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Purpose: This work assesses the change in tear function after LASIK surgery. Methods: This prospective, observational study was conducted in the Refractive Clinic of a tertiary care rural hospital. Tear dysfunction symptoms and the tear function tests were assessed in 269 eyes of 134 patients, OSDI score was used to document the tear dysfunction symptoms. Tear function was assessed by tear meniscus height, tear film break?up time (TBUT), Lissamine green staining, corneal fluorescein staining, Schirmer test 1 without anesthesia before and at 4–6 weeks and 10–12 weeks after LASIK surgery. Results: Preoperatively OSDI score was 8.54 ± 7.71. It increased to 15.11 ± 9.18 postoperatively at 4–6 weeks after LASIK surgery and 13 ± 9.56 at 10–12 weeks after LASIK surgery Mean TBUT preoperatively was 7.82 ± 3.57 sec which decreased to 5.34 ± 2.56 sec at 4–6 weeks and to 4.53 ± 2.63 sec at 10–12 weeks postoperatively. The number of eyes with clear secretion decreased from 40.5% preoperatively to 23.4% at 4–6 weeks and to 22.3% at 10–12 weeks postoperatively, whereas the granular and cloudy secretions increased significantly in eyes after LASIK surgery. The prevalence of eyes with Lissamine green score >3 (dry eye) increased from 17.1% preoperatively to 27.9% at 4–6 weeks and to 30.5% at 10–12 weeks. Similarly, the number of eyes showing positive fluorescein corneal staining increased from 5.6% preoperatively to 19% postoperatively at 4–6 weeks. Mean Schirmer score was 28.83 ± 6.39 mm preoperatively, 22.47 ± 5.38 mm at 4–6 weeks, and 21.27 ± 4.99 mm at 10–12 weeks after LASIK surgery. Conclusion: The prevalence of dry eye increased after LASIK as was assessed by an increase in the tear dysfunction symptoms using OSDI score and the deranged values of various tear function tests after LASIK surgery
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Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF. Intravenous (IV) ferric carboxymaltose (FCM) reduces the hospitalization risk due to HF worsening and improves functional capacity and quality of life (QOL) in HF patients. The current consensus document provides criteria, an expert opinion on the diagnosis of ID in HF, patient profiles for IV FCM, and correct administration and monitoring of such patients.
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Purpose: To assess the prediction accuracy of intraocular lens (IOL) formulas and study the effect of axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), and lens thickness (LT) on the accuracy of formulas using optic biometry. Methods: This study was performed on 164 eyes of 164 patients who underwent uneventful cataract surgery. Ocular biometry values were measured using Lenstar?900, and intraocular lens (IOL) power was calculated using the SRK/T, SRK II, Hoffer Q, Holladay 2, and Barrett Universal II formulas. We evaluated the extent of bias within each formula for different ocular biometric measurements and explored the relationship between the prediction error and the ocular parameters by using various IOL formulas. Results: The summarization of refractive prediction error and absolute prediction error for each IOL formulation was performed after adjusting the mean refractive error to zero. The deviation in the error values was minimum for SRK/T (0.265) followed by Holladay 2 (0.327) and Barret (0.382). Further, SRK/T had the lowest median (0.15) and mean (0.198) absolute error as compared to other formulations. For the above formulations, 100% of the eyes were in the diopter range of ±1.0. It was observed that the overall distribution of error was closer to zero for SRK/T, followed by Holladay 2 and then Barrett. Conclusion: In summary, we found that accuracy was better in SRK/T formula. We achieved a better understanding of how each variable in the formulas is relatively weighed and the influencing factors in the refraction prediction.
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Background@#B-cell non-Hodgkin lymphomas (NHL) are hematologic malignancies that arise in the lymph node. Despite this, the malignant cells are not cleared by the immune cells present.The failure of anti-tumor immunity may be due to immune checkpoints such as the PD-1/PDL-1 axis, which can cause T-cell exhaustion. Unfortunately, unlike Hodgkin lymphoma, checkpoint blockade in NHL has shown limited efficacy. @*Methods@#We performed an extensive functional analysis of malignant and non-malignant lymph nodes using high dimensional flow cytometry. We compared follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and lymph nodes harboring reactive hyperplasia (RH). @*Results@#We identified an expansion of CD8+PD1+ T-cells in the lymphomas relative to RH. Moreover, we demonstrate that these cells represent a mixture of activated and exhausted T-cells in FL. In contrast, these cells are nearly universally activated and functional in DLBCL. This is despite expression of counter-regulatory molecules such as PD-1, TIM-3, and CTLA-4, and the presence of regulatory T-cells. @*Conclusion@#These data may explain the failure of single-agent immune checkpoint inhibitors in the treatment of DLBCL. Accordingly, functional differences of CD8+ T-cells between FL and DLBCL may inform future therapeutic targeting strategies.
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Adrenocortical carcinoma is a rare tumour with incidence of 1 per million all over the world. Age distribution is bimodal with peaks occurring at 5-20 years and 40-50 years. Tumours greater than 9 cm commonly involve inferior vena cava (IVC) or right side of heart. 80 percent of the carcinomas are functional. We describe a case report of a rare tumour of a non-functioning adrenocortical carcinoma in a 40 year old female having incidence of 0.5/million world over with no extra-adrenal spread at presentation without IVC or right heart involvement in spite of having a large size of 12 cm. Patient underwent successful surgical extirpation with adjuvant radiotherapy with regular follow ups and disease free survival since the surgery. It is imperative to determine hormone levels in symptomatic and asymptomatic patients with adrenal masses. The possibility of adrenocortical carcinoma should not be ruled out in a functioning/non-functioning tumour. All solid incidentalomas on computed tomography (CT)/magnetic resonance imaging (MRI) greater than 5 cm in size should be removed surgically with adjuvant therapy consideration after histopathological reporting.
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Background: Substance use is emerging as a major cause of morbidity and mortality across the world. Solan, a fast urbanizing town of India has witnessed mushrooming of industries and educational institutes. A surge in the persons booked under the Narcotic Drug and Psychoactive Substance Act 1985 led us to look into the determinants of the substance use in this region.Methods: We undertook a cross sectional study of one year secondary data analysis of 750 substance users screened at the de-addiction centre of Solan Hospital. The data mining was done by the cluster analysis technique. SPSS 16 and STATA 13 software were employed.Results: Mean age of users was 31 years with dominance of males (89.20 %), two third of total users were married, 75% were unemployed, 42% had upper school level education. About 60 and 38% were using cannabis and chitta (a synthetic opioid) respectively. Only 2% were consuming tobacco and alcohol. 62% of substance users had the fear of legal action and 44% had no family history of substance use. 39% had only single parent, 54% had started substance use under peer pressure and duration of use varied between 6 to 24 months. Alcohol and cannabis were used more in urban and rural areas respectively. 63 and 70% had family history and experience of peer pressure respectively.Conclusions: Cluster analysis has generated substance specific socio-demographic determinants of substance use which would help in planning appropriate substance use alleviation strategies.
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Background: In view of recent publications of conflicting evidence on the safety and efficacy of hydroxychloroquine as prophylaxis and as a treatment for COVID-19 patients, we need to assess the effect of hydroxychloroquine in COVID-19 patients of authors own local population.Methods: In this retrospective chart review study, categorization of confirmed COVID-19 cases nasopharyngeal swab of RT-PCR was done into a group of patients who received hydroxychloroquine standard dose and another control group who did not receive hydroxychloroquine. The main comparing parameter was to see virus clearance days across both groups.Results: A total of 112 patients were included for the study, and grouped of 72 patient who received HCQS and remaining 40 patients as control. The virus clearance time in days was found to be 9.01±3.08 for HCQS group and for control group it was 8.64±2.34 days (Man Whitney U test value = 2.13, p=0.756).Conclusions: There is no significant difference found in attaining virus negative status with use of HCQS administration in this study.
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Background: India contributes to one fifth of global live births and more than a quarter of neonatal deaths. A systematic analysis of global, regional and national causes of child mortality in 2013 identified preterm birth complications and infections to be the two major causes of neonatal deaths in India. So, there is need of a simple, easy to use and reliable screening tool for assessment of gestational age at peripheral level for early referral of a neonate to a tertiary care hospital, thereby reducing neonatal mortality.Methods: A hospital based observational cross-sectional study included 350 live new-borns within 48 hours of birth, from September 2018 to February 2019. Gestational age assessed by new ballard score, birth weight, foot length and right nipple to umbilicus distance were noted. Babies categorised as per the gestational age profile as small, appropriate and large for gestational age using fenton charts. Data analysis done, correlation coefficient, and p value calculated to obtain results.Results: Out of 350 babies, males (185) outnumbered females (165); 154 were LBW, 89 VLBW and 76 were ELBW. AGA neonates were 193, and 157 belonged to SGA. There were no post-term and large for gestational age newborns. Both foot length and right nipple to umbilicus distance correlated well with gestational age in all age groups (p<0.001).Conclusions: Foot length as well as right nipple to umbilicus distance can be used as a reliable tool for assessment of gestational age and birth weight of newborns by any health care professional to identify and refer high risk neonate.
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Background: To find out correlation of thrombocytopenia with malaria. Malaria is a protozoal disease caused by infection with parasite of genus Plasmodium. Thrombocytopenia is a common and early sign of malarial infection and 60-80% thrombocytopenia is observed in malarial cases and present more frequently and severe in complicated P. falciparum malaria.Methods: A cross sectional study done in Central Pathological Lab of Department of Pathology, RMCH, Bareilly. Blood samples collected in ethylenediaminetetraacetic acid vial and blood smear was examined for malaria parasite within red blood cells. Malaria rapid test was done for detection of Plasmodium species and platelet count was done.Results: 780 cases of malaria was studied from September 2018 to December 2018, male predominance of 54.5%, maximum malarial positive cases 26.92% in the age group of 21-30 years, maximum 86.28% cases were of P. vivax, and thrombocytopenia was observed in 91.54% cases.Conclusions: Mostly developing countries with limited resources and trained health manpower are malaria-endemic region of world. Thrombocytopenia is associated with both P. vivax and P. falciparum infections. In our study significance association between malaria and thrombocytopenia has been observed. We suggest malaria should be a consideration in all patients with fever and thrombocytopenia.
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Background: A major impediment in treatment for cancers is resistance to chemotherapy and is primarily attributed to over-expression of efflux pumps. This study aimed to establish the cytotoxicity of malabaricone-A (MAL-A) in P-glycoprotein/multidrug resistance (P-gp/MDR) over-expressing hematopoietic cancer cell lines.Methods: Leukemia and multiple myeloma cell lines were indirectly evaluated for their P-gp/MDR status by examining Calcein-AM fluorescence and cell viability was assessed by the MTS-PMS assay.Results: The fluorescence of calcein was significantly decreased in three cell lines LP-1, RPMI-8226 and CEM-ADR 5000 and reversal with verapamil endorsed their P-gp/MDR activity. The mean IC50 of MAL-A in these MDR+ cell lines (5.40±1.41 to 12.33±0.78 µg/ml) was comparable with the MDR- leukemic (9.72±1.08 to 19.26±0.75 µg/ml) and multiple myeloma cell lines (9.65±0.39 to 18.05±0.17 ?g/ml).Conclusions: Irrespective of their P-gp activity, the cytotoxicity of MAL-A was comparable, making it worthy of future pharmacological consideration in multidrug resistance.
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Background: Among the various modalities of anti-cancer treatment, cancer chemotherapy plays a very vital role. The alarming side effects being its main drawback leads to relentless research for newer agents. A new natural agent with promising anti-cancer properties from in-vitro studies leads to this study. Here we have evaluated the anti-tumor activity of a crude extract of fruit rind of Myristica malabarica in an Ehrlich ascites carcinoma model in mice.Methods: A murine model of cancer was established with i.p. inoculation of Ehrlich Ascites carcinoma (EAC) cells; animals were divided into five groups (including normal control) to observe the inhibitory effect of a crude extract of the fruit rind of Myristica malabarica/rampatri (0-100mg/kg b.w. i.p.) as compared with methotrexate (0.4mg/kg bw., i.p.). Blood and ascitic fluid were collected on the 10th day for analysis.Results: In the EAC model, there was an increase in tumor volume, tumor weight, and tumor packed cell volume, which was decreased by rampatri (50 and 100mg/kg bw) along with an increase in the mean survival time (MST). Rampatri caused minimal alterations in hematological parameters, renal functions remained unchanged but an increase in hepatic SGOT was demonstrated.Conclusions: The crude extract of rampatri (containing Malabaricones) exhibited significant anti-tumor activity with minimal effect on hematological and renal functions.
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Background: United States Food and Drug Administration (FDA) is the fastest drug review agency in the world. FDA is responsible for protection of the public health by assuring that foods are safe, wholesome, sanitary and properly labelled. Approved Novel drugs are often innovative products that serve unmet medical needs or otherwise help to advance patient care.Methods: FDA novel drug approvals were analysed from calendar year (CY) 2012 to 2016 on the basis of three criteria i.e., impact, access and predictability. Impact measured on the basis of: percentage of novel drug approvals (a) first in class (b) for rare diseases. Access measured on the basis of: percentage of novel drug approvals (a) first cycle approval (b) approval in the U.S. before other countries and (c) percentage of priority reviews. Predictability measured by: the percentage of novel drug approvals that met the PDUFA goal dates for the application review.Results: Total number of novel drugs approved from CY 2012 to 2016 was 176 (average 35 novel drugs/ year). Impact of novel drug approvals: 40% were first in class and 39% were for rare diseases. Access of novel drug approvals: 84% were first cycle approval, 60% were approval in US before other countries, 51% priority reviews among novel drug approvals. Predictability of novel drug approvals: 97% approvals able to meet PDUFA goal dates for application review.Conclusions: Novel drug approvals during CY 2012-2016 had a high quality which is very much evident by their high impact, good access and high predictability.
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BACKGROUND: Bendamustine is a chemotherapeutic agent that has shown broad activity in patients with lymphoid malignancies. It contains both alkylating and nucleoside analog moieties, and thus, is not commonly used for stem cell mobilization due to concerns that it may adversely affect stem cell collection. Here we describe the lymphoma subset of a prospective, non-randomized phase II study of bendamustine, etoposide, and dexamethasone (BED) as a mobilization agent for lymphoid malignancies. METHODS: This subset analysis includes diffuse large B-cell lymphoma (N=3), follicular lymphoma (N=1), primary mediastinal B-cell lymphoma (N=1), and NK/T-cell lymphoma (N=1). Patients received bendamustine (120 mg/m² IV d 1, 2), etoposide (200 mg/m² IV d 1–3), and dexamethasone (40 mg PO d 1–4) followed by filgrastim (10 mcg/kg/d sc. through collection). RESULTS: We successfully collected stem cells from all patients, with a median of 7.9×10⁶/kg of body weight (range, 4.4 to 17.3×10⁶/kg) over a median of 1.5 days (range, 1 to 3) of apheresis. All patients who received transplants were engrafted using kinetics that were comparable to those of other mobilization regimens. Three non-hematologic significant adverse events were observed in one patient, and included bacterial sepsis (grade 3), tumor lysis syndrome (grade 3), and disease progression (grade 5). CONCLUSION: For non-Hodgkin lymphoma, mobilization with bendamustine is safe and effective.
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Humans , Autografts , Bendamustine Hydrochloride , Blood Component Removal , Body Weight , Dexamethasone , Disease Progression , Etoposide , Filgrastim , Hematopoietic Stem Cell Mobilization , Hematopoietic Stem Cells , Kinetics , Lymphoma , Lymphoma, B-Cell , Lymphoma, Follicular , Lymphoma, Non-Hodgkin , Prospective Studies , Sepsis , Stem Cells , Transplantation, Autologous , Tumor Lysis SyndromeABSTRACT
Background: Kasni (Cichorium intybus L.) reported to play an important role in the effective management of serum liver enzymes SGPT & SGOT in various animal models and this study is extension to newly diagnosed patients of type 2 diabetes mellitus. Methods: Newly diagnosed 90 patients of Type2 DM, age 35-65years, of either sex were divided into 3 groups. In group I only Metformin sustained release once a day and in group II/III 6 grams crude seed powder or 50 ml decoction of crude seed powder was given twice a day for 90 days in combination with Metformin sustained release orally once in a day. Serum liver enzyme levels of SGPT & SGOT were measured at zero, 30th, 60th and 90th day. Results: All the three groups showed a significant reduction in SGPT & SGOT across the four time periods. Post hoc Tukey HSD test shown that there was a significant difference between group I & II (p=0.011) and group I & III (p=0.000) for SGPT and group I & II (p=0.012) and group I & III (p=0.000) for SGOT. Conclusions: The add on therapy with Kasni seed preparations is more effective for the management of altered SGPT and SGOT levels in Type2 diabetes mellitus patients than only oral hypoglycaemic agent in decreasing SGPT & SGOT of selected patients. Among Kasni seed preparation treated groups, decoction was found more effective than crude seed powder.
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Settings and Design: This study documents a survey of final‑year ophthalmology postgraduates on the subject of their surgical training and their future plans after residency. Purpose: This survey aimed to answer the question, “What is the present status of surgical training in ophthalmic training centers?” by obtaining information from students about (1) various methods used in surgical training (2) numbers and types of surgeries performed by them in the training centers (3) their plans after residency. Materials and Methods: A questionnaire containing 21 questions was distributed to 155 students attending an intensive 4‑day teaching program. The questions related to orientation training, wet lab training, facilities for training, free surgical camps and detailed information about numbers and types of surgeries observed and performed. Completed questionnaires were collected, and responses analyzed. Results: One hundred and seven completed responses were analyzed. The majority had not received formal orientation training. More than half had undergone wet lab training. Most residents performed their first ophthalmic surgery during the 1st year of residency and went to the operation theatre multiple times a week. Most of the students planned to undergo further training after residency. More than half of the students found their surgical training to be fair or satisfactory. Conclusions: The number and frequency of ophthalmic surgeries done by residents appear satisfactory, but further efforts from trainers on enhancing the quality and range of surgical training would benefit students and improve their satisfaction.
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Background: Dexmedetomidine is a centrally acting alpha-2 adrenoceptor agonist. In this study, we compared dexmedetomidine to fentanyl in attenuating sympathetic response to laryngoscopy and tracheal intubation. Methods: Eighty ASA grade I-II patients requiring tracheal intubation were included in this prospective study and were randomly assigned to the dexmedetomidine (Group D) and fentanyl group (Group F) (40 patients in each group). Both the drugs were given at 1 μg/kg dose prior to laryngoscopy. We assessed heart rate, blood pressures and complications (bradycardia, hypotension and sedation). Results: The two groups were comparable in demographic parameters. The baseline mean heart rate (P=0.94) was not significantly different between Group F and Group D. Increase in heart rate after laryngoscopy and intubation was significantly lower in Group D compared to Group F (P=0.039). Mean heart rate remained lower at one minute after intubation in Group D but it was not statistically significant (94.64 s vs 86.28 sec). The difference in mean heart rate between two groups was comparable at three, five, ten and fifteen minutes after intubation. The baseline Mean arterial pressure was comparable between the groups (P=0.83) and remained similar throughout 15 minutes after intubation. Group D showed significant hypotension compared to Group F (P=0.03), whereas there was no significant bradycardia between these groups (P=0.19). Mean sedation score is higher in Group D compared to Group F. Conclusion: At 1 μg/kg dose, both dexmedetomidine and fentanyl cause partial attenuation of sympathetic response to laryngoscopy and intubation but dexmedetomidine blunts this response more effectively than fentanyl.
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Background: Lung cancer is the leading cause of cancer deaths globally in which about 40% patients reporting in advanced stage disease. Both platinum and non platinum combinations have been shown to be equally effi cacious as initial fi rst-line treatment of advanced non-small cell lung cancer (NSCLC), however because of the toxicity of cisplatin, combination treatment can only be administered to a minority of patients in good general health. Gemcitabine could be combined with one of the other new agents to create novel non-platinum-doublet combinations with effi cacy and/or toxicity profi le superior to that of standard platinum based combinations. Hence, this study was conducted to compare the toxicity profi les of gemcitabine monotherapy and the cisplatin/etoposide combination therapy. Methods: This was a randomized prospective study, which included 96 patients selected on the basis of histologically or cytologically confi rmed Stage III B or IV of NSCLC. Study was divided into two arms-Arm A received gemcitabine monotherapy in a dose of 1000 mg/m2 on day 1 and 5 of the cycle and repeated after every 3 weeks while Arm B received cisplatin (25 mg/m2 on day 1, 2 and 3) + etoposide (100 mg/m2). Patient were evaluated for adverse events by following World Health Organization grading of toxicity. Results: Out of the 96 patients enrolled in the study, 74 (77.0%) patients were eligible and were analyzed. Of these, 36 (37.5%) patients belonged to Arm A and 38 (39.5%) to Arm B. Transient vomiting (45.8% vs. 37.5%), leukopenia (33.3% vs. 8.3%) were seen more in Arm A, while thrombocytopenia (33.3% vs. 12.5%), patchy hair loss (68.4% vs. 16.6%) was seen more in Arm B. Nephrotoxicity was seen almost similarly in both the groups. Conclusions: Single-agent gemcitabine appears to have a safer toxicity profi le than the combination cisplatin-etoposide in the fi rst-line chemotherapy of advanced NSCLC. With less toxic anticancer drugs like gemcitabine, the physician now has greater choice in choosing treatment, which can have better effect on the patients concerned.
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To study the epidemiology of chronic kidney disease [CKD] in children, and to look for risk factors to predict renal replacement therapy [RRT] and mortality. This is a retrospective cohort study conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between 2006 and 2014, where the files of 1,000 children with CKD were reviewed. We determined the effect of consanguinity and hypertension, and being a Saudi indigene on mortality and RRT. We compared children with congenital versus non-congenital causes of CKD. The mean +/- standard deviation age at presentation was 4.9 +/- 4.3 years. The median duration of follow up was 1.5 [interquartile range [IQR]: 0.4-4.0] years. Only 9.7% of children received RRT, and 8.3% died. The underlying etiology for CKD was congenital in 537 children. The congenital CKD group presented at a younger age group [3.5 +/- 4.0 versus 6.6 +/- 3.9 years, p<0.0001], had more advanced stages of CKD [p<0.0001], higher rates of consanguinity [75.4% versus 47.1%, p<0.0001], and RRT [p<0.004] than children with non-congenital CKD. Risk factors for RRT among children with CKD include being a Saudi indigene [relative risk [RR]=1.49, 95% confidence interval [CI]: 1.01-2.21], and hypertensive [RR=5.29, 95% CI: 3.54-7.91]. The risk factor for mortality was hypertension [RR=2.46, 95% CI: 1.66-3.65]. Congenital causes of CKD represent the main etiology of CKD in children living in the western province of Saudi Arabia. Significant risk factors for RRT include congenital CKD, Saudi nationality, and hypertension. Hypertension is also a predictor of mortality in children with CKD
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Humans , Renal Replacement Therapy , Mortality , Retrospective Studies , Cohort Studies , Child , Risk FactorsABSTRACT
Innovations are needed to increase universal HIV screening by primary care providers. One potential intervention is self-audit feedback, which describes the process of a clinician reviewing their own patient charts and reflecting on their performance. The effectiveness of self-audit feedback was investigated using a mixed methods approach. A total of 2111 patient charts were analyzed in a quantitative pre-post intervention study design, where the intervention was providing self-audit feedback to all internal medicine residents at one institution through an annual chart review. Qualitative data generated from the subsequent resident focus group discussions explored the motivation and mechanism for change using a knowledge-attitude-behavior framework. The proportion of primary care patients screened for HIV increased from 17.9% [190/1060] to 40.3% [423/1051]. The adjusted odds ratio of a patient being screened following resident self-audited feedback was 3.17 [95% CI 2.11, 4.76, p < 0.001]. Focus group participants attributed the improved performance to the self-audit feedback. Self-audit feedback is a potentially effective intervention for increasing universal HIV screening in primary care. This strategy may be most useful in settings where [1] baseline performance is low, [2] behavioral change is provider-driven, and [3] resident trainees are targeted