Tag: pubmed

Saudi J Kidney Dis Transpl. 2022 Mar-Apr;33(2):236-244. doi: 10.4103/1319-2442.379021.

ABSTRACT

It is essential to determine the optimum protein intake in renal transplant recipients on steroids with renal dysfunction to maintain a neutral nitrogen balance. Our aim was to study the effect of higher (1.2 g/kg/day) and lower (0.8 g/kg/day) protein intakes on nitrogen balance, body composition, glomerular filtration rate (GFR), and proteinuria in renal transplant recipients with low estimated GFR (eGFR) (15-44 mL/min/1.73 m²). This prospective, open-labeled, randomized, cross-over, interventional study enrolled patients who were ≥4 months posttransplant with eGFR between 15 and 44 mL/min/1.73 m². Subjects were randomized to either Group 1 [Diet: proteins (1.2 g/kg/day), 35 kcal/kg/day] or Group 2 [Diet: proteins (0.8 g/kg/day) and 35 kcal/kg/day] for one month. Subjects crossed over to the other diet for 2^nd month. Body composition analysis, serum creatinine, blood urea nitrogen, serum protein, serum albumin, 24-h proteinuria, GFR measurement (24 h creatinine clearance), three-day diet recall and nitrogen balance estimation were performed at baseline and at the end of the first and 2^nd month. Statistical analysis was performed using IBM SPSS Statistics version 21. Thirty-two of 35 patients completed the study. Three-day diet recall showed that daily protein and energy consumption was 1.2 g/kg and 36.47 kcal/kg with higher and 0.94 g/kg and 31.94 kcal/kg with lower protein diets, respectively. Nitrogen balance was +3.61 g/day (P = 0.0002) with higher and +1.66 g/day with lower protein diets. A significant increase was noted in muscle mass (P = 0.0317), blood urea nitrogen (P = 0.0118), GFR (P = 0.0114), and proteinuria (P = 0.010) with a higher protein diet. Renal transplant recipients remained in positive nitrogen balance with both diets. Muscle mass and proteinuria increased significantly with a higher protein diet.

PMID:37417175 | DOI:10.4103/1319-2442.379021

J Vector Borne Dis. 2023 Apr-Jun;60(2):207-210. doi: 10.4103/0972-9062.364762.

ABSTRACT

BACKGROUND & OBJECTIVES: India imposed one of the world’s largest nationwide lockdown in the aftermath of COVID-19 pandemic in March 2020 which was partly extended up to December. Some of the impacts of the COVID-19 lockdown on the economy, research, travel, education, and sports were readily apparent; the same was less obvious in the occurrence of vector-borne diseases (VBDs). The objective of this study was to statistically determine the impact of the COVID-19 lockdown on the occurrence of VBDs in India.

METHODS: The reported incidence of VBDs such as malaria, dengue, Chikungunya, Japanese encephalitis, and kala-azar in India during the years 2015-2019 was analyzed by fitting Poisson and negative binomial (NB) models for each VBDs separately. The number of cases reported was compared with the number of cases predicted for each year from 2015 to 2020 for all the VBDs under study to infer whether or not the lockdown had any impact on their prevalence in India.

RESULTS: The percentage of the actual case was lower by 46, 75, 49, 72, and 38 respectively for malaria, dengue, Chikungunya, Japanese encephalitis, and kala-azar when comparing the lockdown period and the year before lockdown (2020 vs. 2019). The number of cases predicted for the year 2020 based on the trend of the five preceding years (2015-2019) also showed a great variation between actual and predicted cases. The differences in cases were considered as the cases missed in 2020 were largely due to the lockdown.

INTERPRETATION & CONCLUSION: The analysis showed that the lockdown had a considerable impact on the occurrence of VBDs.

PMID:37417171 | DOI:10.4103/0972-9062.364762

Indian J Ophthalmol. 2023 Jul;71(7):2862-2865. doi: 10.4103/IJO.IJO_2_23.

ABSTRACT

PURPOSE: To find the association between reduced best-corrected visual acuity and non-pathologic components after optical correction in individuals with low to high myopia.

METHODS: Myopic children under 16 years of age were reviewed using electronic medical records and the following data were extracted and recorded: participant’s age, gender, uncorrected visual acuity (UCVA), manifest refraction, and best corrected visual acuity (BCVA). Spherical equivalent and cylinder were classified into low, moderate, and high categories based on the magnitude range. Similarly, astigmatism was defined into with-the-rule, against-the-rule, and oblique based on the location of the steepest meridian. Reduced BCVA was defined when the decimal visual acuity was less than 0.66 (equivalent to Snellen’s acuity of 6/9 or 20/30). Logistic regression was performed to test the factors associated with reduced visual acuity after optical correction in the absence of myopic pathologic changes. Statistical significance was considered if P < 0.05.

RESULTS: Overall 44.9% (N = 242/538) of myopes had reduced best-corrected visual acuity (BCVA) and none of the patients had pathologic myopic lesions. Using logistic regression, we found that high spherical refraction (OR 27.98, 95% CI 14.43-54.25, P < 0.001) and moderate spherical refraction (OR 5.52, 95% CI 2.56-11.91, P < 0.001) were significantly associated with reduced best corrected visual acuity despite any pathological lesions. Additionally, oblique and ATR astigmatism were associated with reduced visual acuity in myopic children with (OR 2.05, 95% CI 0.77-5.42) and (OR 1.59, 95% CI 0.82-3.08).

CONCLUSION: Higher magnitude of refractive error components causes reduced visual acuity in the absence of pathologic changes.

PMID:37417135 | DOI:10.4103/IJO.IJO_2_23

Indian J Ophthalmol. 2023 Jul;71(7):2856-2861. doi: 10.4103/IJO.IJO_82_23.

ABSTRACT

PURPOSE: During the coronavirus disease 2019 (COVID-19) pandemic, private practice, inpatient consult services, and academic residency programs in ophthalmology saw a decrease in patient encounters. This study elucidates how community hospital ophthalmology consult (OC) services were affected during the pandemic. We aim to determine whether there was a change in resident OC volume in a community-based ophthalmology program consult service during the COVID-19 pandemic. Secondary objectives included analyzing the change in the types of diagnoses and the number of patients seen for diabetic retinopathy over the same time.

METHODS: A retrospective cross-sectional study was conducted reviewing the electronic health record (EHR) charts from OCs for the period 2017-2021. Records were categorized by referral source and the nature of OCs (trauma, acute, or chronic); OCs were further grouped by year and weak of referral. An intermonth analysis of weekly OC counts in each category was performed for the average number of consults in February-April 2017-2019 and for February-April 2020. A one-tailed t-test was performed. All t-tests assumed equal variances.

RESULTS: Weekly OCs in 2020 revealed no statistically significant differences in overall cases or in acute or chronic cases when the volume before the COVID-19 pandemic was compared to the volume after the onset of the pandemic. However, a statistically significant increase in the average weekly trauma cases was noted when 2020 (an average of 2.7 cases per week) was compared to the weekly average for the same weeks of years 2017- 2019 (0.4; P = 0.016). This statistically significant increase in trauma in 2020 disappeared when comparing weeks 11-17 in 2020 (2.2 cases per week) and the average of 2017-2019 (1.1).

CONCLUSION: This report outlines no significant change in OCs before and after the onset of the pandemic compared to three previous years. There was, however, an increase in trauma consults during the pandemic and an increase in the number (though not the proportion) of diabetic retinopathy (DR+) patients seen by residents. This report uniquely describes no significant changes in the resident volume of patients seen during the COVID-19 global pandemic.

PMID:37417134 | DOI:10.4103/IJO.IJO_82_23

Indian J Ophthalmol. 2023 Jul;71(7):2835-2840. doi: 10.4103/IJO.IJO_2777_22.

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the onset of dissociated vertical deviation (DVD) and inferior oblique overaction (IOOA), their subsequent development, and their correlation with pre and postoperative parameters.

METHODS: Medical records of patients with infantile esotropia who underwent surgery between 2005 and 2017 were retrospectively reviewed. DVD and IOOA were measured before and after surgery. Patients were divided into two groups based on horizontal and vertical deviation at the time of presentation: those with infantile esotropia only (group A) and patients with infantile esotropia who developed vertical deviation (group B).

RESULTS: Out of a total of 102 patients, DVD occurrence was seen in 53 patients (51.9%) and IOOA was seen in 50 patients (48.04%). DVD was seen in 22 patients at the time of initial examination and in 31 patients postoperatively. IOOA at presentation was seen in 45 patients (44.1%) and 5 patients (8.8%) postoperatively. No statistical difference was found in the age of surgery, angle of deviation, mean follow-up, and mean refractive error within both groups. The postoperative motor outcome was statistically comparable between the two groups (P = 0.29). Sensory outcomes of fusion (P = 0.048) and stereopsis (P-value = 0.00063) were better in group A.

CONCLUSION: No correlation was found between the age of occurrence and development of vertical deviation with refractive error, angle of deviation, age, or type of surgery. We found that motor outcomes are not affected but sensory outcomes are affected in patients with vertical deviations. This indicates that DVD and IOOA are developed due to inherent disruption of fusion and stereopsis.

PMID:37417130 | DOI:10.4103/IJO.IJO_2777_22

Indian J Ophthalmol. 2023 Jul;71(7):2803-2807. doi: 10.4103/IJO.IJO_692_23.

ABSTRACT

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.

PMID:37417124 | DOI:10.4103/IJO.IJO_692_23

Indian J Ophthalmol. 2023 Jul;71(7):2756-2759. doi: 10.4103/IJO.IJO_659_23.

ABSTRACT

PURPOSE: Ripasudil is a class of drug which alters the trabecular meshwork to increase the aqueous outflow and has been shown to be effective in pseudoexfoliative glaucoma (PXF G). This study aimed at assessing the efficacy and safety profile of ripasudil as an adjunct treatment in patients with PXF G at maximal tolerated antiglaucoma medications.

METHODS: In this prospective, interventional study, 40 patients with PXF G were enrolled between May 2021 and Jan 2022. Ripasudil 0.4% was started as an adjunctive drug to the ongoing antiglaucoma medications. On follow-up visits at 1, 3, and 6 months, the visual acuity, intraocular pressure (IOP), anterior segment, and fundus findings were evaluated. The premedication and postmedication IOP values were compared by paired t-test, and a P-value <0.05 was considered statistically significant.

RESULTS: Average age at recruitment was 60.02 ± 8.74 years. Baseline premedication IOP was 25.375 ± 3.276 mmHg. IOP reduction at 6 months was found to be statistically significant in all patients, with the maximal response being 24.13%. Also, 87.5% (35/40) of patients reached target IOP or even lower IOP at the end of study. There was no statistically significant association between the PXF grade and IOP. However, the grade of inferior iridocorneal angle pigmentation was found to be higher in eyes with elevated IOP (P < 0.05). Only three patients developed conjunctival hyperemia as an adverse reaction, which was mild and transient.

CONCLUSION: Ripasudil showed additional IOP-lowering effect with other antiglaucoma medications and exhibited no significant side effects.

PMID:37417116 | DOI:10.4103/IJO.IJO_659_23

Indian J Ophthalmol. 2023 Jul;71(7):2733-2738. doi: 10.4103/ijo.IJO_1989_22.

ABSTRACT

PURPOSE: To find out the mean rate of progression (MROP) of visual fields (VF) in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) using FORUM^® Glaucoma Workplace.

METHODS: Two hundred and one eyes of 105 patients were included in this prospective cohort study. Patients with POAG and OHT were recruited, and VF analysis with 24-2 and or 10-2 was done using SITA standard strategy in Zeiss Humphrey Visual Field Analyzer (HFA). All the previous VFs were identified from FORUM software, and the baseline indices were recorded from the first reliable VF analysis. The present VF analysis was compared to the previous one using FORUM software, and the rate of progression (ROP) in VF was obtained by Guided Progression Analysis.

RESULTS: MROP of VF in the POAG group was – 0.085 dB/year, ranging from -2.8 to 2.8 dB/year with a standard deviation (SD) of 0.69. In the OHT group, the MROP of VF was -0.003 dB/year, ranging from – 0.8 to 0.5 dB/year with an SD of 0.27. The MROP of VF in medically treated eyes with POAG was -0.14 dB/year with an SD of 0.61 and in surgically treated eyes was -0.02 dB/year with an SD of 0.78. The overall baseline mean VF index (VFI) was 83.19% and the final mean VFI was 79.80%. There was a statistically significant decrease in the mean VFI value from baseline to the final visit (P-value 0.0005).

CONCLUSION: The mean ROP of VF in the POAG group was -0.085 dB/year and in the OHT group was – 0.003 dB/year.

PMID:37417113 | DOI:10.4103/ijo.IJO_1989_22

BMJ Qual Saf. 2023 Jul 6:bmjqs-2022-015832. doi: 10.1136/bmjqs-2022-015832. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate whether the Acute Frailty Network (AFN) was more effective than usual practice in supporting older people living with frailty to return home from hospital sooner and healthier.

DESIGN: Staggered difference-in-difference panel event study allowing for differential effects across intervention cohorts.

SETTING: All English National Health Service (NHS) acute hospital sites.

PARTICIPANTS: All 1 410 427 NHS patients aged 75+ with high frailty risk who had an emergency hospital admission to acute, general or geriatric medicine departments between 1 January 2012 and 31 March 2019.

INTERVENTION: Membership of the AFN, a quality improvement collaborative designed to support acute hospitals in England deliver evidence-based care for older people with frailty. 66 hospital sites joined the AFN in six sequential cohorts, the first starting in January 2015, the sixth in May 2018. Usual care was delivered in the remaining 248 control sites.

MAIN OUTCOME MEASURES: Length of hospital stay, in-hospital mortality, institutionalisation, hospital readmission.

RESULTS: No significant effects of AFN membership were found for any of the four outcomes nor were there significant effects for any individual cohort.

CONCLUSIONS: To realise its aims, the AFN might need to develop better resourced intervention and implementation strategies.

PMID:37414555 | DOI:10.1136/bmjqs-2022-015832

J Neurol Neurosurg Psychiatry. 2023 Jul 6:jnnp-2023-331499. doi: 10.1136/jnnp-2023-331499. Online ahead of print.

ABSTRACT

BACKGROUND: Simultaneous comparisons of multiple disease-modifying therapies for relapsing-remitting multiple sclerosis (RRMS) over an extended follow-up are lacking. Here we emulate a randomised trial simultaneously comparing the effectiveness of six commonly used therapies over 5 years.

METHODS: Data from 74 centres in 35 countries were sourced from MSBase. For each patient, the first eligible intervention was analysed, censoring at change/discontinuation of treatment. The compared interventions included natalizumab, fingolimod, dimethyl fumarate, teriflunomide, interferon beta, glatiramer acetate and no treatment. Marginal structural Cox models (MSMs) were used to estimate the average treatment effects (ATEs) and the average treatment effects among the treated (ATT), rebalancing the compared groups at 6-monthly intervals on age, sex, birth-year, pregnancy status, treatment, relapses, disease duration, disability and disease course. The outcomes analysed were incidence of relapses, 12-month confirmed disability worsening and improvement.

RESULTS: 23 236 eligible patients were diagnosed with RRMS or clinically isolated syndrome. Compared with glatiramer acetate (reference), several therapies showed a superior ATE in reducing relapses: natalizumab (HR=0.44, 95% CI=0.40 to 0.50), fingolimod (HR=0.60, 95% CI=0.54 to 0.66) and dimethyl fumarate (HR=0.78, 95% CI=0.66 to 0.92). Further, natalizumab (HR=0.43, 95% CI=0.32 to 0.56) showed a superior ATE in reducing disability worsening and in disability improvement (HR=1.32, 95% CI=1.08 to 1.60). The pairwise ATT comparisons also showed superior effects of natalizumab followed by fingolimod on relapses and disability.

CONCLUSIONS: The effectiveness of natalizumab and fingolimod in active RRMS is superior to dimethyl fumarate, teriflunomide, glatiramer acetate and interferon beta. This study demonstrates the utility of MSM in emulating trials to compare clinical effectiveness among multiple interventions simultaneously.

PMID:37414534 | DOI:10.1136/jnnp-2023-331499