Nevin Manimala

Indian J Ophthalmol. 2021 Jun;69(6):1517-1521. doi: 10.4103/ijo.IJO_2455_20.

ABSTRACT

PURPOSE: This study aimed to share our experience in the hospital cornea retrieval program as a new eye bank.

METHODS: This was a retrospective study conducted in a tertiary care institute from August 26, 2019 to March 22, 2020. The medical and eye bank records were analyzed for hospital mortality, mortuary records, and donors approached. The corneal collection was divided between Voluntary (received from voluntary calls), HCRP (cornea received from hospital deaths), and Medico-Legal Cases (received from MLC deaths in hospital) to see the trend of donation and utilization over time.

RESULTS: During the study period, 154 corneas (77 pairs) were collected. The HCRP provided a major source of corneas 58.4% (90 corneas) as compared to voluntary 19.5% (30 corneas) and MLC 22.1%(34 corneas). There were younger tissues in MLC than HCRP donors, and older tissues in Voluntary donors, and the difference was statistically significant. There was no significant difference in the quality of optical grade tissues and the utilization of corneas for transplants between the three groups. Post hoc analysis showed more non-optical tissues in the voluntary donations (P = 0.004), maximum donors with medical contraindications in the HCRP group (P = 0.001), and time-lapse in corneal retrieval in MLC cases (P = 0.0001). Of these 154 corneas, 78 (50.6%) were assessed as suitable for transplantation, of which 59 (75.6%) tissues were optical grade tissues. The overall utilization was 39.6%.

CONCLUSION: HCRP is indeed challenging for a new eye bank, but proper understanding and implementing strategies may help for good utilization of tissues.

PMID:34011733 | DOI:10.4103/ijo.IJO_2455_20

Indian J Ophthalmol. 2021 Jun;69(6):1487-1490. doi: 10.4103/ijo.IJO_2956_20.

ABSTRACT

PURPOSE: To assess pre and post vergence and accommodation parameters after monitored reading on a smartphone device.

METHODS: This prospective comparative study was performed in a tertiary eye care center for a duration of 6 months (December 2017 – May 2018). A total of 47 healthy emmetropic subjects of age group ranging from 18-30 years were recruited for the study. Participants underwent an initial visual screening protocol, followed by accommodation and vergence parameters assessment. The subjects were given reading text of optotype N6 at 40cm working distance for 30 minutes in a smart phone device. Pre and post measurements were documented.

RESULTS: Among 47 subjects there were 17 male and 30 females with mean age group of 21.2+2.06 years. There was a statistically significant worsening of accommodative components (negative & positive relative accommodation, lag of accommodation). In vergence parameters, a statistically significant deterioration of negative (12.8 + 1.65 to 12.38 + 1.93 PD) and positive fusional vergence (15.48 + 1.53 to 16.08 +1.61 PD) was observed. The mean vergence facility also showed a statistically significant change in pre and post task measurements (13.51 + 1.64 to 10.71 + 1.91 cpm (cycles per minute)).

CONCLUSION: The current study investigated that perusing text with a smart phone for 30 minutes shows significant effect on accommodative and vergence components for near task, with greater impact on vergence parameters. Drawn out exposure to digital screens at near, may bring about visual quality dysfunction.

PMID:34011725 | DOI:10.4103/ijo.IJO_2956_20

Indian J Ophthalmol. 2021 Jun;69(6):1457-1463. doi: 10.4103/ijo.IJO_2964_20.

ABSTRACT

PURPOSE: To evaluate optical coherence tomography angiography findings in patients with multiple sclerosis (MS).

METHODS: This prospective noninterventional study was conducted on 30 eyes of relapsing-remitting MS patients. Group (1) included 10 eyes with a history of optic neuritis (ON), group (2) included 10 eyes without any history of optic neuritis (MS-ON), and group (3) included 10 eyes of normal age/sex/refraction matched participants. Optical coherence tomography (OCT) and OCT-A (ZEISS Cirrus™ HD-OCT Model 4000 (Carl Zeiss-Meditec, Dublin, CA) of the optic disc were done for all patients.

RESULTS: The best-corrected visual acuity was diminished in MS cases, especially in patients with ON with P value <0.001. The retinal nerve fiber layer (RNFL) thickness showed a significant decrease in the average thickness and in all quadrants, notably the temporal quadrant in group 1 (P < 0.001). Ganglion cell layer thickness was diminished in average thickness and in all quadrants in both groups of MS, but only the first group showed statistical significance with P value <0.001). In respect to optic disc perfusion, Average, superficial, and deep vascular density index (AVDI, VDI 1, VDI 2) were statistically significantly lower in groups 1, 2 with (P-value < 0.001).

CONCLUSION: Decreased vascular perfusion of the optic nerve in MS patients, especially in those with ON is strongly correlated with the damage of RNFL and ganglion cell layer detected by OCT.

PMID:34011720 | DOI:10.4103/ijo.IJO_2964_20

Indian J Ophthalmol. 2021 Jun;69(6):1369-1374. doi: 10.4103/ijo.IJO_2491_20.

ABSTRACT

PURPOSE: The aim of this study was to create vision standards for various tasks performed by hairdressers and to assess the spectacle compliance and its impact at work.

METHODS: The observational cross-sectional study enrolled hairdressers in and around Chennai, Tamil Nadu. It was done in three phases: (i) Job profiling from visual task analysis, creating vision standards for various hairdressing tasks and arriving at test protocols; (ii) Comprehensive eye examination, and (iii) Assessment of spectacle compliance and its impact on work. Descriptive analysis using Microsoft Excel and SPSS (IBM SPSS Statistics Version 21.0) was performed.

RESULTS: There were 305 participants with a mean age of 48 (SD ± 12) years. The visual acuity demand was found to be 6/18 and N15, for distance and near, respectively. Appropriate spectacles were prescribed for 203 (67%) hairdressers. Even with the best possible refractive correction, a few hairdressers did not meet the distance (13) and near (11) visual acuity standard. In all, 54 hairdressers were referred for further examination to a tertiary eye care center for lenticular changes, retinal abnormalities, and glaucoma screening. Among the subjects who were dispensed with spectacles, 181 (86%) were available for telephonic spectacle compliance assessment, and 164 (90%) were compliant with spectacle usage at work. Improved visual ability was reported by 133 (81%) hairdressers at work.

CONCLUSION: This study provides vision standards for hairdressers. From the visual task analysis, hairdressing tasks were found to be visually demanding and hazardous. The study emphasizes that providing appropriate spectacle correction showed a clinically evident positive impact at work.

PMID:34011702 | DOI:10.4103/ijo.IJO_2491_20

Pediatrics. 2021 May 19:e2020042325. doi: 10.1542/peds.2020-042325. Online ahead of print.

ABSTRACT

BACKGROUND: Hospital-associated venous thromboembolism (HA-VTE) is an increasing cause of morbidity in pediatric populations, yet identification of high-risk patients remains challenging. General pediatric models have been derived from case-control studies, but few have been validated. We developed and validated a predictive model for pediatric HA-VTE using a large, retrospective cohort.

METHODS: The derivation cohort included 111 352 admissions to Monroe Carell Jr. Children’s Hospital at Vanderbilt. Potential variables were identified a priori, and corresponding data were extracted. Logistic regression was used to estimate the association of potential risk factors with development of HA-VTE. Variable inclusion in the model was based on univariate analysis, availability in routine medical records, and clinician expertise. The model was validated by using a separate cohort with 44 138 admissions.

RESULTS: A total of 815 encounters were identified with HA-VTE in the derivation cohort. Variables strongly associated with HA-VTE include history of thrombosis (odds ratio [OR] 8.7; 95% confidence interval [CI] 6.6-11.3; P < .01), presence of a central line (OR 4.9; 95% CI 4.0-5.8; P < .01), and patients with cardiology conditions (OR 4.0; 95% CI 3.3-4.8; P < .01). Eleven variables were included, which yielded excellent discriminatory ability in both the derivation cohort (concordance statistic = 0.908) and the validation cohort (concordance statistic = 0.904).

CONCLUSIONS: We created and validated a risk-prediction model that identifies pediatric patients at risk for HA-VTE development. We anticipate early identification of high-risk patients will increase prophylactic interventions and decrease the incidence of pediatric HA-VTE.

PMID:34011634 | DOI:10.1542/peds.2020-042325

J Clin Pathol. 2021 May 19:jclinpath-2021-207446. doi: 10.1136/jclinpath-2021-207446. Online ahead of print.

ABSTRACT

AIMS: Public Health England has identified that in COVID-19, death rates among ethnic minorities far exceeds that of the white population. While the increase in ethnic minorities is likely to be multifactorial, to date, no studies have looked to see whether values for routine clinical biochemistry parameters differ between ethnic minority and white individuals.

METHODS: Baseline biochemical data for 22 common tests from 311 SARS-CoV-2 positive patients presenting to hospital in April 2020 in whom ethnicity data were available was retrospectively collected and evaluated. Data comparisons between ethnic minority and white groups were made for all patient data and for the subset of patients subsequently admitted to intensive care.

RESULTS: When all patient data were considered, the ethnic minority population had statistically significant higher concentrations of C reactive protein (CRP), aspartate aminotransferase and gamma-glutamyl transferase, while troponin T was higher in the white group. A greater proportion of ethnic minority patients were subsequently admitted to intensive care, but when the presenting biochemistry of this subset of patients was compared, no significant differences were observed between ethnic minority and white groups.

CONCLUSION: Our data show for the first time that routine biochemistry at hospital presentation in COVID-19 differs between ethnic minority and white groups. Among the markers identified, CRP was significantly higher in the ethnic minority group pointing towards an increased tendency for severe inflammation in this group.

PMID:34011620 | DOI:10.1136/jclinpath-2021-207446

BMJ Open. 2021 May 19;11(5):e049763. doi: 10.1136/bmjopen-2021-049763.

ABSTRACT

INTRODUCTION: Substantial variation in the delivery of hip fracture care, and patient outcomes persists between hospitals, despite established UK national standards and guidelines. Patients’ outcomes are partly explained by patient-level risk factors, but it is hypothesised that organisational-level factors account for the persistence of unwarranted variation in outcomes. The mixed-methods REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE) study, aims to determine key organisational factors to target to improve patient care.

METHODS AND ANALYSIS: Quantitative analysis will assess the outcomes of patients treated at 172 hospitals in England and Wales (2016-2019) using National Hip Fracture Database data combined with English Hospital Episodes Statistics; Patient Episode Database for Wales; Civil Registration (deaths) and multiple organisational-level audits to characterise each service provider. Statistical analyses will identify which organisational factors explain variation in patient outcomes, and typify care pathways with high-quality consistent patient outcomes. Documentary analysis of 20 anonymised British Orthopaedic Association hospital-initiated peer-review reports, and qualitative interviews with staff from four diverse UK hospitals providing hip fracture care, will identify barriers and facilitators to care delivery. The COVID-19 pandemic has posed a major challenge to the resilience of services and interviews will explore strategies used to adapt and innovate. This system-wide understanding will inform the development, in partnership with key national stakeholders, of an ‘Implementation Toolkit’ to inform and improve commissioning and delivery of hip fracture services.

ETHICS AND DISSEMINATION: This study was approved: quantitative study by London, City and East Research Ethics Committee (20/LO/0101); and qualitative study by Faculty of Health Sciences University of Bristol Research Ethics Committee (Ref: 108284), National Health Service (NHS) Health Research Authority (20/HRA/71) and each NHS Trust provided Research and Development approval. Findings will be disseminated through scientific conferences, peer-reviewed journals and online workshops.

PMID:34011603 | DOI:10.1136/bmjopen-2021-049763

BMJ Open. 2021 May 19;11(5):e046274. doi: 10.1136/bmjopen-2020-046274.

ABSTRACT

INTRODUCTION: Acute kidney injury (AKI) has high morbidity and mortality in intensive care units, which can lead to chronic kidney disease, more costs and longer hospital stay. Early identification of AKI is crucial for clinical intervention. Although various risk prediction models have been developed to identify AKI, the overall predictive performance varies widely across studies. Owing to the different disease scenarios and the small number of externally validated cohorts in different prediction models, the stability and applicability of these models for AKI in critically ill patients are controversial. Moreover, there are no current risk-classification tools that are standardised for prediction of AKI in critically ill patients. The purpose of this systematic review is to map and assess prediction models for AKI in critically ill patients based on a comprehensive literature review.

METHODS AND ANALYSIS: A systematic review with meta-analysis is designed and will be conducted according to the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). Three databases including PubMed, Cochrane Library and EMBASE from inception through October 2020 will be searched to identify all studies describing development and/or external validation of original multivariable models for predicting AKI in critically ill patients. Random-effects meta-analyses for external validation studies will be performed to estimate the performance of each model. The restricted maximum likelihood estimation and the Hartung-Knapp-Sidik-Jonkman method under a random-effects model will be applied to estimate the summary C statistic and 95% CI. 95% prediction interval integrating the heterogeneity will also be calculated to pool C-statistics to predict a possible range of C-statistics of future validation studies. Two investigators will extract data independently using the CHARMS checklist. Study quality or risk of bias will be assessed using the Prediction Model Risk of Bias Assessment Tool.

ETHICS AND DISSEMINATION: Ethical approval and patient informed consent are not required because all information will be abstracted from published literatures. We plan to share our results with clinicians and publish them in a general or critical care medicine peer-reviewed journal. We also plan to present our results at critical care international conferences.

OSF REGISTRATION NUMBER: 10.17605/OSF.IO/X25AT.

PMID:34011595 | DOI:10.1136/bmjopen-2020-046274

BMJ Open. 2021 May 19;11(5):e043523. doi: 10.1136/bmjopen-2020-043523.

ABSTRACT

OBJECTIVE: The aim of this economic evaluation was to assess whether home management could represent a cost-effective strategy in the patient pathway of type 1 diabetes (T1D). This is based on the Delivering Early Care In Diabetes Evaluation trial (ISRCTN78114042), which compared home versus hospital management from diagnosis in childhood diabetes and found no statistically significant difference in glycaemic control at 24 months.

DESIGN: Cost-effectiveness analysis alongside a randomised controlled trial.

SETTING: Eight paediatric diabetes centres in England, Wales and Northern Ireland.

PARTICIPANTS: 203 clinically well children aged under 17 years, with newly diagnosed T1D and their carers.

OUTCOME MEASURES: The base-case analysis adopted n National Health Service (NHS) perspective. A scenario analysis assessed costs from a broader societal perspective. The incremental cost-effectiveness ratio (ICER), expressed as cost per mmol/mol reduction in glycated haemoglobin (HbA1c), was based on the mean difference in costs between the home and hospital groups, divided by mean differences in effectiveness (HbA1c). Uncertainty was considered in terms of the probability of cost-effectiveness.

RESULTS: At 24 months postintervention, the base-case analysis showed a difference in costs between home and hospital, in favour of home management (mean difference -£2,217; 95% CI -£2825 to -£1,609; p<0.001). Home care dominated, with an ICER of £7434 (saved) per mmol/mol reduction of HbA1c. The results of the scenario analysis also favoured home management. The greatest driver of cost differences was hospitalisation during the initiation period.

CONCLUSIONS: Home management from diagnosis of children with T1D who are medically stable represents a less costly approach for the NHS in the UK, without impacting clinical effectiveness.

TRIAL REGISTRATION NUMBER: ISRCTN78114042.

PMID:34011587 | DOI:10.1136/bmjopen-2020-043523

BMJ Open. 2021 May 19;11(5):e042374. doi: 10.1136/bmjopen-2020-042374.

ABSTRACT

OBJECTIVE: The goal of treatment in ulcerative colitis (UC) is to induce and maintain remission. The addition of granulocyte and monocyte apheresis (GMA) to conventional therapy may be a promising therapeutic alternative. In this meta-analysis, we aimed to assess the efficacy and safety profile of GMA as an adjunctive therapy.

DESIGN: Systematic review and meta-analysis.

METHODS: We searched four databases (MEDLINE, Embase, Web of Science and Cochrane Central Register of Controlled Trials) for randomised or minimised controlled trials which discussed the impact of additional GMA therapy on clinical remission induction and clinical remission maintenance compared with conventional therapy alone. Primary outcomes were clinical remission induction and maintenance, secondary outcomes were adverse events (AEs) and steroid-sparing effect. ORs with 95% CIs were calculated. Trial Sequential Analyses were performed to adjusts for the risk of random errors in meta-analyses.

RESULTS: A total of 11 studies were eligible for meta-analysis. GMA was clearly demonstrated to induce and maintain clinical remission more effectively than conventional therapy alone (598 patients: OR: 1.93, 95% CI 1.28 to 2.91, p=0.002, I²=0.0% for induction; 71 patients: OR: 8.34, 95% CI 2.64 to 26.32, p<0.001, I²=0.0% for maintenance). There was no statistically significant difference in the number of AEs (OR: 0.27, 95% CI 0.05 to 1.50, p=0.135, I²=84.2%).

CONCLUSION: GMA appears to be more effective as an adjunctive treatment in inducing and maintaining remission in patients with UC than conventional therapy alone.

PROSPERO REGISTRATION NUMBER: CRD42019134050.

PMID:34011580 | DOI:10.1136/bmjopen-2020-042374