Nomogram of peripapillary retinal nerve fiber layer thickness in myopic eyes of north Indian population

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 ?m, 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 ?m, 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 ?m, 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.

Effect of myricetin on cognitive impairments in the transgenic Drosophila model of Parkinson’s Disease

Parkinson’s Disease (PD) is a progressive neurodegenerative disorder involving the loss of dopaminergic neurons. Despite the availability of many drugs to ease the life of PD patients, there is no permanent cure until now. Now-a-days, there has been a considerable attention towards the use of herbal products to treat PD patients worldwide due to less side effects. In this context, here we investigated myricetin, a common plant derived flavonoid, on the cognitive impairments exhibited by the transgenic Drosophila expressing human ?-synuclein in the neurons. The PD flies were allowed to feed on the diet having 10, 20 and 40 ?M of myricetin for 24 days and then assayed for cognitive impairments. The exposure of myricetin showed a dose dependent significant delay in the cognitive impairments. Molecular docking studies showed the positive interaction between myricetin and ?-synuclein. The results suggest a protective effect of myricetin against the cognitive impairments.

Isolation and identification of multidrug-resistant Escherichia coli from cattle, sheep, poultry and human in Cumilla, Bangladesh

Aims@#Antimicrobial resistance (AMR) is a significant public health concern of modern civilization. The potential risk of AMR is significant in terms of both human and animal health. This study aims to assess the antimicrobial resistance pattern of selected antimicrobials against Escherichia coli of animal, poultry and human origin in the Cumilla district of Bangladesh.@*Methodology and results@#A total of 200 samples were collected from different sources. Isolation and identification of commensal E. coli were performed following standard bacteriological and molecular techniques. Antimicrobial susceptibility testing was performed following the Kirby-Bauer disc diffusion technique. Ampicillin, tetracycline and sulfamethoxazole-trimethoprim resistance genes were detected by polymerase chain reactions (PCR). A total of 152 (76%; 95% confidence interval (CI) 70-81%) E. coli were isolated from cattle, sheep, chicken and human, where 37.5% of isolates were found to be multidrug-resistant (MDR). In the cultural sensitivity test, E. coli showed the highest resistance to sulfamethoxazole-trimethoprim (71%), tetracycline (63%), ampicillin (62%), where gentamicin (23%) showed the lowest resistance, followed by ceftriaxone (26%). The prevalence of resistance genes like blaTEM, tetA, tetB, tetC, sul1 and sul2 were 100%, 95%, 11%, 8%, 58% and 52%, respectively.@*Conclusion, significance and impact of study@#The emergence of multidrug-resistant commensal E. coli and resistance genes circulating in animals, poultry and humans limit the treatment options for serious infections.

Glyceryl behenate-based solid lipid nanoparticles as a carrier of haloperidol for nose to brain delivery: formulation development, in-vitro, and in-vivo evaluation

Abstract This study was aimed to develop the haloperidol (HPL) loaded solid lipid nanoparticles (SLNs) for brain targeting through the intranasal route. SLNs were fabricated by the emulsification diffusion technique using glyceryl behenate as lipid and tween 80 as a surfactant. SLNs were evaluated for particle size, zeta potential, structure, entrapment efficiency, solid state characterization by differential scanning calorimetry (DSC), and in-vitro release. In-vivo biological evaluation was performed on albino Wistar rats for the determination of pharmacokinetic as well as brain targeting parameters. Particle size, PDI, zeta potential, and entrapment efficiency of optimized formulation (HPL-SLNs 6) were found to be 103±09 nm, 0.190±0.029, -23.5±1.07 mV, and 79.46±1.97% respectively. In-vitro drug release studies exhibited that 87.21± 3.63% of the entrapped drug was released from the SLNs within 24 h. DSC curves confirmed that during entrapment in SLNs, the drug was solubilized in the lipid matrix and converted into the amorphous form. Enhanced HPL targeting to the brain was observed from HPL-SLNs as compared to HPL-Sol when administered intranasally. The value of AUC 0-∞ in the brain for HPL-SLNs i.n. was found to be nearly 2.7 times higher than that of HPL-Sol i.v., whereas 3.66 times superior to HPL-Sol administered i.n. Stability studies revealed that the formulation remains unchanged when stored at 4±2 °C (refrigerator) and 25±2 °C /60 ±5% RH up to six months. Finally, it could be concluded that SLN is a suitable carrier for HPL with enhanced brain targeting through i.n administration, as compared to the HPL-Sol, administered i.n. and i.v.

Prospective cohort study of referred Malawian children and their survival by hypoxaemia and hypoglycaemia status

Objective To investigate survival in children referred from primary care in Malawi, with a focus on hypoglycaemia and hypoxaemia progression. Methods The study involved a prospective cohort of children aged 12 years or under referred from primary health-care facilities in Mchinji district, Malawi in 2019 and 2020. Peripheral blood oxygen saturation (SpO2) and blood glucose were measured at recruitment and on arrival at a subsequent health-care facility (i.e. four hospitals and 14 primary health-care facilities). Children were followed up 2 weeks after discharge or their last clinical visit. The primary study outcome was the case fatality ratio at 2 weeks. Associations between SpO2 and blood glucose levels and death were evaluated using Cox proportional hazards models and the treatment effect of hospitalization was assessed using propensity score matching. Findings Of 826 children recruited, 784 (94.9%) completed follow-up. At presentation, hypoxaemia was moderate (SpO2: 90­93%) in 13.1% (108/826) and severe (SpO2: < 90%) in 8.6% (71/826) and hypoglycaemia was moderate (blood glucose: 2.5­4.0 mmol/L) in 9.0% (74/826) and severe (blood glucose: < 2.5 mmol/L) in 2.3% (19/826). The case fatality ratio was 3.7% (29/784) overall but 26.3% (5/19) in severely hypoglycaemic children and 12.7% (9/71) in severely hypoxaemic children. Neither moderate hypoglycaemia nor moderate hypoxaemia was associated with mortality. Conclusion Presumptive pre-referral glucose treatment and better management of hypoglycaemia could reduce the high case fatality ratio observed in children with severe hypoglycaemia. The morbidity and mortality burden of severe hypoxaemia was high; ways of improving hypoxaemia identification and management are needed.

Enfermedad por neumococo: desafíos actuales en los pacientes con enfermedad renal crónica y diabetes mellitus

La enfermedad por neumococo se defino como cualquier infección causada por la bacteria Streptococcus pneumoniae; esta se denomina invasiva cuando el aislamiento de este microorganismo se confirma en sitios corporales que son normalmente estériles, tales como la sangre y el líquido cefalorraquídeo, y no invasiva cuando la infección se produce en sitio corporales que normalmente no son estériles. La enfermedad renal crónica y la diabetes mellitus son factores de riesgo importantes para el desarrollo de enfermedad neumocócica debido a su estado de inmunosupresión, por lo que la vacunación antineumocócica es una medida preventiva fundamental en los pacientes que padecen estas condiciones.

Pneumococcal disease is defined as any infection caused by the bacteria Streptococcus pneumoniae; it is called invasive when the isolation of this microorganism is confirmed in sites of the body that are normally sterile, such as blood and cerebrospinal fluid, and non-invasive when the infection occurs in sites of the body that are normally non-sterile. Chronic kidney disease and diabetes mellitus are important risk factors for the development of pneumococcal disease due to their status of immunosuppression;therefore, anti-pneumococcal vaccination is a fundamental preventive measure in patients who suffer from these conditions.

The quality of subgroup analyses in chronic pain randomized controlled trials: a methodological review

The quality of subgroup analyses (SGAs) in chronic non-cancer pain trials is uncertain. The purpose of this study was to address this issue. We conducted a comprehensive search in MEDLINE and EMBASE from January 2012 to September 2018 to identify eligible trials. Two pairs of reviewers assessed the quality of the SGAs and the credibility of subgroup claims using the 10 criteria developed by Sun et al.in 2012. The associations between the quality of the SGAs and the studies’ characteristics including risk of bias, funding sources, sample size, and the latest impact factor, were assessed using multivariable logistic regression. Our search retrieved 3,401 articles of which 66 were eligible. The total number of SGAs was 177 of which 52 (29.4%) made a subgroup claim. Of these, only 15 (8.5%) were evaluated as being of high quality. Among the 30 SGAs that claimed subgroup effects using an appropriate method of performing interaction tests, the credibility of only 5 were assessed as high. None of the subgroup claims met all the credibility criteria.No significant association was found between the quality of SGAs and the studies’ characteristics. The quality of the SGAs performed in chronic pain trials was poor.To enhance the quality of SGAs, scholars should consider the developed criteria when designing and conducting trials, particularly those which need to be specified a priori.

Clinical outcomes of moderate to severe COVID-19 patients receiving invasive vs. non-invasive ventilation

Objective: To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit (HDU) in relation to invasive vs. non-invasive mode of ventilation. Methods: In this study, the patients required either non-invasive [oxygen ≤10 L/min or >10 L/min through mask or nasal prongs, rebreather masks and bilevel positive airway pressure (BiPAP)] or invasive ventilation. For analysis of 30-day in hospital mortality in relation to use of different modes of oxygen, Kaplan Meier and log rank analyses were used. In the end, independent predictors of survival were determined by Cox regression analysis. Results: Invasive ventilation was required by 15.1% patients while 84.9% patients needed non-invasive ventilation. Patients with evidence of thromboembolism, high inflammatory markers and hypoxemia mainly required invasive ventilation. The 30-day in hospital mortality was 72.7% for the invasive group and 12.9% for the non-invasive group (1.8% oxygen 10 L/min, 3.6% rebreather mask and 4.5% BiPAP). The median time from hospital admission to outcome was 7 days for the invasive group and 18 days for the non-invasive group (P<0.05). Age, presence of co-morbidities, number of days requiring oxygen, rebreather, BiPAP and invasive ventilation were independent predictors of outcome. Conclusions: Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator associated lung injury. Thus, protective non-invasive ventilation remains the necessary and safe treatment for severely hypoxic COVID-19 patients.

Comparison of normal saline solution with low-chloride solutions in renal transplants: a meta-analysis

Background@#Normal saline solution (NSS) has been the fluid of choice for renal transplant patients, but it can lead to hyperchloremic acidosis and hyperkalemia. This study was performed to compare the safety profile of low-chloride solutions with that of NSS in renal transplant patients. @*Methods@#We conducted a systemic review search on PubMed, Embase, and the Central Cochrane Registry. Randomized clinical trials (RCTs) and matched cohort studies involving NSS as the control arm and low-chloride solutions as an intervention arm were chosen. The standardized mean difference for continuous variables, the odds ratio (OR) for discrete variables, and a 95% confidence interval (CI) for effect sizes were used. A p-value of <0.05 was considered statistically significant. Analysis was performed using a random-effects model irrespective of heterogeneity, which was evaluated using I2 statistics. @*Results@#Nine RCTs and one cohort study with a total of 726 patients were included. After transplantation, serum potassium was significantly lower in the low-chloride group (standardized mean difference compared to NSS group, –0.38 mEq/L; 95% CI, –0.66 to –0.11; p = 0.007). Similarly, postoperative chloride was lower in the low-chloride group (–2.41 mEq/L [–3.34 to –1.48], p < 0.001). No statistically significance was observed in delayed graft function (OR, 0.98 [0.56–1.69], p = 0.93), day 3 creatinine (–0.14 mg/dL [–0.46 to 0.18], p = 0.38), or day 7 urine output (–0.08 L [–0.29 to 0.12], p = 0.43). @*Conclusion@#Use of NSS during renal transplant leads to increased incidence of hyperchloremic acidosis with subsequent hyperkalemia, but clinical significance in the form of delayed graft function or postoperative creatinine remains comparable to that of low-chloride solutions.

The quality of subgroup analyses in chronic pain randomized controlled trials: a methodological review

The quality of subgroup analyses (SGAs) in chronic non-cancer pain trials is uncertain. The purpose of this study was to address this issue. We conducted a comprehensive search in MEDLINE and EMBASE from January 2012 to September 2018 to identify eligible trials. Two pairs of reviewers assessed the quality of the SGAs and the credibility of subgroup claims using the 10 criteria developed by Sun et al.in 2012. The associations between the quality of the SGAs and the studies’ characteristics including risk of bias, funding sources, sample size, and the latest impact factor, were assessed using multivariable logistic regression. Our search retrieved 3,401 articles of which 66 were eligible. The total number of SGAs was 177 of which 52 (29.4%) made a subgroup claim. Of these, only 15 (8.5%) were evaluated as being of high quality. Among the 30 SGAs that claimed subgroup effects using an appropriate method of performing interaction tests, the credibility of only 5 were assessed as high. None of the subgroup claims met all the credibility criteria.No significant association was found between the quality of SGAs and the studies’ characteristics. The quality of the SGAs performed in chronic pain trials was poor.To enhance the quality of SGAs, scholars should consider the developed criteria when designing and conducting trials, particularly those which need to be specified a priori.

Prevalence and clinical correlates of psychiatric morbidity among caregivers of patients attending a psychiatric hospital in North India

Background: Consequent to the high prevalence of psychiatric disorders in present day world, their caregivers form an important group in the public health. Research on the physical and psychological well-being of caregivers is being carried worldwide with varied results. Psychological health of these caregivers is usually ignored both by these persons themselves and the health-care providers. The objective of the study was to screen for psychiatric morbidity among caregivers of patients attending a psychiatric hospital in North India, and to study the clinical correlates of the same.Methods: A total of 205 patients and their caregivers were consecutively recruited over a one month period. Sociodemographic and clinical information of patients was obtained either from the hospital records or from the caregiver. Scoring of the patient’s global assessment of functioning (GAF) was done by clinicians. The caregivers were administered a sociodemographic questionnaire, general health questionnaire (GHQ-12) and Zarit Burden interview. The presence of psychiatric morbidity was confirmed by a consultant psychiatrist.Results: Among the caregivers, 32.2% had GHQ scores of 3 and above. Majority of caregivers in this study were females (59.0%) while as majority of the patients were males (61.9%). Factors associated with psychiatric morbidity among caregivers include the high level of subjective burden of care, low level of functioning, and comorbid medical and psychiatric conditions.Conclusions: The study reveals a high level of psychiatric morbidity among the caregivers of patients with mental health problems.

Mass Gathering (Hajj) Community Pharmacies Services: New Initiative in Saudi Arabia

Objective: To illustrate the pharmacy indicators during the mass gathering hajj as a new initiative in the Kingdom of Saudi Arabia. Methods: It is a new initiative project drove by national mass gathering pharmaceutical programs. The projects drove the mass gathering medicine guidelines and the international business model, pharmacy project guidelines project management institution guidelines of a new project. The initiative project is written through project management professionals and consisted of several parts, including the initial phase, the planning phase, the execution phase and the monitoring and controlling phase. Results: The mass gathering community pharmacy services with a defined vision, mission and goals. The services had various advantages, including clinical and economic on patients and healthcare services as demonstrated in the review. The continuation of the project assured by risk management elements description. Furthermore, the monitoring and controlling of the services as illustrated. The transition to operation project, though closing project stage declared in the analysis. Conclusion: The mass gathering medication safety is a new initiative project is part of the mass gathering medicine. There are various part of medication safety services can be started during mass gathering; it is highly recommended in Saudi Arabia.

Mass Gathering Hajj Emergency Pharmacy: New Initiative Project in Saudi Arabia

Objectives: To explore the mass gathering hajj emergency pharmacy as new initiatives in the Kingdom of Saudi Arabia. Methods: It is a new initiative project drove by national mass gathering pharmaceutical programs. The projects drove the mass gathering medicine guidelines and the international business model, pharmacy project guidelines project management institution guidelines of a new project. The initiative project is written through project management professionals and consisted of several parts, including the initial phase, the planning phase, the execution phase and the monitoring and controlling phase. Results: The mass gathering emergency pharmacy services with a defined vision, mission and goals. The services had various benefits, including clinical and economical on pilgrims, as described in the review. The continuity of the project assured by the risk management model description. Moreover, the monitoring and controlling of the services as demonstrated. The transition to operation project though closing project stage exemplified in the analysis. Conclusion: The mass gathering emergency pharmacy is a new initiative project in the mass gathering medicine. There are various emergency pharmacy services can be started during the mass gathering with clinical emergency pharmacy; it is highly suggested in Saudi Arabia.

Knowledge of Dietary Supplements among Women in the Aseer Region of the Kingdom of Saudi Arabia

Background: A significant growth in dietary supplement usage has occurred and this trend is particularly evident among females. This underlines the need to establish current knowledge levels among a female participant cohort based in the Aseer Region of the Kingdom of Saudi Arabia (KSA), along with determining the types of products being used and the typical reasons cited for their consumption.Methods: A total of 173 participants drawn from various age groups took part in this descriptive cross-sectional survey design. The survey was conducted over a three-month period from September to November 2019, using a structured online questionnaire.Results: The results of this research show that dietary supplement usage was highly prevalent among study participants. Young females (18–24 years) demonstrated significantly higher knowledge levels as compared to all other age groups (p<0.001 vs.other participants).Conclusion: This study has clearly shown that the participants in fact have a very varied range of knowledge, very often according to age, about the use of dietary supplements. 18–24-year-olds demonstrated higher levels of dietary supplement knowledge compared to the other age groups.

Mass Gathering (Hajj) Clinical Pharmacy Services: New Initiative in Saudi Arabia

Objective: To declare the clinical pharmacy services during the mass gathering hajj period as a new initiative in the Kingdom of Saudi Arabia. Methods: It is a new initiative project drove by national mass gathering pharmaceutical programs. The projects drove the mass gathering medicine guidelines and the international business model, pharmacy project guidelines project management institution guidelines of a new project. The initiative project is written through project management professionals and consisted of several parts, including the initial phase, the planning phase, the execution phase and the monitoring and controlling phase. Results: The mass gathering clinical pharmacy services with a defined vision, mission and goals. The services had multiple benefits, including clinical and economical on the healthcare system, as described in the review. The continuation of the services assured by risk management elements description. Moreover, the monitoring and controlling of the projects as illustrated. The transition to operation project, though closing project stage illustrated in the analysis. Conclusion: The clinical pharmacy services during the mass gathering hajj period is a new initiative project in the mass gathering medicine. Multiple clinical pharmacy services can be started during a mass gathering with an emphasison decrease morbidity and mortality; it is highly recommended in the Kingdom of Saudi Arabia.

Mass Gathering (Hajj) Medication Safety Services: New Initiative in Saudi Arabia

Objective: To demonstrate the mass gathering hajj medication safety as new initiatives in the Kingdom of Saudi Arabia. Methods: It is a new initiative project drove by national mass gathering pharmaceutical programs. The projects drove the mass gathering medicine guidelines and the international business model, pharmacy project guidelines project management institution guidelines of a new project. The initiative project is written through project management professionals and consisted of several parts, including the initial phase, the planning phase, the execution phase and the monitoring and controlling phase. Results: The medication safety services during the mass gathering with a defined vision, mission and goals. The services had multiple benefits, including clinical and economical on patients and healthcare services, as described in the review. The extension of the project assured by risk management elements description. Besides, the monitoring and controlling of the services as illustrated. The conversion of operation project, though closing project stage illustrated in the analysis. Conclusion: The mass gathering medication safety is a new initiative project that is part of the mass gathering medicine. There is various part of medication safety services can be started during the mass gathering; it is highly recommended in Saudi Arabia.