Evaluation of Connective Tissue Changes in Different Histological Grades of Oral Squamous Cell Carcinoma: A Histochemical Study

Introduction: In squamous cell carcinoma, cells invade the stroma in the form of islands, strands or sheets, which are surrounded by an extracellular matrix, thus producing reactive changes in the stroma. These reactive changes in the stroma may alter the biological behavior of oral cancer which convey some diagnostic and prognostic significance. Objective: This study was to compare staining intensity of various components of connective tissue such as collagen, elastin and glycoprotein among three histological grades of oral squamous cell carcinoma and normal oral mucosa. Materials and Methods: A total sample of 48 in which 36 cases of histologically diagnosed oral squamous cell carcinoma, 12 each of well, moderate and poorly differentiated squamous cell carcinomas and 12 sections of normal mucosa as the control group were selected for the present study. The sections of tissue blocks were stained with connective tissue specific stains such as Verhoeff’s -VanGieson stain and PAS for collagen, elastin and glycoprotein respectively. Results: Staining intensity of collagen, elastin and glycoprotein around tumor island among different grades of OSCC and normal mucosa revealed statistically significant changes (P value <0.001). Collagen and glycoprotein degradation and elastosis are more prominent in poorly differentiated squamous cell carcinomas. Conclusion: Observable changes were seen in the stroma, in all the three grades of OSCC’s compared to normal mucosa. There was an increased stromal response in poorly differentiated carcinomas, when compared to the other grades. Role of the stroma is like a double-edged sword, at times helping in tumor invasion and otherwise warding off the tumor cells.

Radiological Assessment of Morphological Changes of Lumbar Spine: From First to 9th Decade of Life

Methods@#Radiograms of 1,496 patients (555 males and 941 females) from the first to 9th decade were examined for this study. Sagittal and coronal alignment, disc space narrowing, spur formation including diffuse idiopathic spinal hyperostosis (DISH), spondylolisthesis, and ballooned discs associated with biconcave bodies due to osteoporosis were among the parameters of lumbar spine morphologies examined on high-quality radiographs by both human observers and computers. @*Results@#The alignment of the lumbar spine altered after birth and set at growth maturity, and then the curve was maintained till the end of the 5th decade afterward and the curve gradually hypolordotic. There were three types of coronal alignment abnormalities can be seen: idiopathic, osteopathic, and discogenic (degenerative lumbar scoliosis [DLS]). DLS developed after 6th decade. There was no scoliosis associated with spondylolysis or the post-laminofacetectomy period. Disc space narrowing and corporal spur formation were not seen till the end of 3rd decade comparatively speaking, the corporal spurs generated in the non-scoliotic spine were smaller than those in the scoliotic spine. DISH began to appear in the 5th-decade patients and its incidences increased gradually afterward. Porosis-related vertebral body collapse started to happen after 6th decade. There are three different types of spondylolisthesis: anterior, posterior, and lateral. The lateral slip occurred only in the scoliotic spine. All types were related to degenerative discs. @*Conclusions@#It has been shown that the morphology of the lumbar spine changes throughout time.

Association of country economy and socioeconomic factors on risk factor control for primary prevention of cardiovascular disease in patients with diabetes mellitus: Insights from the DISCOVER study

Background: We sought to describe global patterns in achievement of risk factor control for primary prevention in patients with T2D and explore the association of country's GNI/capita with risk factor control. Methods: The DISCOVER study is a prospective, observational study of patients with T2D from 38 countries enrolled at initiation of second-line glucose-lowering therapy. We examined achievement of risk factor control (glycosylated hemoglobin <7%, blood pressure <140/90 mmHg, prescription of a statin) at 3 years among those without optimal control at baseline. Countries were stratified by gross national income (GNI)/capita, from 2017). We examined the impact of country GNI/capita with achievement of risk factor control. Findings: Our cohort included 9613 patients with T2D and without baseline cardiovascular disease (mean age 57.2 ± 8.7 years, 47.9% women). At baseline, 6354/7646 patients (83.1%) had suboptimal glucose control, 3449/9200 patients (37.5%) had suboptimal BP control, and 2800/4221 patients (66.7%) were not on an appropriate statin (sample sizes differed due to missing covariate data). Optimal control at 3 years of follow-up was achieved in 41% (glucose), 56% (blood pressure), and 29% (statins) of patients. There was significant variability in achievement of risk factor control across countries but no association between country GNI/capita with achievement of risk factor control (p > 0.08 for all). Interpretation: In a global, prospective study of patients with T2D, we found that cardiovascular risk factor control achievement was suboptimal despite 3 years of follow-up in specialized health care systems. Neither country-level nor patient-level socioeconomic factors fully explained this finding.

A study of perceived stress level and sleep quality among physicians in a hospital of West Bengal, during the second wave of the present coronavirus disease-19 pandemic

Background: Stressful life events may lead to insomnia, a very common sleep disorder. Aim and Objectives: The aim of the study was to study the correlation of perceived stress levels and sleep quality among physicians during the coronavirus disease-19 Pandemic. Materials and Methods: Physicians working in Burdwan Medical College were selected as a study group and age, sex-matched controls were selected from other non-medical workers. This online survey was conducted using Google Forms. The form was shared with participants using emails and WhatsApp. In the first section of the form the importance of the study was explained and informed consent was taken from the participants. In the second part of the form, subjects were asked to fill up demographic details and relevant history; in the third part, participants were asked to fill up two scales: Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI). Results: 128 doctors and 114 other staff participated in the present study. Doctors had significantly higher PSS and PSQI levels as compared to the other group. Doctors’ PSQI: Mean ± SD = 7.59 ± 4.37 and other staff PSQI: Mean ± SD = 5.77 ± 2.75; P: 0.00013**. Doctors’ PSS: 18.43 ± 4.04 and other staff PSS: 15.14 ± 1.7; P < 0.0001**. PSS and PSQI levels were positively correlated in both groups with r values of 0.975 for Doctors and 0.544 for other staff, respectively. Conclusions: Doctors were found to have higher PSS and PSQI levels as compared to the control group. PSS levels were found to be positively correlated with PSQI levels and more so among doctors.

Seasonal analysis of food items and feeding habits of endangered riverine catfish Rita rita (Hamilton, 1822) / Análise sazonal de itens e hábitos alimentares de bagres ribeirinhos Rita rita (Hamilton, 1822) ameaçados de extinção

This investigation presents the food and feeding activity of and endangered riverine catfish Rita rita, during February 2017-January 2018. A total of 225 fish individuals was analyzed for stomach contents by characterizing the dominant food items and morphometric features. The results divulged ten major food items consumed, preferably fish scales and eggs, teleost fishes, copepods, cladocerans, rotifers, and mollusks. Total length and body weight of fish varied between 9-34 cm (20.53 ± 6.90 cm) and 10-400 g (9125.94 ± 102.07 g), respectively. The index of relative importance (IRI%) showed the importance of rotifers over the other food items. Morisita's index of diet overlap indicated seasonal variations in catfish diets with summer and monsoon displaying the least overlap, while maximum overlap during monsoon and winter seasons. The non-metric multidimensional scaling (nMDS) indicated the close association between the food items available during summer and winter seasons with a significant difference among the seasons (ANOSIM, R = 0.638, P = 0.013). Levin’s niche breadth index arranged in the order of 0.88>0.81>0.78>0.63>0.43 for the size classes of V, IV, III, II and I, respectively. The PCA explained 95.39% of the total variance among the food items and fish size groups. Small-sized fish individuals displayed a greater correlation with food items suitable for their mouth size. In conclusion, the variety and frequency of food items recorded indicated considerable feeding plasticity and opportunistic feeding behavior with a shift from carnivorous to omnivorous feeding nature. This study could render useful information on the food and feeding habits of R. rita and provide background for preparing its diet for future aquaculture practices.

Esta investigação apresenta a alimentação e a atividade alimentar de bagres ribeirinhos Rita rita ameaçados de extinção, no período de fevereiro de 2017 a janeiro de 2018. Um total de 225 peixes foi analisado quanto ao conteúdo do estômago, caracterizando os itens alimentares dominantes e as características morfométricas. Os resultados apresentaram dez principais itens alimentares consumidos, preferencialmente escamas e ovos de peixes, teleósteos, copépodes, cladóceros, rotíferos e moluscos. O comprimento total e o peso corporal dos peixes variaram entre 9-34 cm (20,53 ± 6,90 cm) e 10-400 g (9125,94 ± 102,07 g), respectivamente. O índice de importância relativa (IRI%) mostrou a importância dos rotíferos sobre os demais itens alimentares. O índice de sobreposição de dieta de Morisita indicou variações sazonais nas dietas de bagres no verão e nas monções, exibindo a menor sobreposição, enquanto a sobreposição máxima ocorreu durante as estações das monções e do inverno. A escala multidimensional não métrica (nMDS) indicou a estreita associação entre os itens alimentares disponíveis durante o verão e o inverno, com uma diferença significativa entre as estações (ANOSIM, R = 0,638, P = 0,013). O índice de amplitude de nicho de Levin foi organizado na ordem de 0,88 > 0,81 > 0,78 > 0,63 > 0,43 para as classes de tamanho de V, IV, III, II e I, respectivamente. O PCA explicou 95,39% da variação total entre os itens alimentares e os grupos de tamanho de peixes. Peixes de pequeno porte apresentaram maior correlação com itens alimentares adequados ao tamanho da boca. Em conclusão, a variedade e a frequência dos itens alimentares registrados indicaram plasticidade alimentar considerável e comportamento alimentar oportunista, com uma mudança da natureza carnívora para onívora. Este estudo pode fornecer informações úteis sobre os hábitos alimentares e de alimentação de R. rita e apresentar subsídios para a preparação de sua dieta em futuras práticas de aquicultura.

Seasonal analysis of food items and feeding habits of endangered riverine catfish Rita rita (Hamilton, 1822)

Abstract This investigation presents the food and feeding activity of and endangered riverine catfish Rita rita, during February 2017-January 2018. A total of 225 fish individuals was analyzed for stomach contents by characterizing the dominant food items and morphometric features. The results divulged ten major food items consumed, preferably fish scales and eggs, teleost fishes, copepods, cladocerans, rotifers, and mollusks. Total length and body weight of fish varied between 9-34 cm (20.53 ± 6.90 cm) and 10-400 g (9125.94 ± 102.07 g), respectively. The index of relative importance (IRI%) showed the importance of rotifers over the other food items. Morisitas index of diet overlap indicated seasonal variations in catfish diets with summer and monsoon displaying the least overlap, while maximum overlap during monsoon and winter seasons. The non-metric multidimensional scaling (nMDS) indicated the close association between the food items available during summer and winter seasons with a significant difference among the seasons (ANOSIM, R = 0.638, P = 0.013). Levins niche breadth index arranged in the order of 0.88>0.81>0.78>0.63>0.43 for the size classes of V, IV, III, II and I, respectively. The PCA explained 95.39% of the total variance among the food items and fish size groups. Small-sized fish individuals displayed a greater correlation with food items suitable for their mouth size. In conclusion, the variety and frequency of food items recorded indicated considerable feeding plasticity and opportunistic feeding behavior with a shift from carnivorous to omnivorous feeding nature. This study could render useful information on the food and feeding habits of R. rita and provide background for preparing its diet for future aquaculture practices.

Resumo Esta investigação apresenta a alimentação e a atividade alimentar de bagres ribeirinhos Rita rita ameaçados de extinção, no período de fevereiro de 2017 a janeiro de 2018. Um total de 225 peixes foi analisado quanto ao conteúdo do estômago, caracterizando os itens alimentares dominantes e as características morfométricas. Os resultados apresentaram dez principais itens alimentares consumidos, preferencialmente escamas e ovos de peixes, teleósteos, copépodes, cladóceros, rotíferos e moluscos. O comprimento total e o peso corporal dos peixes variaram entre 9-34 cm (20,53 ± 6,90 cm) e 10-400 g (9125,94 ± 102,07 g), respectivamente. O índice de importância relativa (IRI%) mostrou a importância dos rotíferos sobre os demais itens alimentares. O índice de sobreposição de dieta de Morisita indicou variações sazonais nas dietas de bagres no verão e nas monções, exibindo a menor sobreposição, enquanto a sobreposição máxima ocorreu durante as estações das monções e do inverno. A escala multidimensional não métrica (nMDS) indicou a estreita associação entre os itens alimentares disponíveis durante o verão e o inverno, com uma diferença significativa entre as estações (ANOSIM, R = 0,638, P = 0,013). O índice de amplitude de nicho de Levin foi organizado na ordem de 0,88 > 0,81 > 0,78 > 0,63 > 0,43 para as classes de tamanho de V, IV, III, II e I, respectivamente. O PCA explicou 95,39% da variação total entre os itens alimentares e os grupos de tamanho de peixes. Peixes de pequeno porte apresentaram maior correlação com itens alimentares adequados ao tamanho da boca. Em conclusão, a variedade e a frequência dos itens alimentares registrados indicaram plasticidade alimentar considerável e comportamento alimentar oportunista, com uma mudança da natureza carnívora para onívora. Este estudo pode fornecer informações úteis sobre os hábitos alimentares e de alimentação de R. rita e apresentar subsídios para a preparação de sua dieta em futuras práticas de aquicultura.

Seasonal analysis of food items and feeding habits of endangered riverine catfish Rita rita (Hamilton, 1822) / Análise sazonal de itens e hábitos alimentares de bagres ribeirinhos Rita rita (Hamilton, 1822) ameaçados de extinção

This investigation presents the food and feeding activity of and endangered riverine catfish Rita rita, during February 2017-January 2018. A total of 225 fish individuals was analyzed for stomach contents by characterizing the dominant food items and morphometric features. The results divulged ten major food items consumed, preferably fish scales and eggs, teleost fishes, copepods, cladocerans, rotifers, and mollusks. Total length and body weight of fish varied between 9-34 cm (20.53 ± 6.90 cm) and 10-400 g (9125.94 ± 102.07 g), respectively. The index of relative importance (IRI%) showed the importance of rotifers over the other food items. Morisita's index of diet overlap indicated seasonal variations in catfish diets with summer and monsoon displaying the least overlap, while maximum overlap during monsoon and winter seasons. The non-metric multidimensional scaling (nMDS) indicated the close association between the food items available during summer and winter seasons with a significant difference among the seasons (ANOSIM, R = 0.638, P = 0.013). Levin's niche breadth index arranged in the order of 0.88>0.81>0.78>0.63>0.43 for the size classes of V, IV, III, II and I, respectively. The PCA explained 95.39% of the total variance among the food items and fish size groups. Small-sized fish individuals displayed a greater correlation with food items suitable for their mouth size. In conclusion, the variety and frequency of food items recorded indicated considerable feeding plasticity and opportunistic feeding behavior with a shift from carnivorous to omnivorous feeding nature. This study could render useful information on the food and feeding habits of R. rita and provide background for preparing its diet for future aquaculture practices.

Esta investigação apresenta a alimentação e a atividade alimentar de bagres ribeirinhos Rita rita ameaçados de extinção, no período de fevereiro de 2017 a janeiro de 2018. Um total de 225 peixes foi analisado quanto ao conteúdo do estômago, caracterizando os itens alimentares dominantes e as características morfométricas. Os resultados apresentaram dez principais itens alimentares consumidos, preferencialmente escamas e ovos de peixes, teleósteos, copépodes, cladóceros, rotíferos e moluscos. O comprimento total e o peso corporal dos peixes variaram entre 9-34 cm (20,53 ± 6,90 cm) e 10-400 g (9125,94 ± 102,07 g), respectivamente. O índice de importância relativa (IRI%) mostrou a importância dos rotíferos sobre os demais itens alimentares. O índice de sobreposição de dieta de Morisita indicou variações sazonais nas dietas de bagres no verão e nas monções, exibindo a menor sobreposição, enquanto a sobreposição máxima ocorreu durante as estações das monções e do inverno. A escala multidimensional não métrica (nMDS) indicou a estreita associação entre os itens alimentares disponíveis durante o verão e o inverno, com uma diferença significativa entre as estações (ANOSIM, R = 0,638, P = 0,013). O índice de amplitude de nicho de Levin foi organizado na ordem de 0,88 > 0,81 > 0,78 > 0,63 > 0,43 para as classes de tamanho de V, IV, III, II e I, respectivamente. O PCA explicou 95,39% da variação total entre os itens alimentares e os grupos de tamanho de peixes. Peixes de pequeno porte apresentaram maior correlação com itens alimentares adequados ao tamanho da boca. Em conclusão, a variedade e a frequência dos itens alimentares registrados indicaram plasticidade alimentar considerável e comportamento alimentar oportunista, com uma mudança da natureza carnívora para onívora. Este estudo pode fornecer informações úteis sobre os hábitos alimentares e de alimentação de R. rita e apresentar subsídios para a preparação de sua dieta em futuras práticas de aquicultura.

A case of neovascular glaucoma secondary to ocular ischemia

Objective@#To present a case of neovascular glaucoma secondary to ocular ischemic syndrome following an uncomplicated phacoemulsification@*Methods@#This is a case description of a 74-year-old male who developed blurred vision and increased intraocular pressure (IOP) two months after an uncomplicated phacoemulsification cataract surgery with posterior chamber lens implantation of the left eye. There was iris neovascularization with absence of retinal dot/blot hemorrhages or neovascularization. The fluorescein angiogram (FA) showed delayed choroidal fluorescence and arteriovenous time. IOP-lowering medications and intravitreal injection of aflibercept were given. Carotid doppler test showed 70% stenosis of the ipsilateral artery but a subsequent magnetic resonance angiography (MRA) did not show evidence of significant stenosis. @*Results@#At his last consultation, visual acuity improved to counting fingers. IOP was maintained at 12 mmHg with one anti-glaucoma medication.@*Conclusion@#Ocular ischemia can confound the outcome of an uncomplicated cataract surgery. Doppler scans are usually chosen as the first-line exam for those suspected of carotid stenosis but, at times, may have contradictory results with MRA.

Health as an investment: Social marketing to facilitate investment in an electronic medical record system in a resource-constrained community in the Philippines

Background@#Health information systems (HIS) such as Electronic Medical Record (EMR) systems are essential in the integration of fragmented local health systems. Investing in HIS is crosscutting; it can address multiple interrelated health system gaps. However, public health authorities, especially those in resource-constrained communities, are often faced with the dual challenge of upgrading and digitalizing local HIS and addressing other more apparent health system gaps. @*Objectives@#The study aimed to identify and document strategies that not only motivate policy change towards adoption of electronic HIS but also address other health system gaps. @*Methodology@#The author, in his capacity as a local health official in a resource-constrained community, developed, implemented, and documented a social marketing strategy wherein community stakeholders were influenced to invest in an electronic medical record (EMR) system because it was shown to also have the capacity to address other priority health system gaps identified. @*Results@#The strategy, based on situational, stakeholder, and risk analyses, prompted local governance to first invest in improving the delivery of services accredited by the national health insurance program (PhilHealth), for which reimbursements would require electronically submitted claim forms. Community stakeholders then supported the proposal to invest in an EMR system because they were persuaded that it can facilitate increased financing from PhilHealth claims reimbursements, which could be used to enable not only improvement in existing health services but to also initiate other health programs.@*Conclusion@#Social marketing using the perspective of health as an investment influenced stakeholders to invest in an EMR system.

Social media, purpose, and use of it: A community-based cross-sectional study in a rural area of a developing nation (India)

Background: Over the past two decades, the world has witnessed drastic progress in the field of communication. Social media are the collective of online communications channels dedicated to community-based input, interaction, content-sharing, and collaboration. Objectives: The objectives of the study were to determine the prevalence of social media use, pattern, and purpose of use and usefulness for conveying health education. Materials and Methods: The current study was undertaken; in a rural community of Punjab province of India from September 2018 to February 2019. Participants were interviewed using a pre-designed, pre-tested structured interview schedule. Results: The total number of participants in the study was 4000. Six hundred eighteen (15.5%) had a smartphone and among them, nearly 90% were using internet. The proportion of male participants (22.9%) using smartphone was significantly higher than female. Seven hundred and forty-two (18.5%) had heard of any form of social media, in which WhatsApp (13.1%) was the most common. The prevalence of the use of social media among the participants was 13.5% (n = 542). Friendship and entertainment were the major purposes for using of social media. Nearly 80% of the social media users think that it should be used more for health education, but only 11.8% of the users thought that the government was using this platform very successfully. Young, male, educated, employed, and business class was using significantly more social media for communication. Conclusions: Media is changing as well as health care and medicine, so time has come to consider one of the cost-effective and popular media to solve complex and diverse problems of health and disease.

Follow-up of Soluble Mesothelin-Related Protein Levels in Participants With Asbestos-Related Disorders

Background@#Asbestos exposure is associated with the development of the cancer malignant mesothelioma (MM). Measurement of soluble mesothelin-related protein (SMRP) has been suggested as a method for detection of MM in its early stages. We prospectively examined SMRP levels in participants with asbestos exposure who are a group at a high risk of development of MM. @*Methods@#This study was a follow-up of our cohort of 322 asbestos-exposed participants. No further participants developed MM or malignancy over the study period. Mean follow-up time was 22.9 months. @*Results@#Mean (standard deviation) SMRP levels at baseline and follow-up were 0.94 (0.79) and 0.91 (0.86) nmol/L (p = 0.1033), respectively. Mean SMRP levels of the healthy individuals exposed to asbestos at baseline was significantly lower than those of participants with asbestosis and pleural plaques alone; similar patterns were found on follow-up measurements. There was a statistically significant effect of age on serial SMRP measurements. Our study confirms higher levels in participants with nonmalignant asbestos-related disorders. Levels decreased in asbestos-related disorders other than asbestosis, where a small increase was observed. We did not detect any further cases of malignancy. @*Conclusion@#Monitoring programs for early detection of MM need to take into account increased SMRP levels found in benign asbestos-related diseases.

General principles and overview of vascular contrast-enhanced ultrasonography

Ultrasonography (US) is the first-line modality for the evaluation of vascular pathology. Although well-established for many diseases, US has inherent limitations that can occasionally hinder an accurate diagnosis. The value of US was improved by the introduction of microbubbles as ultrasonographic contrast agents (UCAs) and the emergence of contrast-enhanced ultrasonography (CEUS), following the introduction of second-generation UCAs and the emergence of modern contrast-specific techniques. CEUS offers valuable information about vascular disease, both on a macrovascular and a microvascular level, with well-established applications for carotid disease, post-interventional follow-up of abdominal aortic aneurysms, and the assessment of portal vein thrombosis. The purpose of this review is to discuss the principles of CEUS and to present an overview of its vascular applications.

Comparative analysis of meibomian gland dysfunction in eyes with and without eyelid margin tattoos

@#OBJECTIVE: To compare the presence and severity of meibomian gland (MG) dysfunction among eyes of female subjects with and without eyelid margin tattoos using infrared meibography and colored photographs. METHODS: This is a cross-sectional, descriptive study that involved 38 Filipino females with and without eyelid margin tattoos. Infrared meibography was performed on the upper and lower eyelids of each eye to assess total or partial MG dropout. Colored photographs were taken to evaluate vascularity, irregularity, thickening of the lid margins, and plugging of MG orifices. Severity of MG dysfunction (MGD) was assessed using Arita’s MGD proposed grading scale. Independent t-test was used to compare MG dropout and other lid margin parameters between the two groups. Prevalence ratio and prevalence odds ratio were calculated to measure the likelihood of MGD among eyes with eyelid tattoos. RESULTS: Seventy-four (74) eyes were included in the study (36 in the tattoo group and 38 in the control group). Scores for abnormal vascularity, irregularity, and thickening of the lid margins were significantly higher in the tattoo group compared to the control group (p<0.0000001). However, plugging of gland orifices scores between the two groups were found to be similar (upper eyelid: p=0.65; lower eyelid: p=0.91). Total MG dropout was significantly greater in the tattoo group (upper eyelid: -1.11 ± 0.82; lower eyelid: 1.37 ± 0.75) compared to the control group (upper eyelid: 0.53 ± 0.83; lower eyelid: 0.45 ± 0.76) (upper eyelid: p=0.003; lower eyelid: p=0.000001) for the upper and lower eyelid, respectively). Analysis of total MG dropout between the two groups showed a prevalence ratio of 2.13. CONCLUSION: Eyelid margin tattoos are associated with several eyelid margin abnormalities and increase the risk of meibomian gland droupout.

Survey of glaucoma practice patterns among members of The Philippine Glaucoma Society

@#OBJECTIVE: To identify the glaucoma clinical practice patterns among the members of the Philippine Glaucoma Society (PGS) from 2015 to 2016 using an online survey. METHODS: An online link was sent to each consenting PGS member which directed them to two poll sites. These sites asked questions about demographics and their preferred clinical practice patterns. Frequency and percent distributions were used to analyze the data. RESULTS: There was a high response rate from PGS members at 97% (42 out of 43 members). More than half of respondents (51%, n=22) defined glaucoma as glaucomatous optic neuropathy with an evident visual field loss. IOP was routinely measured by 90% (n=38) of the respondents with majority preferring to use the Goldmann applanation tonometer (GAT) (98%, n=41). Gonioscopy was done on all new patients by all PGS members but only 62% did regular gonioscopy on follow-up consultations. Most of the respondents relied on the 90D lens (88%) to assess the optic nerve. Visual field examination (VFE) was routinely requested by all respondents. Pachymetry and anterior segment optical coherence tomography (AS-OCT) were used sparingly at only 43% and 12% respectively. Appositional angle closure was addressed by performing laser iridotomy with majority of the respondents preferring a site that is covered by the upper eyelid (57%). Prostaglandin analogues were the top choice as first-line monotherapy for eyes with open-angle glaucoma. Majority of the respondents (55%) opted to do laser trabeculoplasty (LTP) as an adjunct to medical therapy. Mitomycin-C was the preferred intraoperative antimetabolite for trabeculectomy by 98% (n=41). Ahmed (71%, n=30) was the more favored glaucoma drainage device (GDD) by our respondents over Baerveldt (19%, n=8). CONCLUSION: This survey showed majority of the glaucoma practices of PGS members appear to adhere to the current clinical practice guidelines.

Follow-up of Soluble Mesothelin-Related Protein Levels in Participants With Asbestos-Related Disorders

Background@#Asbestos exposure is associated with the development of the cancer malignant mesothelioma (MM). Measurement of soluble mesothelin-related protein (SMRP) has been suggested as a method for detection of MM in its early stages. We prospectively examined SMRP levels in participants with asbestos exposure who are a group at a high risk of development of MM. @*Methods@#This study was a follow-up of our cohort of 322 asbestos-exposed participants. No further participants developed MM or malignancy over the study period. Mean follow-up time was 22.9 months. @*Results@#Mean (standard deviation) SMRP levels at baseline and follow-up were 0.94 (0.79) and 0.91 (0.86) nmol/L (p = 0.1033), respectively. Mean SMRP levels of the healthy individuals exposed to asbestos at baseline was significantly lower than those of participants with asbestosis and pleural plaques alone; similar patterns were found on follow-up measurements. There was a statistically significant effect of age on serial SMRP measurements. Our study confirms higher levels in participants with nonmalignant asbestos-related disorders. Levels decreased in asbestos-related disorders other than asbestosis, where a small increase was observed. We did not detect any further cases of malignancy. @*Conclusion@#Monitoring programs for early detection of MM need to take into account increased SMRP levels found in benign asbestos-related diseases.

Drug Utilization Evaluation Of Benzodiazepines In A Tertiary Care Hospital

Objective: To assess the rationale use of benzodiazepines among various departments in a multi-speciality hospital. Methods: A prospective study was conducted with a sample size of 200 for a period of six months. Data was collected from patients based on inclusion and exclusion criteria. Naranjo Adverse Drug Reaction Probability Scale and Drug Interaction Probability Scale (DIPS) were used as a study tool to measure the causality of adverse drug reactions and drug interactions. Based on the dosage of various benzodiazepines DDD was calculated and compared with WHO Anatomical Therapeutic Chemical (ATC) classification Defined Daily Dose (DDD). Results: BZD’s were mostly prescribed in males (74.5%) and married patients (86.5%) were more exposed to benzodiazepines compared to others. Lorazepam (70.1%) was found to be the most commonly used drug, mainly prescribed for sedation, followed by anxiety. DDD was calculated and majority of patients had DDD in accordance with WHO standard. Based on cost analysis, Clobazam was found to be the high cost and Lorazepam being the low-cost drug. The results of drug utilization evaluation of benzodiazepines study were compiled and reported to the respected department physician and their feedback was collected. Conclusion: The study showed a rational utilization of benzodiazepines and the negative outcomes of BZDs can be reduced by providing drug-related information to the prescribers and consumers.

Adequacy of hemostatic resuscitation improves therapeutic efficacy of recombinant activated factor VII and reduces reexploration rate for bleeding in postoperative cardiac surgery patients with refractory hemorrhage

Background: Excessive bleeding and surgical reexploration are common complications that increase the risk of multi-organ failure and prolonged hospitalization after cardiac surgery. Off-label use of recombinant activated factor VII (rFVIIa) is a recommended treatment for refractory bleeding. Objective: The objective of the study is to determine if the adequacy of hemostatic resuscitation enhances the efficacy of rFVIIa. Methods: This retrospective, observational, cohort study included patients who received rFVIIa for refractory postoperative bleeding after cardiac surgery. Patients were divided into two groups based on the presence or absence of adequate coagulation resuscitation before rFVIIa administration, defined as international ratio (INR) ≤1.5, platelet count ≥100 K/mL, and fibrinogen ≥200 mg/dL. The failure of rFVIIa treatment was defined as surgical reexploration within 24 h, thoracostomy drainage >400 mL/h within 6 h or transfusion of additional blood products or another rFVIIa dose within 6 h after initial rFVIIa dose. Results: Of the 3833 patients, screened who underwent cardiothoracic surgery procedures, 58 patients received rFVIIa for refractory postoperative bleeding. Successful hemostasis with rFVIIa was more likely in patients who were adequately resuscitated compared with those who were not (20 [71.4%] vs. 10 [33.3%], respectively; P = 0.0046). Multiple logistic regression analysis indicated that patients who were adequately resuscitated before rFVIIa were less likely to fail treatment (odds ratio, 0.16; 95% confidence interval [0.04–0.62]; P = 0.007). Conclusions: The therapeutic efficacy of rFVIIa is dependent on the adequacy of hemostatic resuscitation; restoration of normal serum fibrinogen, INR, and platelet counts >100 K/mL may provide an adequate substrate for rFVIIa to be effective in managing refractory postoperative cardiac surgical bleeding.

Eschar and IgM ELISA in the diagnosis of scrub typhus

Scrub typhus is one of the leading causes of acute febrile illness in India. This study aimed to determine the best diagnostic tool for the identification of scrub typhus and study the possible association between diagnostics and clinical characteristics. Patients with fever of ?15 days admitted to the hospital satisfying the case definition of 47 kDa quantitative polymerase chain reaction (qPCR) positivity OR scrub typhus IgM ELISA positivity along with the presence of eschar OR Scrub typhus IgM ELISA positivity along with defervescence of fever within 72 h of initiation of specific therapy were recruited. Of the 116 patients satisfying the case definition, 47 kDa qPCR was positive in 43 (37%) patients, whereas IgM ELISA was positive in 104 (90%) patients and eschar was seen in 59 (51%) patients. The median duration of fever was 7.5 days (interquartile range 6� days). Multiorgan dysfunction syndrome (MODS) was described in 44 (37.9%) patients. Two patients (1.8%) succumbed to the illness. Presence of eschar and IgM ELISA positivity were detected in 106 (91%) cases. Scrub typhus, even with MODS, has low mortality because of immediate institution of specific therapy due to physician awareness. The presence of eschar and IgM ELISA positivity can be used to detect a majority of cases of scrub typhus.

Elastography of focal testicular lesions: current concepts and utility

As a relatively new sonographic technique, tissue elastography has emerged as a qualitative and potentially quantitative adjunctive tool to provide additional information on tissue stiffness, aiming to further improve diagnostic confidence in discriminating benign from malignant focal testicular lesions. The purpose of this review is to provide an overview of the elastography techniques used to assess focal testicular lesions and their typical appearance on tissue elastography.

A cross-sectional study on the HIV-related knowledge, attitudes and practices of male youth having sex with men in Metro Manila / The Health Sciences Journal

INTRODUCTION: The Philippines continues to see an increasing trend in diagnosed cases of HIV. Thepredominant population of males having sex with men (MSM) is the 25-34 years age group, but trendsshow an increasing incidence in younger populations. This study aimed to determine the participants'HIV/AIDS related knowledge, attitudes and practices and its relationships with the sociodemographicfactors of youth MSM in Metro Manila.METHODS: The researchers used an analytic, cross-sectional design using a self-administered questionnaire.The survey tool consisted on 24 items on knowledge and 12 on attitudes. Respondents were classifiedinto "inadequate" and "adequate" knowledge, and "poor" and "good" attitudes for the analysis. Purposivesampling was used to recruit 251 respondents.RESULTS: The mean age of the respondents was 22 ± 1.7 years. Most of the respondents had high HIVknowledge and good attitudes towards PLHIV but still engaged in risky sexual practices. Those who hadundergone HIV testing were significantly more likely to have good knowledge regarding HIV/AIDS. Withregards to attitudes, those not in a relationship were significantly more likely to have positive attitudestowards PLHIV and HIV/AIDS.CONCLUSION: HIV testing status positively influences HIV/AIDS-related knowledge while being singlepositively influences attitudes towards PLHIV and HIV/AIDS. No significant findings were found betweenage, educational attainment and religious affiliation with knowledge and attitudes.