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Purpose: Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40–80. The best way to manage primary open?angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. Methods: An open?label, real?world, multicentric, observation?based 3?month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first?line therapy. Diurnal IOP measurements, best?corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day?1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Results: Four hundred and sixty?nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once?daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. Conclusion: We found that netarsudil 0.02% w/v solution monotherapy when used as the first?line treatment in primary open?angle glaucoma and ocular hypertension was both safe and effective.
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In 2020, the global prevalence of glaucoma was estimated to be 76 million and it was projected to increase to 111.8 million by 2040. Accurate intraocular pressure (IOP) measurement is imperative in glaucoma management since it is the only modifiable risk factor. Numerous studies have compared the reliability of IOP measured using transpalpebral tonometers and Goldmann applanation tonometry (GAT). This systematic review and meta-analysis aims to update the existing literature with a reliability and agreement comparison of transpalpebral tonometers against the gold standard GAT for IOP measurement among individuals presenting for ophthalmic examinations. The data collection will be performed using a predefined search strategy through electronic databases. Prospective methods-comparison studies published between January 2000 and September 2022 will be included. Studies will be deemed eligible if they report empirical findings on the agreement between transpalpebral tonometry and Goldmann applanation tonometry. The standard deviation and limits of agreement between each study and their pooled estimate along with weights and percentage of error will be reported using a forest plot. Cochrane’s Q test and the I2 statistic will be used to assess heterogeneity, and the publication bias will be investigated using a funnel plot, Begg’s and Egger’s tests. The review results will provide additional evidence on the reliability of transpalpebral tonometers that, in turn, could possibly assist practitioners to make informed decision about using it as a screening or diagnostic device for clinical practice, outreach camps, or home-based screening. Institutional Ethics Committee registration number: RET202200390. PROSPERO Registration Number: CRD42022321693.
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Purpose: To investigate the impact of the coronavirus disease 2019 (COVID?19) outbreak on compliance to amblyopia therapy from the perspective of parents of amblyopic children. Methods: The participants for the qualitative study were enrolled from the medical records of a tertiary eye care center during the COVID?19 pandemic. The trained researcher conducted telephonic interviews consisting of validated 15 open?ended questions for 15 min. The questions were related to patients’ compliance toward amblyopia treatment and the date of follow?up with their practitioners. The data collected were entered on Excel sheets in the participant’s own words and later converted to a transcript for analysis. Results: A total of 217 parents of children with amblyopia who were due for follow?up were contacted through telephone. The response rate for willingness to participate was only 36% (n = 78). Of these, 76% (n = 59) of parents reported that their child was compliant toward the treatment during the therapy period and 69% reported that their child was currently not on treatment for amblyopia. Conclusion: In the current study, we have observed that although reported compliance by parents during the therapy period was good, around 69% of patients had discontinued amblyopia therapy. The main reason for the discontinuation of therapy was the failure to visit the hospital during the scheduled follow?up with the eye care practitioner.
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Peripartum cardiomyopathy (PPCM) is an unusual form of dilated cardiomyopathy which manifests as acute heart failure in the last trimester of pregnancy or early postpartum period. Choice of anaesthesia is based on the urgency of lower segment caesarean section and severity of PPCM. Here we report a 31year old female G3P2L2 36weeks + 2days diagnosed as Peripartum Cardiomyopathy came with complaints of leaking per vagina was taken up for emergency caesarean section under general anaesthesia. In this case report, we discuss the anaesthetic management of a case of PPCM posted for emergency caesarean section with intra-operative event of desaturation. Anaesthetic management was directed towards optimization of desaturation, myocardial contractility, preload and after load. No adverse events or complications were observed.
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Diclofenac medication has been extensively used for anti-inflammatory, anti-pyretic, and analgesic actions. Its abiding usage and overdose have induced toxicity and harmful effects on the liver, kidney, and gastrointestinal tract. The research aims to scrutinize the protective effect of Madhuca longifolia seed oil against diclofenac-induced toxicity in female Wistar albino rats. A period of 10 days of study was aimed at 7 groups; Group 1 was assigned as normal control. Group 2 has been administered diclofenac (50 mg/kg b.w. /day, i.p.) only on the last two days of each study period. Group 3 and Group 4 have been pre-treated with 1 mL, and 2 mL of Madhuca longifolia seed oil, respectively, and diclofenac was induced as per Group 2. Group 5 was treated with the standard drug silymarin and diclofenac. Group 6 and Group 7 were given 1 mL and 2 mL of Madhuca longifolia seed oil alone. After the study period, parameters like liver enzyme markers, renal enzyme markers, and antioxidants were measured, and tissue samples were analyzed for histopathological changes. The results proved that pre-treatment of 1 mL of Madhuca longifolia seed oil has efficacy against diclofenac-induced toxicity.
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Diclofenac medication has been extensively used for anti-inflammatory, anti-pyretic, and analgesic actions. Its abiding usage and overdose have induced toxicity and harmful effects on the liver, kidney, and gastrointestinal tract. The research aims to scrutinize the protective effect of Madhuca longifolia seed oil against diclofenac-induced toxicity in female Wistar albino rats. A period of 10 days of study was aimed at 7 groups; Group 1 was assigned as normal control. Group 2 has been administered diclofenac (50 mg/kg b.w. /day, i.p.) only on the last two days of each study period. Group 3 and Group 4 have been pre-treated with 1 mL, and 2 mL of Madhuca longifolia seed oil, respectively, and diclofenac was induced as per Group 2. Group 5 was treated with the standard drug silymarin and diclofenac. Group 6 and Group 7 were given 1 mL and 2 mL of Madhuca longifolia seed oil alone. After the study period, parameters like liver enzyme markers, renal enzyme markers, and antioxidants were measured, and tissue samples were analyzed for histopathological changes. The results proved that pre-treatment of 1 mL of Madhuca longifolia seed oil has efficacy against diclofenac-induced toxicity.
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Intercellular communication between the cell plays an essential role in cell growth and cell formation, including migration, metabolism, and cell differentiation. Cell function and tissue homeostasis are maintained through gap junction intercellular communication (GJIC), thus regulating connexin hemichannels. Mis regulation of such connexin, especially connexin (Cx) 43, affects a comprehensive process, including cell differentiation, inflammation, and cell death. Mis regulation may be due to the missense variant in Cx43. Thus, we screened the complete set of mutations from public mutational databases and obtained 219 missense variants, which were then classified based on their pathogenicity, functional impact, stability, conservation, and physiochemical properties. Variant L214P was scrutinized to have the most deleterious, which was then modelled using the I-TASSER server and performed molecular docking analysis to screen potent inhibitors. The compound Kanamycin, Ginsenoside, and Astragaloside IV have better interactions with Cx43 mutant with a maximum of 5 hydrogen bonds. Ginsenoside is a compound that follows a Lipinski rule of five. Thus, the result obtained from this study suggests that Ginsenoside would be a better potent inhibitor for native and mutant Cx43.
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Background and Objectives@#This study describes the development of an International Classification for Functioning, Disability and Health (ICF)-based inventory for tinnitus (ICF-TINI) that measures the impact of tinnitus on the function, activities, and participation of an individual. @*Subjects and Methods@#This cross-sectional study utilized the ICF-TINI, which included 15 items from the two ICF components of body function and activities. We included 137 respondents with chronic tinnitus. Confirmatory factor analysis validated the two-structure framework (body function, activities and participation). The model fit was assessed by comparing fit values of chi-square (df), root mean square error of approximation, comparative fit index, incremental fit index, and Tucker-Lewis index, with the suggested fit criteria values. Cronbach’s alpha was used to assess internal consistency reliability. @*Results@#The fit indices confirmed the presence of two structures in ICF-TINI, while the factor loading values suggested each item’s goodness of fit. The ICF-internal TINI exhibited high consistency reliability (0.93). @*Conclusions@#The ICFTINI is a reliable and valid tool for assessing the impact of tinnitus on an individual’s body function, activities, and participation.
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Background: Flow characteristics of vinyl polysiloxane (VPS) impression materials are important determinants in the selection of impression materials for the fabrication of accurate indirect restorations. Aims: The purpose of this study was to determine the flow of three commercially available VPS impression materials at different time intervals using a shark fin device (3M ESPE, Seefeld, Germany). Study Setting and Design: This in?vitro study was carried out at the prosthodontics department of a dental institution. Methods and Material: The height of the shark fin produced by each impression material determined the rate of flow. Statistical Analysis: The data were analysed using one?way analysis of variance (ANOVA) and post?hoc Tukey’s test (p?0.05). Results: Shark fin height of group A VPS impression material was significantly higher at 30 and 120 seconds compared to group B and group C VPS impression materials. Shark fin height produced by group B VPS impression materials at 60 and 90 seconds was significantly higher than the group C VPS impression material but non?significant compared to group A. At 120 seconds, there was no significant difference in the shark fin heights of all the tested materials. Conclusion: All the materials exhibited adequate flow characteristics within clinically acceptable limits
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Purpose: To study the presence and development of strabismus in children with telecanthus, epicanthus, and hypertelorism. Methods: This is a prospective, longitudinal, and observational study. Sixty children aged between 6 months and 18 years with telecanthus, epicanthus, and hypertelorism in isolation or in combination were recruited. A detailed analysis of the history, determination of best corrected visual acuity, complete evaluation of strabismus, and ocular examination were carried out. The presence of telecanthus, epicanthus, and hypertelorism and associated strabismus, if any, was noted. All children were followed up for a minimum and maximum period of 12 and 18 months, respectively, to analyze the strabismus (previously present) and for detection of strabismus in those who did not have. The data were analyzed descriptively with mean and standard deviation. Chi square test and Fishers exact test were used to analyze the data between the groups. A P value less than 0.05 was considered to be statistically significant. Results: Telecanthus was the most common lid feature (55%). At baseline, ten (16.66%) children had strabismus (six: esotropia; four: exotropia). Two (3.33%) children underwent surgery. One child developed exotropia at the third follow?up (18 months). At the end of the study, 11 (18.33%) children had strabismus. No significant association was seen between lid characteristics and the type of strabismus. Conclusion: Children with telecanthus, epicanthus, and hypertelorism in isolation or in combination may or may not have associated strabismus. These features can pose difficulty in strabismus diagnosis, which mandates a careful examination, especially in younger age groups and small?angle strabismus. On the other hand, children without strabismus need longer follow?up to detect the development of strabismus and to initiate further management at the earliest.
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From early adolescence to menopause, the menstrual cycle affects a woman’s physiological and psychological health for about 35 to 40 years in a normal population. Properly functioning hypothalamo pituitary ovarian axis, receptive endometrium with healthy ovum and sperm are considered to be the essential factors for conception. Acharyas have quoted Rutu, Kshetra, Ambhu and Beeja as Garbha sambhava samagri which is essential for conception where in Beeja can be taken as ovum. Shatapusha is mentioned in Kashyapa samhitha as Artavajanaka, hence an effort to evaluate its effect on estrous phase of female Wistar albino rats is the aim of this study. The selected animal was grouped into four groups with 6 animals each. The animal experiment showed significant increase in estrus phase of the oestrous cycle in rats which is the active phase of mating where the female receives the male.
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Purpose: To correlate and analyze the pattern of the visual field (VF) defects by perimetry and anterior chamber angle parameters by AS-OCT in primary angle-closure glaucoma (PACG) across varied severity levels on presentation to a tertiary eye care center. Methods: This was a cross-sectional study, which included 323 eyes of clinically diagnosed cases of PACG. Glaucoma severity was categorized according to mean deviation (MD) as mild (-6.00 dB or more), moderate (-6.01 to -12.00 dB), and severe (-12.01 to -30.00 dB). AS-OCT measured the nasal (N) and temporal (T) angle opening distance at 500 ?m (AOD 500) and 750 ?m (AOD 750), anterior chamber angle (ACA), lens vault (LV), and anterior chamber width (ACW). The VF severity was then correlated with the AS-OCT parameters using statistical analysis. Results: The mean age ± standard deviation (SD) of the patients included in the study was 56.03 ± 8.6 years, with a 1:1.2 gender ratio. The number of eyes with mild, moderate, and severe VFs were 140 (43.3%), 88 (27.24%), and 95 (29.41%), respectively. There was no statistically significant correlation in the mean anterior chamber angle parameters (AOD 500, AOD 750, ACA 500, ACA 750, LV, ACW, and axial length (AL)) among the groups. However, the correlation between AOD 500 and LV thickness was found to be significant (P = 0.0000) with a negative Spearman’s rank correlation coefficient (r = -0.3329). Conclusion: The ACA parameters obtained by AS-OCT along the horizontal axis after elimination of pupillary block by laser peripheral iridotomy do not correlate and cannot be used to assess the disease severity of PACG
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Background & objectives: Non-communicable diseases (NCDs) and cancers of breast, oral cavity and cervix contribute to around 5.87 million (60%) deaths in India. Despite this, there is limited evidence on preparedness of the tribal health system in mitigating these conditions. This mixed-methods study aimed at identifying enablers and challenges using a multistakeholder approach for the screening of NCDs and common cancers in a tribal block of Maharashtra, India. Methods: This study was conducted in a tribal community of Dahanu taluka in Palghar district of Maharashtra. A total of nine focus group discussions (FGDs) among tribal women and accredited social health activists (ASHAs), 13 key informant interviews (KIIs) among auxiliary nurse midwives (ANMs) and community health officers (CHO) and facility surveys of five public health facilities were conducted. The FGDs and KIIs were conducted using guides, recorded digitally, transcribed, analyzed and triangulated to identify emerging themes. Results: The tribal women had limited knowledge about NCDs and common cancers. Paucity of health facilities, out-of-pocket expenditure, misconceptions, belief on traditional healers and inability to prioritize health were identified as major challenges. The ASHAs were recognized as a key connecting link between health system and community while provision of culturally appropriate IEC materials and adequate training were recognized as critical enablers by healthcare providers in implementing screening for NCDs and common cancers. Interpretation & conclusions: The study recommends incorporating socioculturally relevant strategies in the tribal population and strengthening health facilities in terms of infrastructure and training with involvement of ASHAs for successful implementation of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) through health and wellness centres.
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Background: Infantile haemangiomas (IHs) are the most common vascular tumours of infancy. In recenttime oral propranolol has achieved great success in treating IHs. To minimize the systemic side events caused by oral propranolol, topical timolol started to be applied in the treatment of IHs, especially for superficial lesions. Methods: We treated 50 children with superficial IHs using oral propranolol on 25 patients and, topical timolol on 25 patients and investigated the efficacy and safety of the two treatment patterns. Results: Both oral propranolol and topical timolol achieved a satisfactory therapeutic outcome, with an effective response rate of 96 and 95.4%, respectively. No significant differences in visual analogy scale (VAS) improvement between the two groups were observed. Systemic adverse events for patients treated with oral propranolol (3.9%) was significantly higher than that for patients treated with topical timolol. Clinical response was not associated with gender, duration of treatment, lesion location, lesion size, and gestational age but closely associated with age at treatment initiation, which indicated that younger age at treatment initiation predicted for a better regression rate. Conclusion: Topical timolol could be the first-line therapy for superficial IHs because of its good efficacy and improved safety profile.
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Objective: To computationally model the CTX-M-5 ?-lactamase and establish its structure, which is exclusively present in human-associated Salmonella. Methods: The CTX-M-5 aminoacid sequence (Uniprot ID:O65975) of Salmonella enterica subsp. enterica serovar typhimurium was retrieved from UniProt database and subjected to homology modeling using MODELLER 9v7. The homology models were duly validated using RAMPAGE tool by generating Ramachandran plots, ERRAT graphs, and ProSA score. DoGSiteScorer server and ConSurf server were used to detect the cavities, pockets, and clefts to identify conserved amino acid sites in the predicted model. Subsequently, the modeled structure was docked using CLC Drug Discovery Workbench against proven drugs and known inhibitors. Results: Obtained high-quality homology model with 91.7% of the residues in favorable regions in Ramachandran plot and qualified in other quality parameters. Docking studies resulted in a higher dock score for PNK (D-benzylpenicilloic acid) molecule when compared to other reported inhibitors. Conclusion: This in silico study suggests that the compound PNK could be an efficient ligand for CTX-M-5 ?-lactamase and serve as a potent inhibitor of CTX-M-5.
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Background: Dilatations of localised segments of the artery are called ‘aneurysms. Approximately 80% of aneurysms form in anterior circulation of circle of Willis. While 20% form in the posterior circulation of the brain. All aneurysms can cause symptoms because of compression of surrounding structures, thrombosis, rupture of emboli. Material and Methods: During routine dissection for I MBBS students in Department of Anatomy, JSS Medical College during intracranial dissection we encountered unruptured saccular aneurysm of intracranial internal carotid artery on right side Case report: Aneurysm of intracranial internal carotid artery was seen on right side of middle cranial fossa in a male cadaver. The aneurysm was close to right optic nerve and measured about 2.2 cm in width and 1.8 cm antero-posteriorly. No other intracranial pathology or anatomical variations were noted. Conclusion: The anatomical knowledge of aneurysm is important to Neurosurgeons, Endovascular surgeons, ENT surgeons and interventional Radiologists.
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It has been two years since the global outbreak of the highly contagious and deadly corona virus disease (COVID-19) caused by SARS-CoV-2 first emerged in China. Since then, various diagnostic, prognostic and treatment strategies undertaken to address the pandemic have been dynamically evolving. Predictive and prognostic role of various biomarkers in COVID-19 has been a subject of intense exploration. We aimed to determine the association of Carcinoembryonic antigen (CEA) and various surrogate inflammatory biomarkers with the severity of COVID-19 disease. This retrospective cohort study was carried out on 98 patients admitted in Jaypee Hospital, Noida with COVID-19 disease. Information regarding demographics, laboratory parameters and clinical history was collected from Hospital Information System. Serum levels of CEA and other biomarkers such as Neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), Interleukin-6 (IL-6), Ferritin, and Procalcitonin (PCT) were assessed. Correlation analyses were performed between the parameters and acute respiratory distress syndrome (ARDS) stages. Logistic regression and ROC curve analysis were performed to assess the various parameters for distinguishing COVID-19 patients requiring ICU admission. Mean hospital stay, NLR, CEA, IL-6, CRP, Ferritin (P< 0.0001) and PCT (P =0.01) were significantly higher in ICU patients when compared to general ward patients. NLR, median serum CEA, IL-6, and CRP levels were significantly higher in non-survivor compared to the survivors (P< 0.0001, 0.0341 and 0.0092). CEA correlated well with disease severity based upon ARDS classification and was a better marker to differentiate patient according to ARDS stages (ARDS 0 vs 2 P= 0.0006; 0 vs 3 P< 0.0001; ARDS 1 vs 2 P= 0.0183; 1 vs 3 P=0.0006). The area under the Receiver operating characteristic (ROC) curve for CEA was 0.7467 (95% CI- 0.64885- 0.84459) which revealed the potential of CEA as a biomarker to distinguish COVID-19 patients requiring ICU admission. CEA can be used to predict the severity of COVID-19 associated ARDS as well as patients requiring ICU admission. Along with routine inflammatory biomarkers (NLR, CRP, IL-6, PCT, and ferritin), CEA should be used for early identification of critical COVID-19 positive patients and for assessing prognosis.