Netarsudil monotherapy as the initial treatment for open-angle glaucoma and ocular hypertension in Indian patients: A real-world evaluation of efficacy and safety

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.

To Study the Effect of Interventions to Reduce the Indoor Air Pollution in Asthmatic Children of Rural India

Background: Around 2.6 billion people cook their food using biomass fuel (BMF), kerosene oil, and coal fuel, by which each year, 4 million people die prematurely from household air pollution or by this inefficient cooking practices. So, this study was planned to measure the effect of interventions of cooking fuel (BMF to LPG) to reduce the indoor air pollution in asthmatic children of rural India. Methods: Prospective observational study was done by door-to-door survey, among school-age children. Households of asthmatic children were encouraged to change their cooking fuel to more secure and were followed up for a period of 9 months. The intervention was in the form of a change of cooking fuel (from BMF to LPG) and proper education. The levels of indoor pollutants (PM10, PM2.5, and PM1) were measured before and after 3 months of follow-up. Result: A total of 56 asthmatic children from 42 households were followed-up for the following 9 months at every 3 months visit. The mean age was 9.27 ± 3.94 years with an equivalent sex ratio. There was at least one smoker in 73.81% of households of asthmatic children. Nearly, 45% of children were living in 101–500 square yard area and 67.86% with the inhabitation of ? 3/room. The level of all particulate matter decreased significantly at 3 months (p < 0.05). At 3, 6, 9 months of follow-up, respiratory symptoms and morbidity significantly diminished. Conclusion: The change in cooking fuel to more secure was found to be one of the factors decreasing indoor pollutants and respiratory symptoms/morbidity among asthmatic children in rural areas.

Comparison of Demography, Resource Utilization and Outcomes of COVID 19 patients admitted during First and Second waves at a tertiary care institute in Kanyakumari, South India

Introduction: The novel Coronavirus disease 19 (COVID-19) affected India, predominantly in two time periods – the first wave from March to December 2020, and the second wave that raged from April to July 2021. Although the time duration of second wave was shorter than the first, the onslaught of the disease was much more severe during the second wave. Objective: To compare the demographic characteristics and clinical outcomes of COVID-19 patients admitted during the first and second pandemic waves. Method: Demographic characteristics, duration of hospitalization, critical unit admission, and mortality data of 137 and 345 COVID-19 positive individuals, from first and second waves respectively, were retrospectively analyzed in a teaching hospital in South India. Descriptive statistics, Independent t test, chi square tests and regression analysis were used for statistical analysis, with significance level prefixed at 5%. Results: Median age of hospitalisation was 46.2 years and 48.39 years during first and second waves respectively, with male preponderance in second wave. There was a statistically significant difference in mean duration of stay (9.04 days v/s 7.53 days), mean Spo2 at admission (98.4% v/s 96.6%), ventilation requirement (1.5% v/s 8.7%), oxygen requirement and ICU care between the two waves.Conclusion: During the second COVID wave, significantly higher hospitalisation rates, intensive care requirements and inpatient mortality was observed. Elevated C Reactive Protein levels, lymphocytopenia, history of diabetes and other co-morbidities were associated with poor outcomes in both waves.

Current treatment landscape for obesity in Singapore

The rising prevalence of obesity in Singapore is a harbinger for a corresponding increase in obesity-related complications such as type 2 diabetes mellitus (T2DM) and coronary heart disease. Obesity is a complex disease driven by multiple factors, and hence, treatment cannot follow a 'one-size-fits-all' approach. Lifestyle modifications involving dietary interventions, physical activity and behavioural changes remain the cornerstone of obesity management. However, similar to other chronic diseases such as T2DM and hypertension, lifestyle modifications are often insufficient on their own, hence the importance of other treatment modalities including pharmacotherapy, endoscopic bariatric therapy and metabolic-bariatric surgery. Weight loss medications currently approved in Singapore include phentermine, orlistat, liraglutide and naltrexone-bupropion. In recent years, endoscopic bariatric therapies have evolved as an effective, minimally invasive and durable therapeutic option for obesity. Metabolic-bariatric surgery remains the most effective and durable treatment for patients with severe obesity, with an average weight loss of 25%-30% after one year.

Pleomorphic adenoma of the external auditory canal

ABSTRACT Pleomorphic adenoma (PA) of the external auditory canal (EAC) is a rare clinical entity with a few cases reported in the literature. The clinical diagnosis of these lesions can be formidable due to their rarity and unusual location. This tumor occurs at various other anatomical locations apart from the major salivary glands. A 30-year-old female presented with a two-year history of a gradually enlarging and painless mass in the left external auditory canal. The tumor was excised, and histopathological and immunohistochemical evaluation revealed a mixed tumor with both epithelial and stromal components of different proportions, recognized and classified today by the World Health Organization (WHO) as a pleomorphic adenoma. The post-operative course was uneventful, and at the 10-month follow-up, no recurrence of the pleomorphic adenoma was noted. We highlight the histological features and the immunohistochemical profile of the tumor and review the literature on glandular neoplasms of the EAC and their recent classification, emphasizing on the histogenesis, clinical presentations, and microscopic features of the tumor. In addition, we aim to discuss vital features in differentiating these tumors from other tumors of the external auditory canal to enable clinicians and pathologists to recognize this uncommon benign neoplasm.

The Impact of COVID-19 Pandemic on Influenza Surveillance: A Systematic Review and Meta-Analysis

Background: Influenza activity was reported to be below the seasonal levels during the Coronavirus disease?2019 (COVID?19) pandemic globally. However, during the severe acute respiratory syndrome corona virus?2 outbreak, the routine real?time surveillance of influenza?like illness and acute respiratory infection was adversely affected due to the changes in priorities, economic constraints, repurposing of hospitals for COVID care, and closure of outpatient services. Methods: A systematic review and meta-analysis were carried out to assess the pooled proportion of symptomatic cases tested for influenza virus before the current pandemic in 2019 and during the pandemic in 2020/21. An electronic search of PubMed/MEDLINE, Scopus, and Google Scholar was carried out for the articles reporting the impact of the COVID?19 pandemic on influenza surveillance among humans using search terms. The study was designed based on Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the meta-analysis was performed to synthesize the pooled proportion of patients sampled for influenza with 95% confidence interval (CI). Results: The nine qualified studies from the WHO European region, Canada, Japan, Germany, Italy, Spain, South Africa, and the United States were pooled by random?effects meta?analysis. The overall pooled proportion of symptomatic cases sampled for influenza surveillance before and during the pandemic was 2.38% (95% CI 2.08%–2.67%) and 4.18% (95% CI 3.8%–4.52%), respectively. However, the pooled proportion of samples tested for influenza before the pandemic was 0.69% (95% CI 0.45%–0.92%) and during the pandemic was 0.48% (95% CI 0.28%–0.68%) when studies from Canada were excluded. Conclusion: The meta-analysis concludes that globally there was a decline in influenza surveillance during the COVID?19 pandemic except in Canada.

Presence and development of strabismus in children with telecanthus, epicanthus and hypertelorism

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.

Intracranial Unruptured Right Internal Carotid Artery Aneurysm in A Cadaver: A Case Report

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.

The Impact of Coronavirus Disease 2019 Pandemic on Bronchiolitis (Lower Respiratory Tract Infection) Due to Respiratory Syncytial Virus: A Systematic Review and Meta-Analysis

The coronavirus disease 2019 (COVID‑19) pandemic has changed the epidemiology of respiratory syncytial virus (RSV) infection which accounts for most bronchiolitis and viral pneumonias in infants. This systematic review and meta‑analysis aimed to quantitatively assess the effect of the COVID‑19 pandemic on RSV‑associated bronchiolitis among hospitalized infants. The study protocol was registered in the PROSPERO database (CRD42022314000) and was designed based on Preferred Reporting Items for Systematic Reviews and Meta‑analyses guidelines updated in May 2020. The meta‑analysis component was modified appropriately to synthesize the pooled proportion of infants having RSV‑associated bronchiolitis before the COVID‑19 pandemic in 2019 and during the pandemic with 95% confidence interval (CI). We identified and screened 189 articles and systematically reviewed 50 full texts. Eight qualified studies from Europe and China, including 109,186 symptomatic cases of bronchiolitis before the pandemic in 2019 and 61,982 cases in 2020–2021 were pooled by random‑effects meta‑analysis. The quantitative analysis included laboratory‑confirmed RSV infection in 7691 infants with bronchiolitis reported before the pandemic in 2019. Meanwhile, during the pandemic, 4964 bronchiolitis cases were associated with RSV infection. The pooled proportion of RSV‑associated bronchiolitis cases before the pandemic in 2019 was 16.74% (95% CI 11.73, 22.43%, 95% prediction interval 0.032, 34.16). The pooled proportion of confirmed RSV cases during the pandemic in 2020/2021 was 19.20% (95% CI 12.01, 27.59%, 95% prediction interval 0.046, 42.35). There was an increase in RSV activity after the relaxation of stringent public health measures during the COVID‑19 pandemic.

Role of vacuum assisted closure in wound healing among patients attending a tertiary care hospital

Background: Vacuum assisted closure is procedure to aid in improved wound healing. This negative pressure wound therapy can be used in cases of both acute and chronic wounds. Objectives: To find out pattern of wound healing while using vacuum assisted closure for healing chronic non healing ulcers. Materials and methods: It was a prospective study conducted among patients admitted to the Department of General Surgery. Participant included had chronic non healing ulcer due to various etiologies. The study period was from October 2021 to December 2021. 50 participants were enrolled into the study. The data was compiled and analyzed using SPSS version 26. Results: The wound healing was better after day 3. There was significant positive change in wound healing with P value of less than 0.05 over the follow up period. No other factor was found to influence wound healing. Conclusion: Vacuum assisted closure would enhance wound healing among those suffering from chronic non-healing ulcer.

Are patients comfortable with medical students examining them?

A key feature of medical curricula across the world is the interaction of medical students with patients at teaching hospitals. However, patients may not be comfortable engaging with medical students in certain situations, and there are a number of possible reasons for this. Teaching hospitals often overlook the need to take consent for such interactions. Certain measures can be taken to increase the confidence of patients in the medical students treating them. Studies on the subject make it clear that this ethical question is common throughout the world.

PREVALENCE AND SOCIODEMOGRAPHIC CORRELATES OF SOCIAL ANXIETY DISORDER AMONG MEDICAL UNDERGRADUATES

Background: Social anxiety disorder is a common mental health disorder characterized by persistent fear of being embarrassed, humiliated, rejected and looked down by others. It can cause impairment in education and in professional achievement, quality of life and social relationships. The objective of this study was to measure the prevalence and study associated factors of social anxiety disorder among students of a tertiary medical college and hospital. Methods: This cross-sectional study was conducted among 403 medical students of a medical college and Hospital. The questionnaire used in the study had questions related to socio-demographic details and had the social phobia inventory (SPIN) questionnaire which was used to assess social anxiety disorder. Results: Out of 403 medical students, 61.53% (n=248) students were not having any type of social anxiety disorder. Among 38.46% (n=155) of students who were having SAD, 21.33%(n=86) were having mild SAD and 17.11% (n=69) were having signi?cant SAD. Mild social anxiety is considered as normal. Factors such as age, year of study, self- perception of facial appearance, history of chronic illness, academic performance satisfaction and language barrier were found to be statistically associated with SAD. Conclusion: Social anxiety disorder was signi?cantly associated with age, year of study, self perception of facial appearance, history of chronic illness, academic performance satisfaction and language barrier.

Fetus in Fetu as a suprarenal mass in a neonate - a rare and perplexing entity

Fetus in fetu (FIF) is a rare entity in which a malformed vertebrate fetus is incorporated within its twin. This entity should be differentiated from a teratoma, which has more malignant potential. We describe a neonate with a heterogeneous calcified suprarenal mass. The aspiration cytology revealed a heterogeneous cell population with spindle cells and small round blue cells. Operative and histopathologic examination showed features consistent with a fetus in fetu. This case report describes a rare entity and discusses its clinical presentation, cytological features on fine-needle aspiration, and the difficulties posed in its differentiation from a teratoma.

A Phantom-based Investigation Into the Influence of Low Tube Potential and Matrix Size on Radiation Dose and Image Quality for a 128 Slice Abdominopelvic Ct Protocol

@#Introduction: Reducing radiation dose for CT examinations has been accompanied by an increase in image noise. Studies have highlighted the application of a higher matrix size for improving image quality when assessing the lungs. This study aims to evaluate the influence of a low kVp and higher matrix size on radiation dose and image quality for abdominopelvic CT. Methods: This experiment was done on a 32 cm body phantom and scanned using a 128 slice CT scanner. The study utilised various combinations of kVp settings (140, 120, 100, 80 & 70) and matrix sizes (1024, 768 & 512). The image obtained was analysed objectively and subjectively. For objective analysis, we calculated SNR, and CNR. For subjective analysis, two radiologists evaluated the image in a 3-point scoring scale. Results: The study reported an increase in SNR (0.8%) and CNR (46%) at 120 kVp when increasing the matrix size from 512 x 512 to 768 x 768. Similarly, there was an increase of 14.5 % and 56.4 % in CNR and SNR using 1024 matrix size. The DLP was reduced by 4.5%, 50% and 70.6 % using 100, 80 and 70 kVp respectively. However, there was no change in DLP with higher matrix sizes. Conclusion: The study reported a combination of 100 kVp and 768 matrix size resulted in an almost similar (↓0.9 %) SNR and improved CNR (↑46.4 %) compared to 120 kVp and 512 matrix size. Qualitative analysis also showed a similar image quality with decreased radiation dose for abdominopelvic CT.

Effectiveness of Inspiratory Muscle Training on Respiratory Muscle Strength in Patients Undergoing Cardiac Surgeries: A Systematic Review With Meta-Analysis

To determine the effect of inspiratory muscle training (IMT) on pulmonary function, respiratory muscle strength (RMS), and functional capacity in patients undergoing cardiac surgery. The PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to June 2020. Randomized controlled trials (RCTs) that evaluated patients who underwent cardiac surgery were included in this review. Meta-analysis performed using a random-effects model showed that the mean difference in forced vital capacity, forced expiratory volume in 1 second, 6-minute walk distance, and RMS was 3.47% (95% confidence interval [CI], 0.57 to 6.36), 5.80% (95% CI, 2.03 to 9.56), 78.05 m (95% CI, 60.92 to 95.18), and 4.8 cmH2O (95% CI, -4.00 to 13.4), respectively. There is strong evidence that IMT improves inspiratory muscle strength, pulmonary function, and functional capacity, and reduces the length of hospital stay in patients undergoing cardiac surgery.

Effectiveness of Inspiratory Muscle Training on Respiratory Muscle Strength in Patients Undergoing Cardiac Surgeries: A Systematic Review With Meta-Analysis

To determine the effect of inspiratory muscle training (IMT) on pulmonary function, respiratory muscle strength (RMS), and functional capacity in patients undergoing cardiac surgery. The PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to June 2020. Randomized controlled trials (RCTs) that evaluated patients who underwent cardiac surgery were included in this review. Meta-analysis performed using a random-effects model showed that the mean difference in forced vital capacity, forced expiratory volume in 1 second, 6-minute walk distance, and RMS was 3.47% (95% confidence interval [CI], 0.57 to 6.36), 5.80% (95% CI, 2.03 to 9.56), 78.05 m (95% CI, 60.92 to 95.18), and 4.8 cmH2O (95% CI, -4.00 to 13.4), respectively. There is strong evidence that IMT improves inspiratory muscle strength, pulmonary function, and functional capacity, and reduces the length of hospital stay in patients undergoing cardiac surgery.

A Rare Annular Pancreatic Anomaly

During routine abdominal dissection of an adult male cadaver aged about 60 years, an anatomical variation was found in the pancreaticoduodenal area. The dissection was performed in the Department of Anatomy, JSS Medical College, Mysuru. It was observed that the pancreatic tissue completely encircled second part of duodenum. It consisted of a 360-degree pancreatic ring, it measured around 2 cm in width on its lateral aspect and 5 cm width on its posterior aspect. It measured 4 cm width on its anterior aspect. The part of the duodenum, which lies proximal and distal to the annular pancreas was found distended. A piece of annular pancreas was collected, later was subjected to the histopathological examination under H & E stain. The microscopic structure showed the normal architecture of the pancreatic tissue. Understanding the pancreas development is essential to understand its congenital defects. It develops from ventral and dorsal pancreatic buds; it lies near the developing primitive duodenum. Due to the axial rotation of the second part of the duodenum, the ventral pancreatic bud winds around the posterior surface of the duodenum to meet with the dorsal pancreatic bud. This normal event may tend to show some derangement leading to variable conditions of pancreatic anomalies like the annular pancreas, pancreas divisum, pancreatic duct defects, etc. Though the congenital pancreatic anomalies are relatively uncommon, they may remain asymptomatic for a long duration, often they may find incidentally in some investigations or during surgeries. During our routine dissections, we have come across one such anomaly of the annular pancreas. Meeting such anomalies or variations during gross anatomy dissections will certainly create an overwhelming interest among the students to understand and correlate its embryological basis, and its clinical implications. Annular pancreas (AP) was first described by Tiedemann (1818), the name “Annular Pancreas” coined by Ecker (1862). It is a rare congenital anomaly formed by a thin band of normal pancreatic tissue that completely or partially encircles the second part of duodenum. The reported incidence in adults varies from 0.005 to 0.015 %.1

Usefulness of salivary sialic acid as a tumor marker in tobacco chewers with oral cancer

Aim:This study aims to assess the usefulness of salivary sialic acid (SA) as a tumor marker in the detection of oral squamous cell carcinoma (OSCC) among tobacco chewers. Materials and Methods:After the approval of study protocol by the Institutional Ethics Committee and informed voluntary consent, salivary samples were collected from 96 participants in each group of tobacco chewers with OSCC, tobacco chewers without precancerous or cancerous lesion, and healthy controls. Salivary protein-bound SA (PBSA) and salivary-free SA (FSA) were measured by Yao et al.'s method of acid ninhydrin reaction, and the data were subjected to appropriate statistical analysis. Results: The salivary PBSA and FSA levels in the Groups 1, 2, and 3 participants were 31.17 ± 7.6 mg/dL and 63.45 ± 9.8 mg/dL, 25.45 ± 16.61 mg/dL and 33.18 ± 11.38 mg/dL, and 22.73 ± 3.01 mg/dL and 21.62 ± 8.86 mg/dL, respectively. Salivary FSA levels were significantly increased among the tobacco chewers with OSCC patients (Group 1) and tobacco chewers with no premalignant lesions of the oral cavity (Group 2) compared to the healthy controls (Group 3) with P < 0.05 being statistically significant. Salivary FSA levels were significantly increased in Group 1 as compared with Group 2. The salivary PBSA was high among Group 1 as compared to the control Group 3; there was however no significant difference in the levels of salivary PBSA between Group 1 and Group 2. There was no significant difference in the PBSA levels between OSCC patients of Group 1 and the tobacco chewers without precancerous or cancerous lesion in the oral cavity of Group 2. Conclusion: Salivary PBSA and FSA are significantly raised in both tobacco chewers with OSCC and in tobacco chewers with no precancerous or cancerous lesions in the oral cavity. SA should therefore be used cautiously while considering it as a marker for the early detection of oral cancer. Tobacco can be a crucial confounding factor when SA is used as a biomarker in OSCC since their levels are elevated to some extent even in tobacco chewers without any clinically obvious precancerous or cancerous lesions in the oral cavity