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Background & Objectives: Verbal autopsy (VA) is the systematic and retrospective inquiry (from relatives) about the symptoms of an illness prior to death. In tribal India, 67-75 per cent of deaths occur at home with an unknown cause of death (CoD). Hence, the aim of this study was to determine the CoD in the 16-60 yr age group utilizing VA. Methods: A prospective, community based longitudinal study was conducted in 32 tribal villages in the Melghat region of Maharashtra, between 2004 and 2020. Number of deaths and VAs in 16-60 yr age group were collected by village health workers (VHWs) and supervisors, verified by five different persons (internal-external) and cross-checked by three VA interpretation trained physicians. A modified version of WHO VA was used. Cause-specific mortality fractions were calculated. Results: Of the 1011 deaths recorded, mortality in males was significantly higher than females (P<0.001). A total of 763 VAs were conducted which revealed that tuberculosis was the leading CoD, followed by jaundice, heart diseases, diarrhoea, central nervous system infections and suicide. Suicides were significantly more common among males than in females (P=0.046). Significantly, more deaths occurred during the monsoon (P=0.002), especially diarrhoeal deaths (P=0.024). Interpretation & conclusions: The findings of this study suggest that, in Indian tribal areas, infectious diseases are the leading causes of morbidity and one of the major causes of deaths in economically productive age group. Intensified VHW-mediated interventions are required to reduce the premature deaths.
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Suicídio , Masculino , Feminino , Humanos , Causas de Morte , Estudos Retrospectivos , Estudos Longitudinais , Autopsia , Estudos Prospectivos , Índia/epidemiologiaRESUMO
PURPOSE: To study vessel density (VD) on optical coherence tomography angiography at choroid, chorio-capillaries (CC) and various retinal levels in normal population and various stages of dry AMD and how these changes progress with increase in severity of the disease. METHODS: Prospective, observational, cross-sectional study was done on 252 eyes of 132 patients (males: 61, females: 71) presenting to tertiary-care centre in Central India between February 2021 and January 2022. For study purpose, eyes were divided into five groups according to the size and number of the drusen, viz, Group 1: No AMD (< 50 years), Group 2: No AMD (> 50 years), Group 3: Early AMD, Group 4: Intermediate AMD and Group 5: Advanced AMD. In all eyes, VD was measured at choroid, CC, deep capillary plexus (DCP) of retina and superficial capillary plexus (SCP) of retina. RESULTS: The mean age in case cohort is 61.90 ± 7.97 years. The mean vascular density differed significantly across diagnosis types in all the quadrants (p < 0.05) at choroid, CC and DCP level. At SCP level, the differences were significant across the groups except at the central quadrant. Vessel density was found to be more in early AMD cohort when compared to No AMD (> 50 years) cohort at SCP and DCP level, while it showed continuous reduction later in intermediate and advanced AMD cohort. CONCLUSION: With increase in the severity of disease, significant reduction in VD is also seen in retinal plexuses, along with the changes in choroid and CC. These VD maps may play a role as non-invasive biomarkers for healthy and diseased ageing.
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Degeneração Macular , Vasos Retinianos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Envelhecimento , Capilares , Corioide/irrigação sanguínea , Estudos Transversais , Angiofluoresceinografia/métodos , Degeneração Macular/diagnóstico , Estudos Prospectivos , Retina , Tomografia de Coerência Óptica/métodosRESUMO
PURPOSE: To evaluate the factors influencing final visual outcome after surgical repair of open globe injuries (OGIs) and to correlate the Ocular Trauma Score (OTS) system. METHODS: Prospective cross-sectional study of patients with OGIs from International Globe and Adnexal Trauma Epidemiology Study (IGATES) database at a tertiary referral eye centre in Central India over 2 years. Pre-operative factors affecting final visual outcome and correlation with OTS were evaluated. RESULTS: 208 patients had ocular trauma, of which data from 42 eyes with OGIs were reviewed. The majority of the patients were men (32, 76.2%) below the age of 40 (31, 73.8%). Patients were followed up for at least 6 months. Initial visual acuity (VA) was ≥ 20/40; 2 (4.8%), 20/200 to 20/50; 2 (4.8%), 1/200 to 19/200; 7 (16.7%), LP to HM; 26 (61.9%) and NLP (5, 11.9%). Final VA was ≥ 20/40; 1 (2.4%), 20/50 to 20/200; 8 (19.1%), 1/200 to 19/200; 9 (21.4%), LP to HM; 17 (40.5%) and NLP; 7 (16.7%). Univariate analysis of pre-operative variables showed initial VA (p = 0.0004), presence of hyphaema (p = 0.0323), laceration involving cornea visual axis (p = 0.0192) and retinal detachment (p = 0.0299) were significant prognostic factors in final visual outcome. OTS in our study does not fully correlate with international OTS system. CONCLUSIONS: Initial VA, hyphaema, visual-axis involving cornea laceration and retinal detachment are significant prognostic factors in OGIs. OTS remains a largely effective tool in counselling trauma patients.
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Ferimentos Oculares Penetrantes , Traumatismos Oculares , Estudos Transversais , Traumatismos Oculares/complicações , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/epidemiologia , Ferimentos Oculares Penetrantes/diagnóstico , Ferimentos Oculares Penetrantes/epidemiologia , Ferimentos Oculares Penetrantes/cirurgia , Feminino , Humanos , Índia/epidemiologia , Masculino , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Índices de Gravidade do TraumaRESUMO
PURPOSE: Tubercular retinal vasculitis (TRV) is a heterogeneous disease that can be difficult to manage because of nonspecific presentation and limitations of confirmatory tests for tuberculosis. This is a big data analysis on phenotypes and treatment outcomes for TRV. METHODS: Multicentre retrospective study of patients with TRV between January 2004 and December 2014 and a minimum follow-up of 1 year. RESULTS: Two hundred and fifty-one patients with TRV with a mean age of 38.9 ± 14.4 years (range, 9-86 years) were included. The patients were predominantly males (n = 167/251; 66.5%) of Asian ethnicity (n = 174/246; 70.7%), and geographical origin (n = 137/251; 54.6%). Most patients had features of occlusive type of RV (n = 113/185; 61.1%) except Caucasians (n = 11; 28.2%). There was no significant difference in treatment failure whether patients received antitubercular therapy (ATT) (P = 0.29), although treatment failure was less frequent in patients who received ATT (13.6%; n = 31/228) compared with those who did not (21.7%, n = 5/23). Less treatment failures were observed in patients with occlusive type RV who received ATT; however, this was not significant on survival analysis (P = 0.09). Treatment with ATT was associated with higher failure rates in patients of Hispanic and African American race and those with TRV associated with panuveitis (compared with posterior uveitis). CONCLUSION: In this multinational study of TRV, there was no significant therapeutic effect of ATT. However, a definitive conclusion about the role of ATT could not be made because of a few patients who did not receive ATT. Because this is a retrospective study with a limited 1-year follow-up, the effect of ATT may have been overestimated (or underestimated) in the duration of follow-up.
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Vasculite Retiniana/diagnóstico , Tuberculose Ocular/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Criança , Quimioterapia Combinada , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Recidiva , Vasculite Retiniana/tratamento farmacológico , Vasculite Retiniana/microbiologia , Estudos Retrospectivos , Resultado do Tratamento , Tuberculose Ocular/tratamento farmacológico , Tuberculose Ocular/microbiologia , Adulto JovemRESUMO
In developing countries, livestock are often fed a high-lignin, low-nutrient diet that is rich in aromatic compounds. It is therefore important to understand the structure of the microbial community responsible for the metabolism of these substances. A metagenomic analysis was therefore carried out to assess the microbial communities associated with the liquid and solid fractions of rumen biomaterial from domestic Mehsani buffalo (Bubalus bubalis) fed with varying proportions of roughage. The experimental design consisted of three feeding regimes (50, 75 and 100 % roughage) and two roughage types (green and dry). Genes associated with aromatic compound degradation were assessed via high-throughput DNA sequencing. A total of 3914.94 Mb data were generated from all treatment groups. Genes coding for functional responses associated with aromatic compound metabolism were more prevalent in the liquid fraction of rumen samples than solid fractions. Statistically significant differences (p < 0.05) were also observed between treatment groups. These differences were dependent on the proportion of roughage fed to the animal, with the type of roughage having little effect. The genes present in the highest abundance in all treatment groups were those related to aromatic compound catabolism. At the phylum level, Bacteroidetes were dominant in all treatments closely followed by the Firmicutes. This study demonstrates the use of feed type to selectively enrich microbial communities capable of metabolizing aromatic compounds in the rumen of domestic buffalo. The results may help to improve nutrient utilization efficiency in livestock and are thus of interest to farming industries, particularly in developing countries, worldwide.
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Ração Animal/análise , Bactérias/metabolismo , Búfalos/microbiologia , Fibras na Dieta/metabolismo , Microbioma Gastrointestinal , Rúmen/microbiologia , Compostos Orgânicos Voláteis/metabolismo , Animais , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação , Biodiversidade , Búfalos/metabolismo , Metagenômica , Filogenia , Rúmen/metabolismoRESUMO
BACKGROUND: Left atrial (LA) volume indexing for body surface area (BSA) is the common practice. Since LA volume index is of cardiovascular pathophysiologic significance, it is suggested that indexing for other body size parameters be explored to evaluate a more appropriate alternative method. The aims of this study were to find normal and the best cutoff values for LA volume indexed for multiple body size parameters in normal Indian subjects. METHODS: Data from the multicentric prospective INDEA study conducted through 2018 to 2020 was reviewed and subjects without known cardiac disease and completely normal echocardiograms that had the left atrial volume (LAV) measured by biplane Simpson's method were included. LAV was indexed by BSA (ml/m2), by height (LAV/m), by height raised to exponent 1.72 (mL/m 1.72 and 2.7 (ml/m2.7), by body weight, by ideal body weight (IBW), by ideal body surface area (IBSA) and by height squared (ml/h2). RESULTS: A total of 1046 healthy volunteers (382 female, 38%), mean age 38 ± 10.4 years (range 30-48 years) and body mass index 23.6 kg/m2 (22-25 kg/m2) were analyzed. Mean and normal values were: LAV/BSA 18.7 + 3.15 ml/m2 (range 15-21 ml/m2), LAV/ht 26.0 ± 4.5 ml/m, (range 17-35 ml/m), LAV/ht2 16 ± 2.8 ml/m2 (range 10.4-21.6 ml/m2) and LAV/ht2.7 8.71 ± 2.2 ml/m2.7 (range 6.98-13.58 ml/m2.7). Using ROC curve analysis, LAV/h 1.72 had the highest AUC and the best predictive value to identify LA enlargement but not very different from LAV/BSA. Ideal BSA and ideal body weight as a denominator did not provide any incremental value. CONCLUSION: Normal values for LAV indexed for height, weight, body surface area by three different methods of height as an allometric parameter are described in normal Indian individuals. We reinforce that LA volume indexation for BSA is an acceptable and robust method in non-obese Indian subjects. Indexing for height 1.72 is probably slightly superior method to evaluate LAV.
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Tamanho Corporal , Ecocardiografia , Átrios do Coração , Humanos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Masculino , Índia/epidemiologia , Estudos Prospectivos , Adulto , Pessoa de Meia-Idade , Ecocardiografia/métodos , Tamanho Corporal/fisiologia , Índice de Massa Corporal , Voluntários Saudáveis , Valores de Referência , Superfície Corporal , Tamanho do ÓrgãoRESUMO
PURPOSE: To evaluate real-world outcomes with neovascular age-related macular degeneration (nAMD) in relation to anatomical success, visual outcomes, and safety of intravitreal brolucizumab (IVBr) injection at 1.5 years. METHODS: Prospective, randomized, single-center study between December 2020 and December 2022 that included 71 eyes of 62 patients with nAMD, who received IVBr. Patients were divided into three groups, i.e., naïve choroidal neovascular membrane (CNVM), switched therapy (st) CNVM, and st polypoidal choroidal vasculopathy (stPCV). They were subdivided into dry, minimal fluid (fluid <50 microns)/pigment epithelial detachment (PED) and persistent fluid (fluid >100 microns)/PED subgroups depending upon the fluid level at the end of 1.5 years. Best-corrected visual acuity (BCVA), central macular thickness (CMT), status of fluid, and number of injections at 1.5 years were evaluated. From the beginning, patients were treated on pro re nata (PRN) basis. RESULTS: Of the 71 eyes, 27 eyes (38%) were naïve CNVM, 35 eyes (49.3%) were stCNVM, and 9 (12.7%) were stPCV cases. Significant vision improvement after 1.5 years was seen in the stCNVM category (P = 0.001), while CMT reduction was significant in all three groups (P < 0.05). The mean number of injections required in naïve CNVM and stCNVM groups was significantly less as compared to the stPCV group (P = 0.017). Further, vision improvement was significant in the "Minimal fluid" subgroup (P = 0.002), while the CMT improvement was significant in the "Minimal fluid" and "Dry" subgroups each with P < 0.0001. No ocular/systemic adverse events including intraocular inflammation (IOI) were noted. CONCLUSION: In a real-world scenario, with 203 procedures and 1.5-year follow-up, brolucizumab is found to be efficacious and safe with the need for a lesser number of injections and more interval-free period in the management of naïve CNVM, stCNVM, and stPCV patients.
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Neovascularização de Coroide , Descolamento Retiniano , Humanos , Lactente , Inibidores da Angiogênese , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/tratamento farmacológico , Injeções Intravítreas , Estudos Prospectivos , Descolamento Retiniano/tratamento farmacológico , Epitélio Pigmentado da Retina , Tomografia de Coerência Óptica/métodos , Acuidade VisualRESUMO
OBJECTIVES: This pilot study was undertaken to know the normal values of cord blood insulin and glucose levels in full-term normal pregnancies and pregnancies complicated with maternal conditions like pregnancy induced hypertension (PIH), thyroid dysfunction and Gestational Diabetes Mellitus (GDM). METHOD: Full-term pregnancies from Ketkar maternity hospital, Nagpur, since January 2011 were included in the study. A total of 121 cases have been studied. Demographic and clinical data of the included cases was obtained from the hospital records. Cord blood sample was analyzed for serum insulin and plasma glucose levels. These two metabolic parameters were used to derive (Homeostatic Model Assessment) HOMA index for insulin resistance and Glucose-to-Insulin Ratio (GIR). The data on physical and metabolic parameters was analyzed using parametric statistical significance tests for means and correlation using R-package RESULT: The difference in glucose concentration was found insignificant (p > 0.05) across complicated and uncomplicated pregnancies. However, for the comparison 'no complications' vs PIH, the insulin levels differed significantly at 10% (p = 0.09). Accordingly, for the same comparison, GIR also indicated significant difference at 10% (p = 0.07) between the two maternal groups. The mean cord blood glucose level was higher in PIH cases compared to un-complicated maternal cases; while the mean insulin level was lower in PIH cases as compared to non-complicated cases, as a result mean GIR was higher in PIH category. HOMA did not show significant difference in any comparison. The relationship of metabolic parameters and the derived variables with birth weight in the two maternal groups showed insignificant relationships between birth weight and dependent variables (p > 0.05). CONCLUSION: The levels of insulin and glucose in normal full-term pregnancies was found to be 6.75 +/- 2.96 mIU/ ml and 91.69 +/- 27.05 mg/dl respectively with GIR of 13.57 +/- 7.47 and HOMA 1.57 +/- 0.83. Low serum insulin levels with normal or high GIR was noted in pregnancies complicated by PIH. Insulin resistance as measured by HOMA IR is increased in patients with hypothyroidism. Hyperinsulinemia is seen in babies with birth weight less than 2.5 kg or more than 3.5 kg.
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Glicemia/metabolismo , Sangue Fetal/metabolismo , Insulina/sangue , Gravidez/sangue , Adulto , Peso ao Nascer/fisiologia , Feminino , Sangue Fetal/química , Humanos , Resistência à Insulina , Projetos Piloto , Valores de ReferênciaRESUMO
BACKGROUND: Melghat in India is a hilly, forested, difficult to access, impoverished rural area in northeast part of Maharashtra (Central India) with difficult healthcare access. Melghat has very high Mortality rates, because of grossly inadequate medical facilities. (1) Home deaths contribute to 67% of deaths,(2) which are difficult to track and where cause of death is mostly unknown. METHODS: A feasibility study was carried out in 93 rural villages and 5 hospitals to assess feasibility of tracking real-time community mortality and to ascertain cause of death in 0-60 months and 16-60 years age group using Minimal Invasive Tissue Sampling (MITS) in purpose-modified ambulance. We used the network of village health workers (VHW)s, to establish real-time community mortality tracking. Upon receipt of reports of home death, we performed MITS within 4 h of death in the vicinity of the village. RESULTS: We conducted 16 MITS. Nine, in MITS ambulance in community and seven at MAHAN hospital. The acceptance rate of MITS was 59.26%. Standard operating procedure (SOP) of conducting community MITS in an ambulance, is established. Major challenges were, Covid19 lockdown, reluctance of tribal parents for consent for MITS due to illiteracy, superstitions and fear of organ removal. Ambulance was an easy to reach transport means in remote area, provided a well-designed and discrete facility to perform MITS in community, winning the confidence of bereaved family. This has reduced time interval between time of death and performing MITS. CONCLUSIONS: MITS in purpose-modified Ambulance can be used worldwide for community MITS especially in areas which are remote and lack healthcare access. This solution needs to be assessed in different cultural settings to document culture specific issues.
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Background: Various recent studies have reported that exclusive right nostril breathing (RNB) and left nostril breathing (LNB) has an immediate and sustained effect under various medical conditions. In the present study, we evaluated the effect of short-term left nostril breathing on various sleep parameters in medical students. Methods: We hypothesized that the increase in vagal tone because of LNB can help in improving the quality of sleep. The baseline sleep quality was documented before the start of study in the case and the control group using the 'Pittsburgh Sleep Quality Index' (PSQI) questionnaire. A PSQI global score of more than 5 indicates poor sleep quality. The case group practiced LNB in a graduated manner for a period of 4 weeks. Thereafter, sleep quality was documented for both the groups using the PSQI questionnaire. Results: Practicing LNB significantly lowered all the seven component scores (p < 0.05) and the global PSQI score in the case group (p-value < 0.0001), suggesting that this practice effectively improved the sleep quality in the individuals of this group. Conclusions: Overall, this study suggested that exclusive LNB practice could serve as an important lifestyle modification that can be incorporated in the routine of medical students for improving their sleep quality.
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PURPOSE: To assess the prediction accuracy of intraocular lens (IOL) formulas and study the effect of axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), and lens thickness (LT) on the accuracy of formulas using optic biometry. METHODS: This study was performed on 164 eyes of 164 patients who underwent uneventful cataract surgery. Ocular biometry values were measured using Lenstar-900, and intraocular lens (IOL) power was calculated using the SRK/T, SRK II, Hoffer Q, Holladay 2, and Barrett Universal II formulas. We evaluated the extent of bias within each formula for different ocular biometric measurements and explored the relationship between the prediction error and the ocular parameters by using various IOL formulas. RESULTS: The summarization of refractive prediction error and absolute prediction error for each IOL formulation was performed after adjusting the mean refractive error to zero. The deviation in the error values was minimum for SRK/T (0.265) followed by Holladay 2 (0.327) and Barret (0.382). Further, SRK/T had the lowest median (0.15) and mean (0.198) absolute error as compared to other formulations. For the above formulations, 100% of the eyes were in the diopter range of ±1.0. It was observed that the overall distribution of error was closer to zero for SRK/T, followed by Holladay 2 and then Barrett. CONCLUSION: In summary, we found that accuracy was better in SRK/T formula. We achieved a better understanding of how each variable in the formulas is relatively weighed and the influencing factors in the refraction prediction.
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Lentes Intraoculares , Facoemulsificação , Biometria , Humanos , Implante de Lente Intraocular , Óptica e Fotônica , Refração Ocular , Estudos RetrospectivosRESUMO
Background Acute pancreatitis is a reversible inflammation of the pancreatic parenchyma. Enlargement of the pancreas is often envisaged in such conditions. This study evaluates P/V ratio, as a marker to decide pancreatic enlargement in disease condition. Purpose The aim of this study was to develop imaging-based diagnostic criterion for acute pancreatitis in children based on P/V ratio. Material and Methods This study included 37 children with acute pancreatitis and 283 children asymptomatic for pancreatic disorders, from a single hospital center. The age of children ranged between 2 and 18 years. P/V ratio, which is the ratio of greatest anteroposterior dimension of the head, body, and tail of the pancreas relative to the transverse lumbar vertebral body, was obtained for each child through ultrasonographic examination. Age-adjusted receiver operating characteristics (AROC) analysis was performed on P/V ratio at presentation for each pancreatic region, and the sensitivity at 90% specificity, the threshold errors, and the corresponding cutoffs were obtained. The enlargement assessment was also done after clinical recovery by referring to the cutoffs of respective regions. Results AROC analysis for males and females resulted into a maximum sensitivity of 83.33 and 81.67%, respectively, at 90% specificity for head. The error thresholds for both the groups were same, i.e., 0.098, indicating that 90% of the observations had errors less than the threshold. The corresponding P/V ratio cutoff for males and females was 0.43 and 0.42, respectively. Conclusion Radiologists and clinicians can refer a cutoff value of 0.4 for each region, along with hypoechogenicity, to decide about enlargement of the pancreas in acute pancreatitis condition.
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Purpose: To study the relevance of preoperative OCT predictors in large macular holes (MH) treated using the inverted ILM peel technique. Methods: Prospective study of 95 patients undergoing vitrectomy for large MH between January 2019 and December 2020 was performed by dividing the patients into groups depending on various quantitative parameters and indices of MH such as base diameter (BD), hole form factor (HFF), macular hole index (MHI), diameter hole index (DHI), and tractional hole index (THI) by using parameters such as minimal hole diameter, hole height, nasal and temporal arm lengths. Depending upon the duration of symptoms, patients were divided into three groups: <3 months, 3-6 months, and >6 months. Anatomical success rate, type of closure, and postoperative vision gain were analyzed in relation to the abovementioned diameters, indices, and duration to see if any significance existed. Results: The mean age of patients included in the study was 60.48 ± 13.88 years, with female preponderance (males: females = 37:58). Change in logMAR was statistically significant individually with all studied parameters (P < 0.0001) without influence of size of hole and other indices. BD and DHI levels showed significant association with type of closure as indicated by P values of 0.017 and 0.048, respectively. Duration of symptoms showed no significance in terms of anatomical and functional success. Conclusion: OCT predictors of MH success seem to have lost relevance with inverted flap surgeries as 100% anatomical success is achieved with this technique, with 95.78% (91/95) achieving type 1 closure with statistically significant equivalent functional gain across the indices with no effect of duration of symptoms.
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Perfurações Retinianas , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/cirurgia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Vitrectomia/métodosRESUMO
BACKGROUND: Melghat, an impoverished rural area in Maharashtra state, India; has scarce hospital services and low health-seeking behaviour. At baseline (2004) the under-five mortality rate (U5MR) (number of deaths in children aged 0-5 years/1000 live births) was 147.21 and infant mortality rate (IMR) (number of deaths of infants aged under 1 year/1000 live births) was 106.6 per 1000 live births. We aimed at reducing mortality rates through home-based child care (HBCC) using village health workers (VHWs). METHODS: A cluster-randomised control trial was conducted in 34 randomly assigned clusters/villages of Melghat, Maharashtra state, between 2004 and 2009. Participants included all under-five children and their parents. Interventions delivered through VHWs were patient-public involvement, newborn care, disease management and behaviour change communications. Primary outcome indicators were U5MR and IMR. Secondary outcome indicators were neonatal mortality rate (NMR) (number of neonatal deaths aged 0-28 days/1000 live births) and perinatal mortality rate (PMR) (number of stillbirths and early neonatal deaths/1000 total births). Analysis was by intention-to-treat at the individual level. This trial was extended to a service phase (2010-2015) in both arms and a government replication phase (2016-2019) only for the intervention clusters/areas (IA). FINDINGS: There were 18 control areas/clusters (CA) allocated and analysed with 4426 individuals, and 16 of 18 allocated IA, analysed with 3230 individuals. The IMR and U5MR in IA were reduced from 106.60 and 147.21 to 32.75 and 50.38 (reduction by 69.28% and 65.78%, respectively) compared with increases in CA from 67.67 and 105.3 to 86.83 and 122.8, respectively, from baseline to end of intervention. NMR and PMR in IA showed reductions from 50.76 to 22.67 (by 55.34%) and from 75.06 to 24.94 (by 66.77%) respectively. These gains extended to villages in the service and replication phases. INTERPRETATION: This socio-culturally contextualised model for HBCC through VHWs backed up with institutional support is effective for significant reduction of U5MR, IMR and NMR in impoverished rural areas. This reduction was maintained in the study area during the service phase, indicating feasibility of implementation in large-scale public health programmes. Replicability of the model was demonstrated by a linear decline in all the mortality rates in 20 new villages during the government phase. TRIAL REGISTRATION NUMBER: NCT02473796.
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Mortalidade da Criança , Morte Perinatal , Criança , Cuidado da Criança , Feminino , Humanos , Índia/epidemiologia , Lactente , Mortalidade Infantil , Recém-Nascido , GravidezRESUMO
Aim To determine the role of diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) values in differentiating benign and malignant orbital masses. Materials and Methods After obtaining institutional ethical board approval and informed consent from all patients, an observational study was done for a period of 24 months in the radiology department of a tertiary care hospital in South India. Conventional magnetic resonance imaging and DWI using a 3T scanner was done for all patients with suspected orbital mass lesion. ADC value and clinicohistopathological correlation were studied for every patient. Chi-square test was used to compare the signal characteristics of DWI and ADC maps between benign and malignant lesions. A comparison of mean ADC values for benign and malignant masses was performed using Student's t -test for independent samples. The cut-off value for ADC was obtained using the receiver operating characteristic (ROC) curve. Results Of 44 patients with orbital lesions, 70% were benign and 30% were malignant. There was a significant difference in the mean ADC values of benign and malignant orbital masses. Using ROC curve analysis, an optimal ADC threshold of 1.26 × 10 -3 mm 2 /s was calculated for the prediction of malignancy with 100% sensitivity, 80.65% specificity, and 86.36% accuracy (95% confidence interval: 0.872, 1.00, p < 0.0001). Two ADC thresholds were used to characterize the orbital masses with more than 90% confidence. Conclusion Quantitative assessment of ADC is a useful noninvasive diagnostic tool for differentiating benign and malignant orbital masses. Malignant orbital lesions demonstrate significantly lower ADC values as compared with benign lesions.
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PURPOSE: To study the success rate of LASER as a primary modality of treatment in aggressive posterior retinopathy of prematurity (APROP) cases. METHODS: This is a prospective case series of 56 eyes of 28 preterm babies (males = 21) with APROP who underwent laser therapy. Babies were divided into groups on the basis of gestational age (GA), birth weight (BW), and postmenstrual age (PMA) at which treatment was performed. GA (in weeks): < 28 (n = 7), 28-30 (n = 11), > 30 (n = 10). BW (in grams): < 1000 (n = 8), 1000-1200 (n = 10), > 1200 (n = 10). PMA (in weeks): < 32 (n = 6), 32-34 (n = 18), > 34 (n = 4). Success was calculated as complete regression of disease without need for any other modality of treatment such as anti-vascular endothelial growth factor (anti-VEGF) or pars plana vitrectomy. RESULTS: The overall success rate was 94.64% (53/56). Two babies who needed additional modality of treatment were < 28 weeks of GA (one eye) and 28-30 weeks (two eyes). One baby (one eye) was < 1000 gm and the other (two eyes) was > 1200 gm, while PMA at which additional treatment was needed was 30 weeks in one baby (one eye) and 33 weeks in the other (two eyes). CONCLUSION: In this era of anti-VEGF treatment, even in cases of APROP, LASER should still be considered as a primary modality of treatment, as it is a one-time treatment without the concern of systemic side effects and recurrent/persistent avascular zones.
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PURPOSE: The purpose of this study was to determine the effects of dexamethasone implant (0.7 mg) on biomarkers such as hyper-reflective dots, external limiting membrane integrity and disorganization of retinal inner layers in treatment-naïve patients, patients who received less than three anti-vascular endothelial growth factor injections and non-responder cases with diabetic macular edema and its effects on edema and visual acuity. METHODS: This is a prospective study of treatment-naïve patients, patients who received less than three anti-vascular endothelial growth factor injections and non-responder patients with diabetic macular edema, treated with single dexamethasone implant. Pre- and post-injection-based best-corrected visual acuity, central macular thickness, hyper-reflective dots, external limiting membrane integrity and disorganization of retinal inner layers were assessed. RESULTS: A total of 27 diabetic macular edema eyes, including 9 non-responder eyes, 9 eyes which received less than three anti-vascular endothelial growth factor injections and 9 treatment-naïve eyes, were included in this study. Baseline hyper-reflective dots were 22.22 ± 11.76, 30 ± 7.91 and 19.44 ± 8.82 which reduced to 3.33 ± 1.32, 9 ± 8.35 and 8.78 ± 2.53 four months after implant in treatment-naïve patients, patients who received less than three anti-vascular endothelial growth factor injections and non-responder cases, respectively. Baseline central macular thickness was 589.44 ± 175.37, 537 ± 181.81 and 673.11 ± 138.24 and the central macular thickness after dexamethasone implant was 272.11 ± 39.00, 336.44 ± 132.88 and 524.00 ± 200.39 in treatment-naïve patients, patients who received less than three anti-vascular endothelial growth factor injections and non-responder cases, respectively. External limiting membrane integrity was restored in two patients in each group, whereas two patients with disorganization of retinal inner layers in treatment-naïve group showed reorganization of retinal structures after treatment with dexamethasone implant. CONCLUSION: Better response to dexamethasone implant in cases with more hyper-reflective dots shows that these hyper-reflective dots can be used as a predictive biomarker. Dexamethasone implant might help in restoring external limiting membrane integrity and resolution of disorganization of retinal inner layers.
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Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Inibidores da Angiogênese/uso terapêutico , Biomarcadores , Dexametasona/uso terapêutico , Diabetes Mellitus/tratamento farmacológico , Retinopatia Diabética/tratamento farmacológico , Implantes de Medicamento/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/tratamento farmacológico , Estudos Prospectivos , Estudos Retrospectivos , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio VascularRESUMO
Purpose: The aim of this study was to evaluate the diagnostic ability of optic nerve head (ONH), RNFL, and GC-IPL parameters in differentiating eyes with PPG from normals. Methods: This was a retrospective, cross-sectional, observational study. We studied 73 eyes of 41 patients and compared them to 65 eyes of 34 normal persons. Each patient underwent detailed ocular examination, standard automated perimetry, GC-IPL, ONH, and RNFL analysis. PPG was defined as eyes with normal visual field results and one or more localized RNFL defects that were associated with a glaucomatous disc appearance (e.g., notching or thinning of neuroretinal rim) and IOP more than 21 mm Hg. Diagnostic abilities of GC-IPL, ONH, and RNFL parameters were computed using area under receiver-operating curve (AUROC), sensitivity and specificity, and likelihood ratios (LRs). Results: All GC-IPL parameters differed significantly from normal. The ONH, RNFL, and GC-IPL parameters with best area under curves (AUCs) to differentiate PPG were vertical cup to disc ratio (0.76), inferior quadrant RNFL thickness (0.79), and inferotemporal quadrant GC-IPL thickness (0.73), respectively. Similarly, best LRs were found for clock hour 5, 6, and 12 thicknesses among RNFL; inferior sector and inferotemporal sector thicknesses among GC-IPL parameters. Conclusion: Diagnostic abilities of GC-IPL parameters were comparable to RNFL parameters in differentiating PPG patients from normals. The likelihood of ruling in a disease was greater with GC-IPL parameters.
Assuntos
Glaucoma , Fibras Nervosas , Estudos Transversais , Glaucoma/diagnóstico , Humanos , Pressão Intraocular , Células Ganglionares da Retina , Estudos Retrospectivos , Tomografia de Coerência ÓpticaRESUMO
Purpose: The aim of this study was to evaluate the application and safety of three-dimensional (3D) visualization system in varied anterior segment procedures and Scleral Buckle. Methods: This was a prospective observational study of 313 eyes. Patients undergoing phacoemulsification (PE) with intraocular lens (IOL), trabeculectomies, glaucoma triple procedure (GTP), scleral fixated (SF) IOL, and scleral buckle (SB) were included in the study. Cases were randomly distributed in 3D visualization system (learning and post-learning phase) and conventional microscope group. Parameters studied were complications (intraoperative and early postoperative), surgical outcomes, and surgeon's perspective on various parameters (through a validated questionnaire) like surgical time, time lag, learning curve, ease of doing various steps and its value as an educational tool, for both groups [Questionnaires 1 and 2]. Results: Complications rates were not different in two groups. Surgical outcomes (anatomical and physiological) were similar in both the groups. Mean duration of surgery in PE+IOL, Trabeculectomy, GTP in learning stage by 3D was significantly higher than Microscope, which became insignificant in postlearning stage. For, SB and SFIOL, duration between two groups were insignificantly different. There was significant learning struggle in PE+IOL, SB, and Trabeculectomy. Image resolution, depth perception, illumination and postural comfort was graded higher for 3D surgery across the stages. Time lag, poor color contrast, and field of view were appreciated during the learning stage. Educational relevance of 3D was higher, as appreciated by resident and nurses. Conclusion: 3D surgery is as safe, faster, and predictable after initial learning struggle. Even in anterior segment procedure, no apparent lag was appreciated after learning curve.
Assuntos
Extração de Catarata , Lentes Intraoculares , Facoemulsificação , Humanos , Implante de Lente Intraocular , Complicações Pós-Operatórias , Esclera/cirurgiaRESUMO
Noise Induced Hearing Loss (NIHL) is caused by excessive noise exposure due to occupational activities thus affects communication and quality of life. Prolonged occupational and environmental exposure to loud noise damages key molecules present in the micro-machinery of the ear which are required for the mechano-electrical transduction of sound waves in cochlea. Specific proteins are known to be associated with hearing loss and related structural and functional disabilities in the human inner, outer hair cells and cochlea. Rationale of this study was to identify the cochlear proteins associated with the pathophysiology of NIHL using proteomic approaches in mining based industrial workers. Total (n = 210) samples were collected from mining based industrial workers of central India. Subjects were categorized based on audiometric analysis. Proteome changes of the host serum were investigated using one and two-dimensional electrophoresis in combination with LC-MS/MS and MALDI-TOF-MS. Up-regulated 46 cochlear proteins among confirmed NIHL cases were identified by MASCOT. Shrinkage discriminant analysis provided top 25 discriminating feature proteins namely myosin, transthyretin, SERPIN, CCDC50, enkurin, transferin etc. The identified potential proteins may be used as biomarkers for early detection and to understand the pathogenic mechanism of NIHL. Evaluation of these biomarkers in follow-up cases may further aid in improving NIHL diagnosis. SIGNIFICANCE: Human proteome study in Noise Induced Hearing Loss (NIHL) cases has not been published till date. This study represents most comprehensive proteomic analysis in NIHL cases taken from Indian mine workers. The identified key twenty-five discriminating feature proteins which are upregulated when an individual develops (or is in stage of development of) NIHL, provides insights into the potential roles of these varied proteins in disease progression. The proteins thus identified by proteomic approach may be used as early diagnostic biomarker to predict the occurrence of disease at very early stage.