Role of fetal hemoglobin in the development and progression of retinopathy of prematurity in preterm infants.

Purpose: The objective of this study was to find the association between fetal hemoglobin (HbF) concentration and retinopathy of prematurity (ROP) in preterm infants. Methods: In this observational, prospective, longitudinal study, a total of 410 preterm infants with <36 gestational weeks and <2.5 kg birth weight, who were attending ROP clinic in a tertiary care hospital of central India for 1 year duration were included. Dilated fundus examination was done as per ROP screening guidelines, and ROP was staged as per international classification for retinopathy of prematurity (ICROP) classification, 2021. HbF (%) was measured with high-performance liquid chromatography, and data was analyzed statistically. The relationship between HbF (%) and ROP was evaluated. Those infants who had ROP were further divided into treatment-requiring and non-treatment-requiring groups and HbF was compared in these groups at the first visit and after 1-month follow-up period. The outcome of ROP was studied with HbF levels. Results: A total of 410 preterm infants were included, out of which 110 infants had ROP (26.8%). Infants with ROP had significantly lower percentage of HbF with gestational age groups and birth weight groups, compared to infants without ROP. Higher percentage of HbF was associated with a lower prevalence of ROP. Higher concentration of HbF was found in the ROP infants who regressed spontaneously without treatment and less concentration was found in those who progressed to a severe disease and those who required treatment. The predictive ability of HbF (%) was 0.976 for ROP. Conclusion: Low fraction of HbF was found to be significantly associated with the development and progression of ROP.

An ophthalmology professionalism survey tool: outcomes from a multi-center study in Central India.

Purpose: To describe a professionalism survey tool and its use to assess knowledge of medical professionalism in ophthalmology training programs in Central India. Settings and Design: Multi-center survey study. Methods: A validated 33-question, scenario-based survey addressing professionalism attributes was administered at five centers in central India. The attributes tested included "personal characteristics," "physician-patient relationships," "workplace practice and relationships," and "socially responsible behaviors." A mean attribute score (%) was calculated and compared to "gold standard" responses by a group of expert senior ophthalmologists (100% agreement for responses). Results: A total of 225 participants completed the survey; 124 residents, 47 fellows, and 54 consultants (98.4% response rate). The total mean attribute score was 80.7 ± 9.1 (min 16.67, max 100). There was variation in the mean attribute score by professionalism attribute (P < 0.001), and a trend toward higher mean attribute scores for consultants compared to trainees across all attribute groups. The scores for "personal characteristics" (93 ± 9.7) and "physician-patient relationship" (82 ± 15.8) were the highest, whereas scores for "socially responsible behaviors" (73.9 ± 18.6) and "workplace practices" were low (72 ± 13). Conclusions: There is a generally high level of professionalism knowledge among ophthalmologists in central India. The results suggest that experience does impact knowledge of professionalism. Potential for improvement in professionalism exists in around "workplace practices", and around "socially responsible behaviors". These findings may serve as a valuable discussion starter and teaching tool to enhance professionalism in ophthalmology training programs.

Review on the Degradation Mechanisms of Metal-N-C Catalysts for the Oxygen Reduction Reaction in Acid Electrolyte: Current Understanding and Mitigation Approaches.

One bottleneck hampering the widespread use of fuel cell vehicles, in particular of proton exchange membrane fuel cells (PEMFCs), is the high cost of the cathode where the oxygen reduction reaction (ORR) occurs, due to the current need of precious metals to catalyze this reaction. Electrochemists tackle this issue in the short/medium term by developing catalysts with improved utilization or efficiency of platinum, and in the longer term, by developing catalysts based on Earth-abundant elements. Considerable progress has been achieved in the initial performance of Metal-nitrogen-carbon (Metal-N-C) catalysts for the ORR, especially with Fe-N-C materials. However, until now, this high performance cannot be maintained for a sufficiently long time in an operating PEMFC. The identification and mitigation of the degradation mechanisms of Metal-N-C electrocatalysts in the acidic environment of PEMFCs has therefore become an important research topic. Here, we review recent advances in the understanding of the degradation mechanisms of Metal-N-C electrocatalysts, including the recently identified importance of combined oxygen and electrochemical potential. Results obtained in a liquid electrolyte and a PEMFC device are discussed, as well as insights gained from in situ and operando techniques. We also review the mitigation approaches that the scientific community has hitherto investigated to overcome the durability issues of Metal-N-C electrocatalysts.

Fetal hemoglobin, blood transfusion, and retinopathy of prematurity in preterm infants: An observational, prospective study.

Purpose: The objective of this study was to identify the association between fetal hemoglobin (HbF) concentration, blood transfusion, and retinopathy of prematurity (ROP) in preterm infants. Methods: This was an observational, prospective study. A total of 410 preterm infants born with <36 weeks gestational age and <2.0 kg birth weight in a tertiary care center of central India for a period of 1 year were included in this study. Clinical data were obtained from case notes. HbF of infants was measured in the blood sample using high-performance liquid chromatography at the first visit and after 1 month follow-up and was analyzed statistically. Dilated fundus examination was done as per ROP screening guidelines, and ROP was classified as per the International Classification of Retinopathy of Prematurity (ICROP), 2021. The study subjects were divided into two groups based on the status of ROP. The relationship among HbF, blood transfusion, and ROP was evaluated in both the groups. The relationship between other clinical characteristics and various neonatal risk factors was also studied between the groups. Results: A total of 410 preterm infants were included in this study, of which 110 infants had ROP (26.8%). Blood transfusion was found to be significantly associated with the development of ROP. Higher fraction of HbF (%) was associated with a lower prevalence of ROP. HbF was also inversely related with the severity of ROP. Conclusion: Replacing HbF by adult hemoglobin during blood transfusion may promote the development of ROP. Conversely, maintaining a higher percentage of HbF may be a protective factor against ROP.

Bilateral Optic Neuropathy in Association with Diffuse Cutaneous Systemic Sclerosis with Interstitial Lung Disease.

PURPOSE: To report a rare case of bilateral optic neuropathy in a patient with diffuse cutaneous systemic sclerosis with interstitial lung disease. METHOD: Retrospective case report. RESULT: A middle-aged female, who was a known case of systemic sclerosis with interstitial lung disease, was presented with sudden painless bilateral loss of vision for a month. The fundoscopy findings were suggestive of bilateral optic atrophy. Anti-topoisomerase I was found in the serum. Serum B12 and folate levels were reduced. HRCT Chest was suggestive of interstitial lung disease. MRI brain was normal and MRI orbit showed kinking of the left optic nerve. The findings were suggestive of diffuse cutaneous systemic sclerosis with interstitial lung disease and bilateral optic neuropathy. CONCLUSION: This is a rare case of bilateral optic neuropathy in a patient with diffuse cutaneous systemic sclerosis and interstitial lung disease with profound vision loss, in the absence of renal or cardiac involvement.

Neuroanaesthesia: should volatile anaesthetics or total intravenous anaesthesia be used?

The choice of anaesthesia technique for neurosurgical procedures has always been debatable. Despite the well-known effects of volatile anaesthetics on intracranial pressure, these are still widely used. This article explores the advantages and disadvantages of using volatile or total intravenous anaesthesia in patients undergoing neurosurgery.

Apert Syndrome: An Insight Into Dentofacial Features.

Apert syndrome is a developmental malformation characterised by craniosynostosis (premature fusion of cranial sutures), midface hypoplasia, and syndactyly of hands and feet. Early synostosis of the coronal suture, cranial base, as well as agenesis of the sagittal suture, result in characteristic appearance and dental features like maxillary transverse and sagittal hypoplasia with concomitant dental crowding, a pseudo-cleft palate, and skeletal and dental anterior open bite. In this report, we discuss a case of Apert syndrome, with special emphasis on craniofacial characteristics, a multidisciplinary approach to its treatment, and the dentist's role in management.

Pattern of uveitis in a tertiary eye care center of central India: Results of a prospective patient database over a period of two years.

Purpose: To identify the pattern of uveitis at a tertiary eye center in the central India and to compare with other reported studies. Methods: This prospective observational study was undertaken with all new uveitis cases attending the uvea clinic between January 2016 and September 2017. A standard clinical protocol and detailed investigations were done to find out the specific cause of uveitis. Results: A total of 210 patients with uveitis were evaluated. Anterior uveitis (47.1%) followed by intermediate uveitis (31.90%) were the most common type of uveitis in this study. Specific etiology of uveitis could be established in a majority of cases of uveitis (51.91%), except in intermediate uveitis group where the cause was mostly idiopathic (77.61%). Conclusion: Tuberculosis (46.29%) and viral etiology (38.88%) were the most common forms of infective uveitis (25.71%), whereas spondyloarthropathy (27.27%) and traumatic cause (14.54%) were the most common in the noninfective group of uveitis (26.19%).

On the Influence of Oxygen on the Degradation of Fe-N-C Catalysts.

Fe-N-C catalysts containing atomic FeNx sites are promising candidates as precious-metal-free catalysts for oxygen reduction reaction (ORR) in proton exchange membrane fuel cells. The durability of Fe-N-C catalysts in fuel cells has been extensively studied using accelerated stress tests (AST). Herein we reveal stronger degradation of the Fe-N-C structure and four-times higher ORR activity loss when performing load cycling AST in O2 - vs. Ar-saturated pH 1 electrolyte. Raman spectroscopy results show carbon corrosion after AST in O2 , even when cycling at low potentials, while no corrosion occurred after any load cycling AST in Ar. The load-cycling AST in O2 leads to loss of a significant fraction of FeNx sites, as shown by energy dispersive X-ray spectroscopy analyses, and to the formation of Fe oxides. The results support that the unexpected carbon corrosion occurring at such low potential in the presence of O2 is due to reactive oxygen species produced between H2 O2 and Fe sites via Fenton reactions.

Evaluation of complications and visual outcome in various nucleus delivery techniques of manual small incision cataract surgery.

Purpose: To evaluate various methods of nucleus delivery in manual small incision cataract surgery, with reference to visual outcome, intraoperative, and postoperative complications. Methods: In this prospective randomized interventional study, five groups of 40 cases each were constituted, with reference to nucleus delivery technique: (a) phacosandwich, (b) fishhook, (c) irrigating vectis, (d) viscoexpression, and (e) anterior chamber maintainer (ACM). Visual outcome, intraoperative, and postoperative complications were evaluated in detail. Follow-up was done on first and seventh postoperative days (PODs) and then at fourth and eighth postoperative weeks. Results: The most common intraoperative complication was intraoperative miosis, followed by intraoperative hyphema, seen more in phacosandwich and irrigating vectis groups. The most common postoperative complication was striate keratopathy followed by transient postoperative corneal edema and AC inflammatory response, seen more in phacosandwich and fishhook groups. With reference to visual acuity, on the first POD 95% cases of ACM group achieved visual acuity >+0.5 logMAR unit. The difference in the visual outcome among groups was statistically significant. On fourth and eighth postoperative weeks, best-corrected visual acuity among various groups was comparable. Conclusion: ACM and viscoexpression are effective techniques for early visual rehabilitation. Fishhook has limited utility in softer nuclear grades and black cataracts. Phacosandwich is more suitable for nuclear sclerosis Grades 3-4. Irrigating vectis, viscoexpression, and ACM technique are effective techniques for all grades of nucleus Postoperative surgical-induced astigmatism was comparable in all techniques.

Comparative Evaluation of the Remineralization Potential of Monofluorophosphate, Casein Phosphopeptide-Amorphous Calcium Phosphate and Calcium Sodium Phosphosilicate on Demineralized Enamel Lesions: An In Vitro Study.

AIM: The aim of the study is to compare the remineralization potential of monofluorophosphate, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and calcium sodium phosphosilicate on demineralized enamel lesions. MATERIALS AND METHODS: Enamel sections from 30 sound human premolar crowns were prepared and sectioned into quadrants. Early enamel lesions were created in each sample by immersion in a demineralizing solution for 72 hours. Of the four sections, the first quadrant (A) was not given any surface treatment, the second quadrant (B) was treated with monofluorophosphate dentifrice, the third (C) was treated with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and the fourth (D) was treated with calcium sodium phosphosilicate while being subjected to a five-day pH cycling protocol. The sections were further cross-sectioned to expose the lesion depth and were then viewed under the confocal laser scanning microscope after staining with 0.1 mM rhodamine B dye for 24 hours. The two parameters evaluated were the cross-sectional demineralized lesion area and total fluorescence. RESULTS: Amongst the dentifrices tested, the lowest values for lesion area and total fluorescence were recorded by calcium sodium phosphosilicate (3874.1 µ2 and 107282.6, respectively), followed by casein phosphopeptide-amorphous calcium phosphate (5776.6 µ2 and 129470.8) and then by monofluorophosphate dentifrice (7371.2 µ2 and 233765.9) in increasing order. The highest values for lesion area and total fluorescence were recorded by the no treatment group (16449.2 µ2 and 759743.1). One-way analysis of variance (ANOVA) showed significant variations (p<0.01) between the groups and Scheffe multiple comparisons confirmed the significance (p<0.01) of intergroup variations. CONCLUSION: The results of this study suggest that, among the three agents tested, calcium sodium phosphosilicate is the most effective remineralizing agent followed by casein phosphopeptide-amorphous calcium phosphate. Monofluorophosphate is the least effective remineralizing agent when tested under the conditions mentioned in this study.

Preparation and Electrochemical Properties of NiCo2 O4 Nanospinels Supported on Graphene Derivatives as Earth-Abundant Oxygen Bifunctional Catalysts.

This work reports on the facile synthesis and characterisation of a non-precious-metal bifunctional catalyst for oxygen reduction and evolution reactions (ORR and OER). A few-layer reduced graphene oxide-supported NiCo2 O4 catalyst is prepared using a rapid and easy two-step method of synthesis. It consists of the solvothermal poyl(vinylpyrrolidone)-assisted assembly of metal complexes onto few-layer graphene followed by a calcination step aiming at converting metal complexes into the spinel phase. Using this synthesis approach, the most active material demonstrates an outstanding activity towards the OER and ORR, making it one of the best bifunctional catalysts of these reactions ever reported. This composite catalyst exhibits improved bifunctional behaviour with a low reversibility criterion of 746 mV. The ORR process follows a four-electron pathway and the hydroxyl selectivity is higher than those with pure reduced graphene oxide or NiCo2 O4 materials, showing the synergistic effect between the two phases. Moreover, the high activity of this composite catalyst is confirmed by comparing its performance with those obtained on other cobaltite catalysts prepared using a different synthesis method, or those obtained using a different graphene-based support.

Epidemiology, clinical profile and factors, predicting final visual outcome of pediatric ocular trauma in a tertiary eye care center of Central India.

PURPOSE: Ocular trauma constitutes an important cause of preventable visual morbidity worldwide. This study was done to study the incidence, sociodemographic pattern, and clinical profile of ocular trauma in pediatric age group. Also to evaluate the factors influencing final visual outcome in these patients. METHODS: This was a prospective interventional study concerning ocular trauma in pediatric patients up to 16 years of age of either sex. Various variables having an impact on final visual outcome were studied, and results were analyzed using statistical indices - relative risk, Chi-square test, P value, and linear regression analysis. RESULTS: A total of 220 cases of trauma were evaluated with the mean age being 8.74 ± 3.93 years, males were predominantly affected and open globe injuries outnumbered blunt injuries. Penetrating injuries accounted for 67.79% cases of open globe injury, rupture being the least (2.54%). Stepwise multiple linear regression analysis executed, showed the best predictors in the descending order for final visual outcome were presenting visual acuity, size of corneal tear, type of injury, zone of injury, time period between injury and treatment with a variance of 35.9%, 6.3%, 5.3%, 3.7%, and 2.7%, respectively. All above variables were also found to be statistically significant (P < 0.05) on Chi-square test. CONCLUSION: We report the first study on the epidemiology and clinical outcomes of pediatric ocular trauma in central India. Poor initial Visual Acuity and posterior segment involvement adversely affect the visual outcome. Early medical treatment and globe-salvaging repair should be done in all eyes suffering from trauma.

Eye Donation Awareness and Conversion Rate in Hospital Cornea Retrieval Programme in a Tertiary Hospital of Central India.

INTRODUCTION: Corneal blindness accounts for 6-8 million blinds in the world. In India, it is estimated that there are approximately 6.8 million people who have vision less than 6/60 in at least one eye due to corneal diseases. AIM: This study was done to assess the awareness about eye donation amongst attendants of critically ill and deceased patients, their willingness to donate eyes, the efficacy of grief counselling by Eye Donation Counsellors (EDC), its impact on the conversion rate and the reasons for poor donation rate. MATERIALS AND METHODS: This prospective hospital based study was done in 554 participants (guardians of critically ill and deceased subjects) to understand the awareness of eye donation. Factors related to willingness for eye donation that influenced conversion to actual donation were evaluated. Data was analysed with tests for statistical significance: Chi square test; p<0.05 at 95% confidence interval was set as significant. RESULTS: Awareness index particularly in males <40 years, was found to be statistically more. In participants who were partially/fully aware of eye-donation, time taken for motivation remained less than 12 hours, which was statistically significant (Chi square=106. p<0.001). Subject who were aware, willing for donation in comparison to those who were unaware in a ratio of 2:1. Grief counsellors (57.5%) had the most influence among the causes that were facilitators of donation. CONCLUSION: Utilizing the services of eye donation counsellors is a promising way to motivate the guardians of deceased. Increasing the awareness in society, rendering simple assistances to next of kin and speeding the medico legal formalities can go a long way in increasing the conversion rate and hence actual donation.

Efficacy Profile of Intracameral Amphotericin B. The Often Forgotten Step.

PURPOSE: The objectives of this study were to assess visual and structural outcomes in mycotic keratitis after conventional treatment (topical and systemic antifungals) and intracameral amphotericin B (ICAMB), and to evaluate any complications. DESIGN: This was a prospective, nonrandomized, nonblinded interventional study. METHODS: This study was conducted on 104 eyes of 104 patients with fungal corneal ulcers. Patients were categorized into 2 groups: group A, who received conventional topical and systemic antifungal medications, and group B, who received ICAMB in the dose of 5 to 10 µg in 1 mL of 5% dextrose. Response to treatment was evaluated. Results of the 2 groups were compared with appropriate statistical indices. RESULTS: The mean final visual acuity in patients in group B receiving ICAMB was 1.22 ± 0.31 logMAR units. The improvement in mean visual acuity was 1.40 ± 0.2 logMAR units. In group A, mean visual outcome was 1.25 ± 0.73 logMAR units. There was an improvement by 0.55 ± 0.30 logMAR units. Healing with varying degrees of opacification occurred in a significant number of patients (81.48%) treated with ICAMB as compared with conventional treatment (Z = 2.24, P < 0.05). Complications, such as sloughing, occurred in significantly fewer patients treated with ICAMB as compared with conventional treatment (Z = 2.29, P < 0.05). CONCLUSIONS: In cases of keratomycosis where response to local and systemic antifungal treatment is not evident after 7 days, ICAMB can be safely administered to prevent the progression of ulcers and the development of complications.

Mis- or missed diagnosis: a series of four cases.

Diagnosis forms the backbone of treatment planning. Accurate diagnosis is essential to initiate the appropriate treatment at the apt time. Diagnosis involves eliciting the signs and symptoms of the patient and their accurate interpretations. The subtle signs that can go unnoticed lead to misdiagnosis and subsequent agony to the patient. Alertness on part of the clinician is important to avoid this error. Reported in this paper are four cases that were wrongly diagnosed either due to lack of clinical experience or due to omission of careful clinical, radiographic, and histopathological examinations.

The Effect of Preoperative Weight Loss before Gastric Bypass: A Systematic Review.

Background. Many insurance companies require obese patients to lose weight prior to gastric bypass. From a previous study by the same authors, preoperative weight at surgery is strongly predictive of weight loss up to one year after surgery. This review aims to determine whether preoperative weight loss is also correlated with weight loss up to one year after surgery. Methods. Of the 186 results screened using PubMed, 12 studies were identified. A meta-analysis was performed to further classify studies (A class, B class, regression, and rejected). Results. Of all 12 studies, one met the criteria for A class, six were B class, four were regression, and one was rejected. Six studies supported our hypothesis, five were inconclusive, and no study refuted. Conclusions. Preoperative weight loss is additive to postsurgery weight loss as predicted from the weight at the time of surgery.

Cardiovascular actions of selective estrogen receptor modulators and phytoestrogens.

Cardiovascular disease is the leading cause of death among men and women in Western societies. Over the past decade, interest in a better understanding of gender differences in cardiovascular disease has heightened. Concomitantly, the use of hormone therapy for cardiovascular risk reduction in postmenopausal women has come into question in light of recent landmark clinical studies casting doubt on the benefits of this therapy. As a consequence, alternatives to conventional hormone replacement, including selective estrogen receptor modulators and phytoestrogens, have attracted considerable attention. The authors provide an up-to-date review of the clinical actions of selective estrogen receptor modulators on cardiovascular disease. The actions of tamoxifen, raloxifene, droloxifene, and soy phytoestrogens are discussed in the context of cardiovascular disease epidemiology, coronary events, clinical markers of cardiovascular risk, and vascular function. In addition, the authors' current understanding of the mechanism of action of these agents is discussed and recommendations for clinical practice are reviewed.

Soy protein with isoflavones has favorable effects on endothelial function that are independent of lipid and antioxidant effects in healthy postmenopausal women.

BACKGROUND: Controversy exists about the ability of soy protein and isoflavones to modulate vascular reactivity and biochemical cardiovascular disease risk markers in healthy, normolipidemic postmenopausal women. OBJECTIVE: The objective was to investigate whether the consumption of soy protein with isoflavones would result in improved vascular reactivity and decreased biochemical markers of endothelial dysfunction and inflammation, independent of enhanced lipid and antioxidant effects. DESIGN: Healthy postmenopausal women (n = 28) were enrolled in a randomized, double-blind, crossover study, and they consumed 25 g of 3 protein products/d for 6 wk each, with intervening washout periods. The products were isolated soy protein with isoflavones, ethanol-washed isolated soy protein with trace isoflavones, and total milk protein, which supplied 107, 2, and 0 mg total isoflavone (aglycone) units/d, respectively. We studied vascular function by using brachial artery reactivity values, plasma concentrations of vasoactive factors, endothelial inflammatory markers, and plasma isoflavone concentrations. The resistance of whole plasma and isolated LDL to copper-mediated oxidation was measured by conjugated diene formation. RESULTS: Postocclusion peak flow velocity of the brachial artery was significantly (P = 0.03) lower after treatment with isolated soy protein with isoflavones, which is consistent with a vasodilatory response, than after treatment with total milk protein. Plasma isoflavones and metabolites were significantly (P < 0.01) higher after treatment with isolated soy protein with isoflavones. There were no significant changes in biochemical cardiovascular disease risk markers or conjugated diene formation between the 3 dietary groups. CONCLUSION: Daily consumption of soy protein with isoflavones can result in positive vascular effects that are independent of lipid and antioxidant effects in healthy postmenopausal women.

Unusual presentation of an acute inferior myocardial infarction.

There is a paucity of data on pseudoaneurysms of native coronary arteries; however, several reports exist on coronary artery aneurysms, which occur in approximately 1.5% of patients studied at autopsy or during cardiac catheterization. Patients can present with a wide range of symptoms from asymptomatic to sudden death. Complications include angina, myocardial infarction, fistula formation, spontaneous rupture, and distal embolization as a result of thrombus formation within the aneurysm. Treatment options include surgical ligation with coronary artery bypass surgery and implantation of a covered stent. Coronary anomalies and nonatherosclerotic coronary artery diseases should be suspected when a young patient presents with a myocardial infarction. Additionally, coronary aneurysm or pseudoaneurysm should be considered in patients with connective tissue disorder or the suggestion of connective tissue disorder. These entities may present as masses radiographically or echocardiographically. A high clinical suspicion is required for appropriate diagnosis and treatment.