOL implantation were included in this retrospective study. They were analyzed at days 4, 7/8, and 10/11 following primary cataract surgery on the platform of Berdahl and Hardten astigmatism fix, Barrett Rx formula, and IOLM 700 to determine the optimum axis of repositioning, and underwent IOL realignment on the steep TK axis of IOLM 700 assisted by the Callisto eye. The final outcome parameters were subjective refraction and orientation of toric IOL assessed 22 ± 1 days following repositioning surgery. These parameters were fed in the Barrett Rx formula and its vector analysis graph was utilized to determine the predicted ideal axis with the least residual astigmatism and the estimated residual astigmatism if the toric IOL was realigned according to the axis suggested by Berdahl and Hardten astigmatism fix and Barrett Rx formula.

Results:
Realigning the toric IOL on IOLM 700 steep TK axis along with the Callisto eye reduces the residual refractive astigmatism significantly (P = 0.003) from 2.00 ± 0.78 D to 0.18 ± 0.12 D (90.5 ± 7.6%) in comparison to the estimated 0.57 ± 0.31 D (68.4 ± 21.9%) by Berdahl and Hardten astigmatism fix and 0.61 ± 0.33 D (66.4 ± 23.5%) by Barrett Rx formula.

Conclusion:
Realigning the misaligned toric IOL on the IOLM 700 steep TK axis gives a better reduction in the residual refractive astigmatism in comparison to Berdahl and Hardten astigmatism fix and Barrett Rx formula.
Comparison of anterior chamber angle parameters and iris structure of juvenile open-angle glaucoma and pigmentary glaucoma
Authors: Pasaoglu Isil , Basarir Berna 
Published: February 2022

Purpose:
To compare the quantitative measurements of the anterior chamber angle (ACA) and iris parameters in patients with juvenile open-angle glaucoma (JOAG), pigmentary glaucoma (PG), and healthy controls using anterior segment optical coherence tomography (AS-OCT).

Methods:
This was a retrospective, cross-sectional study of 25 eyes with JOAG, 25 eyes with PG, and 25 control eyes. Anterior chamber depth, angle-opening distance 500 and 750, trabecular–iris space 500 and 750, scleral spur angle, iris thickness (IT, measured at the thickest part), and iris bowing were obtained using AS-OCT (Visante” OCT 3.0 Model 1000, Carl Zeiss Meditec, Inc).

Results:
The quantitative ACA parameters were found to be significantly higher in JOAG and PG patients compared to healthy controls (P < 0.001); there was no significant difference between the eyes with JOAG and PG (P > 0.05). In eyes with JOAG and PG, there was significantly backward bowing of the iris in temporal and nasal angles compared to control subjects (P < 0.001). Median iris bowing was not significantly different between the patients with JOAG and PG (P > 0.05). The temporal and nasal angle iris thickness were significantly thinner in eyes with JOAG than the eyes with PG (P < 0.001) and age-matched control subjects (P < 0.001). The median IT did not differ between the patients with PG and control subjects (P > 0.05). In patients with JOAG, the intraocular pressure (IOP) was inversely correlated with IT (r = -0.43, P < 0.05).

Conclusion:
AS-OCT provided quantitative data on the ACA and iris parameters in JOAG and PG. The evaluation of the ACA and iris structures using AS-OCT revealed higher ACA measurements and posterior bowing of the iris in patients with JOAG and PG. Furthermore, the patients with JOAG were found to have thinner IT than the ones with PG and healthy controls.
Clinico-epidemiologic characteristics of optic neuritis in a tertiary eye centre in Eastern India based on the status of serum aquaporin-4 antibody
Authors: Ambasta Anita , Kusumesh Rakhi , Sharma Janardan , Sinha Bibhuti Prassan , Shree Srishti , Gupta Abhishek , Priyadarshi Rajeev N 
Published: February 2022

Purpose:
To elucidate the clinico-epidemiologic characteristics of optic neuritis based on the status of serum aquaporin-4 antibody (AQP4-Ab) in patients with optic neuritis (ON).

Methods:
Medical records of 106 patients with ON and a follow-up of 3 years were reviewed. For each patient, the following data were extracted: medical history, findings of the ocular examination, brain, orbital or spinal MRI, and serological tests for AQP4. The ON was classified as typical or atypical based on disc examination and improvement in vision after intravenous methylprednisolone (IVMP). The clinical findings (typical or atypical), disease course, and outcomes were analyzed according to the serostatus of the ON.

Results:
10 patients ((9.4%) were seropositive for AQP4-Ab; all had atypical ON. 96 patients (91%) were seronegative for AQP4-Ab: 36 atypical ON and 60 typical ON. Profound visual impairment at presentation was seen in all patients. However, at the end of the study period, seropositive and seronegative atypical ON had poor visual outcomes as compared to seronegative typical ON (P = 0.002). Five seropositive and four seronegative patients with atypical ON developed transverse myelitis. Bilateral disease with relapse was more in seropositive patients (80%); however, seronegative with atypical ON also had bilateral presentation and relapse in 42% and 41%, respectively.

Conclusion:
AQP4-Ab seropositive patients mostly present with atypical features such as bilateral recurrent ON, poor visual outcome, and increased incidence of transverse myelitis. However, atypical clinical features can also be seen in seronegative ON with a poor visual outcome and a recalcitrant course.
Nomogram of peripapillary retinal nerve fiber layer thickness in myopic eyes of north Indian population
Authors: Yasir Ziaul H , Mittal Jimmy , Singh Alok K 
Published: February 2022

Purpose:
To evaluate peripapillary-RNFL thickness in myopia by Cirrus OCT among north Indian population by spherical equivalent (SE), age, gender, and axial length (AL).

Methods:
This was a cross-sectional study held during 2019–2020. Patients aged 18–60 years underwent ophthalmic examination including retinoscopy, AL, and OCT RNFL thickness. Persons with previous ocular surgery or ocular ailment other than refractive error were excluded. The peripapillary-RNFL thickness was noted and compared by demographic determinants.

Results:
We examined 300 eyes of 300 persons (mean age: 30.75 ± 8.57 years; 144 males/156 females). Among them, 224 were myopes and 76 were emmetropes (EM). The mean SE was − 3.3 ± 0.4D (range: −11.0D to + 0.37D). The mean AL was 24.61 ± 1.92 mm (22.1–29.5). Overall temporal, nasal, superior, inferior, and mean peripapillary-RNFL thickness was 66.31 ± 7.58, 78.57 ± 16.00, 120.63 ± 11.69, 116.60 ± 15.80, and 95.50 ± 10.84 mm, respectively. Temporal, nasal, superior, inferior, and mean peripapillary-RNFL thickness was 73.97 ± 8.36, 94.84 ± 7.63, 127.96 ± 8.96, 136.89 ± 6.53, and 108.34 ± 6.28 mm, respectively, in EM eyes as compared to 63.71 ± 6.18, 73.05 ± 14.24, 118.21 ± 11.53, 109.71 ± 11.50, and 91.14 ± 8.31 mm, respectively, in myopic eyes (P < 0.001). Association of peripapillary-RNFL thickness with myopia and its different grades was P < 0.001. Association of mean peripapillary-RNFL thickness with age was P > 0.005 and gender was P = 0.168. Correlation between SE and RNFL thickness was positive and significant. Correlation between AL and RNFL thickness was negative but statistically significant. Association of AL with SE was P < 0.001.

Conclusion:
We provide normative peripapillary-RNFL thickness in the north Indian population in order to help in screening for myopia with comorbidity such as glaucoma based on RNFL thickness.
Ultrasound Visualization of Torsional Anatomic Changes in the Neck
Authors: Tan Filemon C. , Strakowski Jeffrey A. , Chiou-Tan Faye Y. 
Published: February 2022

Introduction:
The objective of this paper is to demonstrate changes in the sonographic appearance of muscles in region of the neck with cervical movement from neutral anatomic position to right rotational torsion.

Methods:
Sonographic images were obtained in a 56-year-old healthy female. Muscles selected are common targets for botulinum toxin A injection in treatment for cervical dystonia. Sonographic images were obtained with the transducer placed over the muscle of interest with the neck in both anatomic-neutral and right-rotated positions. Cine loop video was also recorded at each site to track muscles throughout torsion.

Results:
The results show that in rotational torsion, (1) the brachial plexus becomes difficult to view due to anisotropy when examining the scalenes. The relationship between the anterior and middle scalenes and brachial plexus becomes less distinct with cervical rotation beyond neutral position. (2) The positional relationship of the sternocleidomastoid (SCM) and the ipsilateral splenius capitus is altered. (3) The jugular vein changes from collapsed to distended in the contralateral SCM view. (4) The position of the trapezius is not altered significantly.

Conclusion:
The sonographic appearance of soft tissue structures about the neck differs significantly with cervical movement from an anatomic neutral position to a position of right torsion. Knowledge of the dynamic positional changes of the muscles in this region in relation to each other, as well as the neurovascular structures, with cervical movement and torsion can potentially improve diagnostic assessment as well as accuracy of interventional procedures.