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Aim: To study the incidence of central macular oedema at 4, 8 and 12 weeks following cataract surgery in diabetic retinopathy eyes. Materials and Methods: A prospective observational study was conducted over a period of 3 months to investigate the presence of centrally involved macular oedema following cataract surgery in diabetic retinopathy patients. Preoperative OCT scans were performed and patients without centrally involved macular oedema were enrolled. Subfield thickness (central, outer and inner) was measured preoperatively and at 4, 8 and 12 weeks postoperatively. The correlation between diabetic macular oedema (DME) and HbA1c, as well as random blood sugar (RBS) levels at the time of surgery, was analysed. Best-corrected visual acuity (BCVA) was assessed preoperatively and postoperatively, and fundus examinations were conducted each visit to evaluate diabetic retinopathy progression. Results: This study included 80 eyes from 44 patients. Postoperatively, central subfield thickness (CSF) increased significantly at first (14.7 μm), second (26.7 μm) and third (30.3 μm) compared to baseline. Inner subfield thickness (ISF) also increased at first (13.3 μm), second (20.6 μm) and third (24.3 μm) months, while the outer subfield thickness (OSF) showed progression from 6.7 μm to 16.6 μm from the first to third month. A statistically significant shift in DME was observed three months post-cataract surgery. There was a significant association between HbA1c levels and the development of DME, but no correlation with RBS levels. BCVA improved remarkably from preoperative mean log MAR of 0.75 to a mean log MAR of 0.1 at 3 months postoperatively. About 30% had mild non-proliferative diabetic retinopathy (NPDR) preoperatively, and in that group, 60% progressed to moderate NPDR. The status of moderate and severe NPDR remained the same postoperatively at 3 months. Of all patients who progressed to moderate NPDR, 3 cases developed non-central macular oedema, and three cases developed both central and non-central macular oedema postoperatively at 3 months. All eyes with severe NPDR resulted in DME, except for one (9.1%) eye. Conclusion: Preoperatively, 57.5% had no macular oedema, while 42.5% had non-central macular oedema. Postoperatively, 4.4% had central oedema, and 10.9% had both central and non-central oedema among those who initially had no macular oedema. Additionally, 38.2% developed oedema in both central and non-central regions among patients initially presenting with non-central macular oedema. There was also a significant statistical difference with longer duration of diabetes mellitus, severity of diabetic retinopathy and elevated HbA1c values with the development of diabetic macular oedema postoperatively. However, larger sample sizes and longer-term follow-up are essential for assessing retinopathy progression and the incidence of DME.

Purpose: To analyze the outcomes following conventional internal limiting membrane (ILM) peeling versus perfluoro octane-assisted inverted flap technique for large macular holes (MH). Methods: A consecutive 99 eyes of 99 patients were enrolled {45 – conventional group and 54 – inverted flap (InFlap) group}. The primary outcome was a difference in closure rate. Secondary outcomes were differences in best-corrected visual acuity (BCVA), restoration of external limiting membrane (ELM) and ellipsoid zone (EZ) between groups at 3 (primary endpoint), 6 and 12 (secondary endpoints) months. Additionally, the effect of different gas tamponades on closure rates, ILM flap disintegration in InFlap group, and subfoveal thickness (SFT) between groups in closed. Results: At 3 months, there was no difference in the closure rate and BCVA between groups. At six months, closure rate was significantly better in the InFlap group. However, this difference was not maintained at 12 months. There was no difference in BCVA between groups at any visit. The ELM recovery was significantly higher in the conventional group at three months; however, there was no difference in ELM/EZ recovery between groups at other visits. The closure rate in the InFlap group was the same irrespective of gas tamponade. The ILM flap was identifiable in one-third of patients at 12 months. In closed MH, SFT was significantly more in InFlap group. Conclusion: The closure rate and visual outcomes remained similar in both groups in the immediate and long term. Conventional ILM peeling technique seems to have early ELM recovery when compared to inverted flap technique.

Introduction Autoimmune hepatitis (AIH) has scarcely been reported on in patients of black African descent. Similarly, few studies have focused on the relationship between AIH and Human-Immunodeficiency Virus (HIV) infection. Aim We aim to describe the presenting features of AIH from a single referral centre in a Sub-Sahara African setting. We also compare the presenting features of HIV-infected and HIV-uninfected patients. Methods This study was a retrospective chart review. Patients were included if they fulfilled criteria for the International AIH Group simplified score for probable or definite AIH, were 18 years or older at inclusion, and attended the adult Gastroenterology clinic at Inkosi Albert Luthuli Central Hospital (IALCH) for the period 1/1/2015 to 31/12/2020 on at least 2 occasions. Results Forty cases were included, of which 33 (82.5%) were female and 33 (82.5%) were black African. Median age at diagnosis was 26 years. A diagnosis of a coexistent autoimmune disease was made in 22.5% of patients, with Systemic Lupus Erythematosus (SLE) being the most common (12.5%). Sixteen patients were HIV-infected, all of whom were female (p =0.03), with a significantly older age of disease onset as compared to their HIV-uninfected counterparts (median age 38 vs 17.5 years, p

Pregnancy in kidney and liver transplant recipients presents unique challenges and risks for both maternal and fetal health. This article examines the management of pregnancy in kidney and liver transplant recipients, focusing on pre-pregnancy counselling, trimester-specific care, the teratogenic effects of immunosuppressive drugs, and the role of the multidisciplinary team. While South African (SA) data on this topic are limited, the Transplant Pregnancy Registry International has provided valuable insights. Despite the increased risk of maternal and fetal complications, the overall risk of graft loss during pregnancy is low. Graft survival rates are comparable between pregnant and non- pregnant transplant recipients, except for pregnancies occurring within 1 year of transplantation. By addressing the complexities of managing pregnant women with kidney or liver transplants, this article underscores the importance of tailored care and the involvement of various medical specialists. It also explores the safety of and potential complications associated with specific immunosuppressive therapies during pregnancy. Further research is needed to enhance our understanding and optimise the management of these high-risk pregnancies in SA.

Tomato cultivation is an important agricultural activity in northeast of Argentina, and disease control is indispensable for its production. The purpose of the current study was to identify two fungi isolated from tomato plants cultivated in greenhouses, with symptoms of leaf mould disease and a strain of the genus Cladosporium from a culture collection, and evaluate their in vitro susceptibility to four commercial fungicides. Macro and microscopic examination, molecular characterisation and sequence analysis were applied for identification. Broth dilution and spread plate methods were used to determine the minimal inhibitory concentration (MIC) and minimal fungicide concentration (MFC). The active ingredients of the products were azoxystrobin+difenoconazole, trifloxystrobin+tebuconazole, chlorothalonil and metalaxyl-M+mancozeb. The results were processed using the Kruskal-Wallis method. The isolates were identified as Cladosporium cladosporioidesa-c; consequently, lesions found on tomato plants did not corrspond to Cladosporium fulvum. There was a significant statistical difference between the obtained values. Qualitatively, the three strains had a similar behaviour for chlorothalonil (MIC values: 0.25 - 0.5 μg/ml, MFC values: 4 μg/ml). In all cases, tests with metalaxyl-M+mancozeb yielded higher values than those achieved for chlorothalonil (MIC values: 8 μg/ml, MFC values: 8- 32 μg/ml). trobilurin-formulated fungicides were less effective against C. cladosporioidesa-b (MIC values: 16-256 μg/ml, MFC values: >64 μg/ml). C. cladosporioidesc was the most sensitive isolate. The information about the presence of a non-frequent fungus and its fungicide susceptibility, would be useful for establishing control strategies and enhance production.

Relevance. The Sverdlovsk region is a highly endemic territory for infections transmitted by ixodic ticks. The possibilities of laboratory diagnostics of tick–borne infections in the routine practice of a clinician in the region today are limited mainly by testing blood serum for antibodies to the tick-borne encephalitis virus (TBE virus) and Lyme disease (LD) pathogens – Borrelia burgdorferi sensu lato complex, therefore, among tick-borne infections in the region currently mainly TBE and LD are registered. In case of negative results for antibodies to the pathogens of the above infections, the diagnosis may remain unknown. Aims. To study the etiological structure of infections transmitted by ixodic ticks in the Sverdlovsk region at the present stage, as well as to characterize the epidemiological and clinical features of the course of tick-borne infections detected in conditions of a combination of natural foci. Materials and methods. The study included 227 patients undergoing inpatient or outpatient treatment during the epidemic season of tick activity in 2021 (June-August) at LLS MO "New Hospital" (Urban Center of Natural Focal Infections). The case histories (epidemiological, clinical and laboratory indicators) were studied from each patient, as well as the material (blood) was examined prospectively and retrospectively using molecular biological (PCR) and serological (ELISA, planar protein biochip) methods. Results and discussion. During the study, six diseases were identified among the examined patients: TBE, LD (erythematous and nonerythematous forms), Borrelia miyamotoi disease (BMD), human granulocytic anaplasmosis (HGA), human monocytic ehrlichiosis (HME), as well as "Viral fever transmitted by arthropods" (VFTA). Among the examined patients, the proportion of patients with monoinfection was 49,5%, with mixed infection – 50,5%. Additional studies conducted by us using specific PCR for the presence DNA rickettsia and the causative agent of Q-fever in the blood of patients gave negative results. The general epidemiological characteristics for the above identified infections were the vector-borne mechanism, the prevalence of diseases in groups of middle-aged and elderly people, the largest number of cases of infection with pathogens of any tick-borne infection occurred in Yekaterinburg and its surroundings, for all infections, the duration of tick bite in most cases did not exceed one day; there were differences by sex, incubation period. Clinical symptoms were similar, except for the erythematous form of LD (the presence of erythema migrans at the byte site of tick), because the vast majority of patients had a general infectious syndrome; general laboratory indicators varied. Confirmation of the diagnosis was based on the results of the complex application of molecular biological and serological research methods. Conclusions. The modern etiological structure of infections transmitted by ixodic ticks in the Sverdlovsk region is represented not only by TBE and LD, but also by new disease to our country, such as BMD, HGA, HME, while a high proportion of mixed infections in various combinations has been revealed.

BackgroundThe COVID-19 pandemic resulted in rapid changes in how patient care was provided, particularly through the expansion of telehealth and audio-only phone-based care. ObjectiveThe goal of this study was to evaluate inequities in video and audio-only care during various time points including the initial wave of the COVID-19 pandemic, later stages of the pandemic, and a historical control. We sought to understand the characteristics of care during this time for a variety of different groups of patients that may experience health care inequities. MethodsWe conducted a retrospective analysis of electronic health record (EHR) data from encounters from 34 family medicine and internal medicine primary care clinics in a large, Midwestern health system, using a repeated cross-sectional, observational study design. These data included patient demographic data, as well as encounter, diagnosis, and procedure records. Data were obtained for all in-person and telehealth encounters (including audio-only phone-based care) that occurred during 3 separate time periods: an initial COVID-19 period (T2: March 16, 2020, to May 3, 2020), a later COVID-19 period (T3: May 4, 2020, to September 30, 2020), and a historical control period from the previous year (T1: March 16, 2019, to September 30, 2019). Primary analysis focused on the status of each encounter in terms of whether it was completed as scheduled, it was canceled, or the patient missed the appointment. A secondary analysis was performed to evaluate the likelihood of an encounter being completed based on visit modality (phone, video, in-person). ResultsIn total, there were 938,040 scheduled encounters during the 3 time periods, with 178,747 unique patients, that were included for analysis. Patients with completed encounters were more likely to be younger than 65 years old (71.8%-74.1%), be female (58.8%-61.8%), be White (75.6%-76.7%), and have no significant comorbidities (63.2%-66.8%) or disabilities (53.2%-61.1%) in all time periods than those who had only canceled or missed encounters. Effects on different subpopulations are discussed herein. ConclusionsFindings from this study demonstrate that primary care utilization across delivery modalities (in person, video, and phone) was not equivalent across all groups before and during the COVID-19 pandemic and different groups were differentially impacted at different points. Understanding how different groups of patients responded to these rapid changes and how health care inequities may have been affected is an important step in better understanding implementation strategies for digital solutions in the future.

BackgroundAn effective and scalable information retrieval (IR) system plays a crucial role in enabling clinicians and researchers to harness the valuable information present in electronic health records. In a previous study, we developed a prototype medical IR system, which incorporated a semantically based query recommendation (SBQR) feature. The system was evaluated empirically and demonstrated high perceived performance by end users. To delve deeper into the factors contributing to this perceived performance, we conducted a follow-up study using query log analysis. ObjectiveOne of the primary challenges faced in IR is that users often have limited knowledge regarding their specific information needs. Consequently, an IR system, particularly its user interface, needs to be thoughtfully designed to assist users through the iterative process of refining their queries as they encounter relevant documents during their search. To address these challenges, we incorporated “query recommendation” into our Electronic Medical Record Search Engine (EMERSE), drawing inspiration from the success of similar features in modern IR systems for general purposes. MethodsThe query log data analyzed in this study were collected during our previous experimental study, where we developed EMERSE with the SBQR feature. We implemented a logging mechanism to capture user query behaviors and the output of the IR system (retrieved documents). In this analysis, we compared the initial query entered by users with the query formulated with the assistance of the SBQR. By examining the results of this comparison, we could examine whether the use of SBQR helped in constructing improved queries that differed from the original ones. ResultsOur findings revealed that the first query entered without SBQR and the final query with SBQR assistance were highly similar (Jaccard similarity coefficient=0.77). This suggests that the perceived positive performance of the system was primarily attributed to the automatic query expansion facilitated by the SBQR rather than users manually manipulating their queries. In addition, through entropy analysis, we observed that search results converged in scenarios of moderate difficulty, and the degree of convergence correlated strongly with the perceived system performance. ConclusionsThe study demonstrated the potential contribution of the SBQR in shaping participants' positive perceptions of system performance, contingent upon the difficulty of the search scenario. Medical IR systems should therefore consider incorporating an SBQR as a user-controlled option or a semiautomated feature. Future work entails redesigning the experiment in a more controlled manner and conducting multisite studies to demonstrate the effectiveness of EMERSE with SBQR for patient cohort identification. By further exploring and validating these findings, we can enhance the usability and functionality of medical IR systems in real-world settings.

The practice of ophthalmology has advanced exponentially due to technology. This has raised the bar of medical care from acceptable visual acuity to the highest precision in acuity. In such an era, it is the need of the hour to be aware of the medico-legal implications in ophthalmology to avert any lawsuits. Lawsuits can be due to breach of confidentiality, inadequate consent, negligence, unmet expectations in a procedure, etc. The majority of lawsuits are related to cataract and corneal surgeries, but the instances of lawsuits related to retinal conditions are on the rise, especially those related to screening of Retinopathy of prematurity resulting in huge sums of compensations. The awareness of regulations can guide the healthcare professionals in such instances. These include the knowledge of laws governing every step of practice and the rights of both healthcare professionals and patients. In addition, clear communication regarding the risks, benefits, and outcomes of the procedure, strict adherence to guidelines, and meticulous documentation are effective tools to avoid litigations. This review article aims to describe various regulations governing the practice of ophthalmology, implications in everyday practice, and steps to safeguard against lawsuits.

Almost 56% of Indian adolescent girls aged 15–19 years suffer from anemia. Adolescent age is a period of many significant physiological changes that increase nutritional demand, and they remain at risk for nutritional deficiencies. Our aim is to assess the prevalence of Vitamin B12 deficiency among school-going adolescent girls aged 13–16 years of rural Mysore. This study was a cross-sectional study, conducted in two high schools in rural Mysuru. Adolescent girls aged 13–16 years were included. The chosen subjects underwent complete hemogram, peripheral smear examination, and vitamin B12 level estimation. Out of 98 subjects enrolled, 40.81% were found to be deficient in vitamin B12. Macrocytes and hyper-segmented neutrophils were found to have statistically significant (P value < 0.001) relationship with vitamin B12 deficiency. The relationship between vitamin B12 deficiency with either type of diet and anemia was statically insignificant (P > 0.05). The prevalence of vitamin B12 deficiency among rural adolescent girls in Mysuru is high. Other causes of nutritional anemia apart from iron deficiency, such as vitamin B12 deficiency, must be considered in the etiology of anemia and optimally treated. It is recommended to further strengthen the adolescent national health programs and food fortification programs.

Purpose: Our study was designed to determine ophthalmologists' dexterity in performing standard ophthalmic procedures at various levels of expertise via a structured questionnaire. Methods: A structured questionnaire was administered via the Google platform from August 20 to September 19, 2022, to assess the perspectives and preferences of ophthalmologists concerning their proficiency in using their right hand, left hand, or both hands to perform routine tasks required in the practice of ophthalmic medicine and surgery. Results: Two hundred and three participants took part in the survey. A majority (n = 162, 79.8%) of the clinicians considered themselves right-handed, nine (4.4%) considered themselves left-handed, and 32 (15.7%) considered themselves ambidextrous. Also, 86% (n = 174) of the participants considered ambidexterity an essential trait in the practice of ophthalmic medicine and surgery. The number of cataract surgeries performed had an impact on the comfort of using both hands for performing anterior vitrectomy (P < 0.001), injection of viscoelastic (P < 0.001), and toric marking (P < 0.05), but not on the performance of capsulorhexis and switching of foot pedals. The number of procedures carried out had an impact on the comfort of using both hands in gonioscopy (P < 0.001), 90 D evaluation (P < 0.001), and 20 D evaluation (P < 0.05). More years of experience had an impact on skills involving the use of both hands for slit lamp joystick usage (P < 0.05) and laser procedures (P < 0.001). Conclusion: Irrespective of a person's handedness, trained ambidexterity in the required fields is achievable and has a significant impact on one's ability to perform the required skill optimally and appropriately.

Background: Infertility can have a significant impact on the identity of women. Individual women, who are infertile, experience tragic emotions, as well as those who are sad for great losses, like the death of a loved one. In this case, the woman is experiencing the loss of the ability to procreate. Aim: In the present study, our major concern was to implement the health-related quality of life (HRQOL) Questionnaire on South Indian polycystic ovarian syndrome (PCOS) women to assess the impact of various clinical features of polycystic ovary syndrome on the HRQOL of South Indian women diagnosed. Settings and Design: A total of 126 females in the first phase and 356 females in the second phase between the age group of 18–40 years characterised under the Rotterdam criteria were selected for the study. Materials and Methods: The study was carried out in three different phases which included a one-to-one interview, group discussion and questionnaire session. In our study, we found that all the females who attend the study showed positivity for all the domains developed in the previous study and suggested that further domain can be developed. Statistical Analysis Used: Suitable statistical methods were used with Graph pad PRISM (version 6). Results: Hence, in our study, we developed a further new sixth domain called as 'social impact domain'. Among South Indian PCOS women, we found that infertility and social issue have the most significant impact on HRQOL. Conclusion: The revised questionnaire by including the sixth domain called 'Social issue' is likely to be useful in measuring the quality of health of female having PCOS in regard to South Indian population.

Background: Panoramic radiography is a routinely advised extraoral radiograph in a dental practice due to its diverse implications in the field of oral and maxillofacial diagnosis. The visibility of normal structures in the panoramic radiographs is of paramount importance as their margins should be delineated clearly from pathological structures that will aid in the correct diagnosis and treatment planning. Aims and Objective: The study aimed to compare the subjective image quality of selected anatomical landmarks on CCD-based panoramic images with and without processing. The objective was to highlight the importance of processed images, which are frequent in day-to-day practice. Materials and Methods: The study comprised 60 subjects with a complete complement of permanent teeth excluding third molars. Selected subjects were clinically examined, and a digital panoramic examination was done. The radiograph obtained was assessed for the subjective image analysis based on the visibility of six major anatomical landmarks using a 3-point scale, and the overall image assessment was done using a 4-point scale. The data was tabulated for statistical analysis. Results: Digital panoramic radiographs with post-processing showed superior visibility with regard to the six anatomical landmarks as well as for overall image assessment which was found to be statistically significant (P

Purpose: Dry eye is a multifactorial disease of the ocular surface. It showed an increased incidence during the pandemic situation, which may be due to long hours of exposure to electronic gadgets. We aimed to find the prevalence of dry eye disease among medical students during the coronavirus disease 2019 (COVID-19) pandemic and pre-pandemic periods. Methods: This was a cross-sectional study conducted in a tertiary care teaching institute. This was an institution-based, cross-sectional study conducted among medical students. A modified Ocular Surface Disease Index (OSDI) questionnaire was used to find the severity and prevalence of dry eye disease. Considering 95% confidence interval (CI) and prevalence as 50%, the calculated sample size was 271. Online responses were collected and entered in an Excel sheet. The Chi-square test, univariate and multivariate logistic regression were used for statistical analysis. Results: Data were collected from 271 medical students; the prevalence of dry eye disease was 41.5 and 55.19 during the pre-pandemic and pandemic periods, respectively. There was a significant rise in dry eye disease cases during the pandemic when compared to pre-pandemic period (P < 0.05). The odds of getting dry eye disease were 1.7 times more during the pandemic than pre-pandemic. Conclusion: The lockdown situation during the pandemic forced people to use electronic gadgets for work, recreation, and academics. Prolonged screen time predisposes to the development of dry eye disease.

Opacification of intraocular lens (IOL) is one of the uncommon causes of delayed decrease in vision postcataract surgery. It occurs more commonly with hydrophilic IOLs and less with hydrophobic IOLs. Here, we present a case of an 81-year-old lady, who came 7 years after an uneventful phacoemulsification with decrease in vision in her left eye (LE). Slit-lamp examination revealed an opacified IOL with a grossly normal posterior segment. Anterior segment optical coherence tomography (ASOCT) revealed a band of hyper reflectance on the anterior and posterior surface of IOL with a clear zone in between. She underwent IOL exchange with consequent vision improvement.

A case report of a healthy young male, presented with binocular diplopia of sudden onset with mild bilateral abduction limitation, progressed rapidly to near total ophthalmoplegia. Rest of the ophthalmic examination, blood pressure, and magnetic resonance imaging of brain were normal. Basic blood work-up was normal except mildly raised serum triglycerides. He gave a history of mild giddiness and ataxia. Neurological evaluation done showed absent deep tendon reflexes and serum anti-GQ1b antibody was raised. A diagnosis of Miller-Fisher syndrome was made and he was given intravenous immunoglobulin. Post-treatment his ocular motility recovered well, with minimal residual diplopia noted for distance. In individuals with abducent nerve palsy, normal imaging, and no systemic risk factors, a careful history asking for subtle neurological symptoms and a complete central nervous system examination is warranted to rule out conditions like Miller-Fisher syndrome which may not be a familiar entity to many ophthalmologists.

Relevance. The COVID-19 pandemic is still making adjustments to the modern realities of both healthcare and society as a whole. The incidence of COVID-19 in children and adolescents is becoming more and more urgent. At the end of January 2022, in Moscow, the number of registered cases of SARS-CoV-2 infection in minors increased 14 times (from 2,000 to 28,000), and the number of hospitalizations increased 10 times, to 120 people per day. During the pandemic, local outbreaks of COVID-19 remain relevant, especially in organized groups. Aim. Description of a local outbreak of COVID-19 in an organized educational group of common residence, preventive measures and characteristics of the infection. Materials and methods. The results of the examination of the focus of COVID-19, medical records of hospitalized patients, regulatory documents, and literary sources were used. A descriptive epidemiological method was used. Statistical data processing was not carried out due to the small sample size. Results. In the spring of 2021, an outbreak of COVID-19 was registered in one specialized educational and methodological center in Moscow with ten victims. The center is located in a five-story brick building designed for the teaching and living of pupils. When registering the first case of COVID-19 in a specialized educational and methodological center, an operating mode was established on the principle of an observatory. Nine children were hospitalized and one teenager was treated for scrap in Moscow. All hospitalized patients underwent computed tomography of the chest organs, no changes in the lungs were noted, which is a significant difference compared to adults, in whom in most cases the SARS-Cov-2 virus enters the lungs. All patients in the hospital received antiviral therapy (Umifenovir 200 mg orally 4 times a day, 5 days), decongestants, local antiseptics, antihistamines were used according to indications. At discharge, all adolescents had positive results for COVID-19 according to the results of PCR swabs from the nasopharynx and oropharynx, and therefore, with an improvement in their general condition, they were transferred for further observation to the observational rehabilitation center COVID-19 «Krylatskiye kholmy». Conclusions. Living in communal dormitories and learning at the place of residence involves close contacts at home and during classes, which predetermines a high risk of infection with the SARS-Cov-2 virus and the occurrence of foci. Promptly carried out anti-epidemic measures make it possible to interrupt the chain of infections in the outbreak. Compared to adults, adolescents experienced fewer and less severe symptoms of COVID-19. Although in most cases, children do not get severely ill from COVID-19 as adults, they can play an important role in the transmission of the infection and in the formation of its outbreak.

Background and Aim: Psychological and biochemical factors are responsible for the behavioral problems in children with epilepsy. A study was conducted to find the prevalence of behavioral problems in children with epilepsy and also to identify the relation among socioeconomic status, age of onset of seizure, and frequency of seizure attacks with the prevalence of behavioral problems. Materials and Methods: It was a prospective observational study conducted in the Department of Pediatrics, Kakatiya Medical College, Warangal. Convenient sampling was considered; the study was conducted for 2 years. Children aged 1–12 years, admitted with epilepsy to pediatric intensive care unit and pediatric wards, were included in this study. Those were having intellectual problems, cerebral palsy, developmental delay, and metabolic and neurodegenerative disorder were excluded from the study. Sociodemographic information was collected from the parents in a standard pro forma. Diagnostic and Statistical Manual of Mental Disorders-oriented scales for different ages were used for the assessment of behavior by translating into regional language. Chi-square test was used; P < 0.05 was considered statistically significant. Results: A total of 112 children were included; male: female ratio was 1.39; 41 (36.6%) children had behavioral problems; age-wise, there was significant difference; gender-wise, there was no significant difference. Attention-deficit/hyperactivity problems were identified to be the predominant. Statistically, there was no significant difference between behavioral problems either with mother education or with parent's socioeconomic status, respectively. When brain imaging was done, normal studies were revealed in 32% of children with behavior problem. Conclusion: Each and every child with epilepsy aged 1 time/year needs thorough screening for behavioral problems irrespective of gender and family characteristics.

Thyroid eye disease has been a well-recognized clinical entity related to thyroid gland dysfunction for more than a century. However, the last couple of decades devoted to specific clinical research regarding this entity has significantly contributed to understanding the etiopathogenesis of the disease that has directed further research towards true disease-modifying therapies. The authors wish to present a comprehensive review of the disease with focus on the recent advancements in management of the same.

Purpose: To find the intraocular lens (IOL) power calculation changes before and after isotonic collagen cross-linking (CXL) in keratoconus patients. Methods: Thirty-five eyes of 25 patients who underwent isotonic CXL were included. The cases included conventional CXL (n = 16), accelerated CXL (n = 7), contact lens-assisted CXL (CACXL) (n = 9), accelerated CACXL (n = 3). All underwent ocular biometry (IOL master), corneal topography (Orbscan II), and simulated keratometry (Orbscan II) preoperatively and 1-year post CXL. Change in best-corrected visual acuity (BCVA), axial length (AL), simulated keratometry (Sim K), anterior chamber depth (ACD), and IOL power were analyzed in the overall data and then grouped based on flattening (Group A) and no flattening (Group B) of Sim K value post CXL procedure. Results: For the overall data, there was no significant change in IOL power (P = 0.05) at the end of 1 year, BCVA showed a significant increase (P < 0.01), and Sim K reading showed a statistically significant flattening (P = 0.001); ACD and AL showed insignificant change. In intergroup comparison, there was no statistically significant change in IOL power. However, in Group A, a significant change in BCVA and Sim K values was observed. In both groups (Group A and Group B), IOL power was found to be negatively correlated with AL and Sim K values. Conclusion: Isotonic CXL did not affect IOL power calculation at the end of 1 year. However, significant change in BCVA and sim K reading was noted.

One of the main challenges of the current money market is the failure to identify, identify and disclose the credit risks of banks. Rating agencies require different rating patterns for a variety of institutions. In this research, we have tried to provide a model for credit rating of banks accepted in the country's capital market by examining the models used by major rating agencies and reviewing various researches and theoretical literature related to this subject and considering the indigenous conditions. This research is mainly descriptive and comparative in terms of the purpose of the study as it attempts to define the credit ratings pattern of banks. The first step in presenting this model is to identify the dimensions and components and ranking indices that were asked after expert theoretical foundations in the form of questions and their opinions were evaluated using Delphi technique with the aim of reaching consensus .Finally, the final model obtained consists of 5 dimensions as follows: Independent credit rating with 6 components of asset quality, financing and liquidity status, profitability and capital status, competitive status, risk and management status, and 60 indicators, then other qualitative features with The 10 indicators are the institutional support rating with 4 indicators, the government support rating with 4 indicators and the country credit rating with two indicators.

BackgroundIdentifying caregiver availability, particularly for patients with dementia or those with a disability, is critical to informing the appropriate care planning by the health systems, hospitals, and providers. This information is not readily available, and there is a paucity of pragmatic approaches to automatically identifying caregiver availability and type. ObjectiveOur main objective was to use medical notes to assess caregiver availability and type for hospitalized patients with dementia. Our second objective was to identify whether the patient lived at home or resided at an institution. MethodsIn this retrospective cohort study, we used 2016-2019 telephone-encounter medical notes from a single institution to develop a rule-based natural language processing (NLP) algorithm to identify the patient’s caregiver availability and place of residence. Using note-level data, we compared the results of the NLP algorithm with human-conducted chart abstraction for both training (749/976, 77%) and test sets (227/976, 23%) for a total of 223 adults aged 65 years and older diagnosed with dementia. Our outcomes included determining whether the patients (1) reside at home or in an institution, (2) have a formal caregiver, and (3) have an informal caregiver. ResultsTest set results indicated that our NLP algorithm had high level of accuracy and reliability for identifying whether patients had an informal caregiver (F1=0.94, accuracy=0.95, sensitivity=0.97, and specificity=0.93), but was relatively less able to identify whether the patient lived at an institution (F1=0.64, accuracy=0.90, sensitivity=0.51, and specificity=0.98). The most common explanations for NLP misclassifications across all categories were (1) incomplete or misspelled facility names; (2) past, uncertain, or undecided status; (3) uncommon abbreviations; and (4) irregular use of templates. ConclusionsThis innovative work was the first to use medical notes to pragmatically determine caregiver availability. Our NLP algorithm identified whether hospitalized patients with dementia have a formal or informal caregiver and, to a lesser extent, whether they lived at home or in an institutional setting. There is merit in using NLP to identify caregivers. This study serves as a proof of concept. Future work can use other approaches and further identify caregivers and the extent of their availability.

BackgroundAdverse reactions to drugs attract significant concern in both clinical practice and public health monitoring. Multiple measures have been put into place to increase postmarketing surveillance of the adverse effects of drugs and to improve drug safety. These measures include implementing spontaneous reporting systems and developing automated natural language processing systems based on data from electronic health records and social media to collect evidence of adverse drug events that can be further investigated as possible adverse reactions. ObjectiveWhile using social media for collecting evidence of adverse drug events has potential, it is not clear whether social media are a reliable source for this information. Our work aims to (1) develop natural language processing approaches to identify adverse drug events on social media and (2) assess the reliability of social media data to identify adverse drug events. MethodsWe propose a collocated long short-term memory network model with attentive pooling and aggregated, contextual representation generated by a pretrained model. We applied this model on large-scale Twitter data to identify adverse drug event–related tweets. We conducted a qualitative content analysis of these tweets to validate the reliability of social media data as a means to collect such information. ResultsThe model outperformed a variant without contextual representation during both the validation and evaluation phases. Through the content analysis of adverse drug event tweets, we observed that adverse drug event–related discussions had 7 themes. Mental health–related, sleep-related, and pain-related adverse drug event discussions were most frequent. We also contrast known adverse drug reactions to those mentioned in tweets. ConclusionsWe observed a distinct improvement in the model when it used contextual information. However, our results reveal weak generalizability of the current systems to unseen data. Additional research is needed to fully utilize social media data and improve the robustness and reliability of natural language processing systems. The content analysis, on the other hand, showed that Twitter covered a sufficiently wide range of adverse drug events, as well as known adverse reactions, for the drugs mentioned in tweets. Our work demonstrates that social media can be a reliable data source for collecting adverse drug event mentions.

Capsular bag distension syndrome (CBDS) is a rare complication of cataract surgery characterized by collection of turbid fluid between the posterior surface of the intraocular lens (IOL) and the posterior capsule. Here, we report a case of CBDS presenting 7 years after uneventful cataract surgery. Patient presented with blurring of vision in the right eye and his best corrected visual acuity (BCVA) was 6/9 N6. Slit lamp examination showed collection of turbid fluid between IOL and posterior capsule, and the opaque fibrosed capsulorhexis margin was adherent to the optic of IOL which was well placed within the bag. Patient underwent neodymium yttrium aluminium garnet (ND-YAG) laser posterior capsulotomy to release the fluid into the vitreous cavity. 6 weeks after the procedure his BCVA improved to 6/6 N6.

The development of resistance is one of the major complications faced by an oncologist for cancer treatment. Autophagy plays a crucial role in driving this resistance against most antineoplastic therapies. The evolutionarily conserved autophagy process meant for quality control of cellular organelles and protein complexes is overwhelmed by proliferative signals from various carcinogens. This leads to the accumulation of defective oncogenic proteins leading to carcinogenesis. As the tumor proliferates and grows in size, it reboots its autophagy pathways to supplement its ever-growing need for nutrients, oxygen, and energy supply. This review will discuss various molecular mechanisms of how physiological and metabolic stressors modulate autophagy, which drives the cancer cell's journey from dormancy to survival by fuelling the metabolic pathways involving internal cell restructuring and reshaping the tumor microenvironment. Considering the preclinical success of autophagy modulators for cancer treatment, this review will bring a new perspective and mechanistic explanation for using autophagy inhibitors for curtailing tumor progression and later using autophagy inducers for preventing cancer remission. This review will also help to formulate or repurpose safer and effective stand-alone and combination anticancer treatment strategies involving autophagy modulators.

Background: Although fat grafting has become an attractive method of correction of soft tissue deficiencies, variability in results exists. As the understanding of mechanism of survival of graft improves, the concepts regarding fat grafting change. There are many ways to process the aspirated fat with no clear method superior. Aim: The aim of this study was to evaluate the role of processing during autologous fat transfer. Materials and Methods: The patients were serially divided into two groups, namely, A and B. Harvesting of lipoaspirate and injection of fat were same in both the groups. In group A, no processing was done. In group B, the fat was processed by sedimentation and injected. Patient satisfaction was assessed following the procedure and statistical analysis was done using the Mann–Whitney U-test. Results: Young females between 21 and 30 years formed the majority of patients who opted for fat grafting procedure. Most of the procedures were performed for defects in the face (93.3%). The most common indication of fat grafting was contour deformities, with abdomen being the most preferred donor site. The mean patients’ satisfaction following fat grafting without processing is 2.2 ± 0.68. The mean patients’ satisfaction following fat grafting with processing is 2.53 ± 0.99. Conclusion: There was not a statistically significant difference in patient outcomes following fat grafting, with or without processing, in terms of patient satisfaction. Autologous fat grafting was found to be a safe procedure with no significant complications.

Background: Symptom elicitation is a simple and inexpensive screening tool used for population screening in tuberculosis (TB) prevalence surveys. However, the information on the yield of TB cases by symptoms is sparsely available. Methods: A cross-sectional pulmonary TB (PTB) prevalence survey was conducted. All available eligible individuals were interviewed for symptoms of PTB. Sputum samples were collected and tested for PTB by smear microscopy and culture. Results: Among 2890 individuals tested for PTB, 77% had cough for 2 weeks or more and one-third reported chest pain for 1 month or more. About 31% were having a history of anti-TB treatment. Cough contributed to 82% PTB cases and the history of anti-TB treatment contributed to another 8.4% confirmed cases. Fever recorded lowest yield among the symptoms of PTB. Conclusion: The study suggests that fever alone may be ignored from symptomatic elicitation, and history of previous anti-TB treatment should be treated as an important indication for PTB symptomatic elicitation.

Background: Teachers in the field of psychiatry has the responsibility to impart changes in students' attitude towards important areas of the subject. Suicide is the psychiatric emergency that a primary care practitioner is most likely to encounter in day to day practice. In this cross-sectional study, we looked into the change in the attitude of an undergraduate student towards suicide with his/her training in psychiatry with the present undergraduate curriculum. Materials and Methods: We recruited undergraduate medical students doing their MBBS course from a medical college of South India. Their responses to Eskin's Attitudes towards Suicide Scale (E-ATSS) and Eskin's Social Reactions to Suicidal Persons Scale (E-SRSPS) were collected. The students were divided into groups of students completed undergraduate training in Psychiatry and those who are yet to get exposed to it. Responses in E-ATSS and E-SRSPS from both groups were compared. Results: The overall attitude of students towards suicide and suicidal person were favourable compared to many previous studies. There was a significant difference in the factor ' suicide as a sign of mental illness' when responses from both groups were compared. 2.72±1.11 in the exposed group compared to 3.16±1.11 of unexposed group. p-value

Purpose: Augmented survival of childhood nephroblastoma and neuroblastoma has increased long-term side effects such as metabolic syndrome (Met S). Risk stratification is difficult after abdominal radiation because waist circumferenc e underestimates adiposity. We aimed to develop a strategy for determining MetS in irradiated survivors using an integrated biomarker profile and vascular ultrasonograp hy. Methods: The NCEP-ATPIII MetS-components, 14 additional serum biomarker s and 9 vascular measurements were assessed in a single-centre cohort of childhood nephroblastoma (n = 67) and neuroblastoma (n = 36) survivors and controls (n = 61). Multivariable regression models were used to study treatment eff ects. Principal component analysis (PCA) was used to study all biomarkers in a combined analysis, to identify patterns and correlations. Results: After 27.5 years of follow-up, MetS occurred more often in sur vivors (14%) than controls (3%). Abdominal radiotherapy and nephrectomy, to a lesser extent, were associated with MetS and separate components and with seve ral biomarker abnormalities. PCA of biomarkers revealed a pattern on PC1 from favourable lipid markers (HDL-cholesterol, adiponectin) towards unfavourable markers (triglycerides, LDL-cholesterol, apoB, uric acid). Abdominal radiotherapy was a ssociated with the unfavourable biomarker profile (β = 1.45, P = 0.001). Vascular measurements were not of added diagnostic value. Conclusions: Long-term childhood nephro- and neuroblastoma survivors freque ntly develop MetS. Additional assessment of biomarkers identified in PCA – adiponectin, LDL, apoB, and uric acid – may be used especially in abdominally irr adiated survivors, to classify MetS as alternative for waist circumference. Vascular ultrasono graphy was not of added value.

Background: Despite proper completion of treatment, pulmonary TB (PTB) patients experience pulmonary dysfunction which can cause significant impact in their quality of life. This study aimed to assess the lung function impairment in patients treated for PTB using spirometry. Methods: A cross- sectional study was conducted in Pulmonary Medicine Department Out-patient department in Sri Ramachandra Institute of Higher Education and Research. Patients aged 15 and above who were treated for pulmonary tuberculosis were included in the study. Demographic data were collected. All participants underwent spirometric measurements. Airflow obstruction was defined as apost- bronchodilation FEV1/FVC < 70% with FVC > 80%, restrictive defects as an FEV1/FVC ratio of > 70% with an FVC < 80% predicted, and mixed defects as FVC of

Background: Anganwadi centers were providing integrated services comprising supplementary nutrition, immunization, health check-up, and referral services to children below six years of age and expectant and nursing mothers. After more than three decades of implementation, the success of Integrated Child Development Services (ICDS) program in tackling maternal and childhood problems still remains a matter of concern. Objectives: To estimate the proportion of pregnant women utilizing various services provided by the anganwadi centre. To assess the association between demographic factors and utilization of anganwadi services by pregnant women. Methods: A cross-sectional study with a sample size of 135 was conducted in three villages attached to a medical college. Pregnant women enrolled in anganwadi the center were included in the study. Data was collected by a predesigned pretested semi-structured questionnaire. Data was presented in proportions, odds ratio with confidence interval, and Chi-square test, Fisher test was applied to find the association between variables by using SPSS ver. 23. Results: The study showed 86.66% utilized supplementary nutrition services, 62.96% received health education, 85.92% took vaccines from anganwadi centre, 40.74% utilized referral services, and 82.22% utilized health checkups services provided by anganwadi centre. Distance from the centre was found to be an important determinant of the utilization of anganwadi services. Conclusions: There is a need to sensitize and motivate beneficiaries to utilize the services offered by anganwadi center.

Purpose: To assess the perspectives of physicians in general and ophthalmologists in particular about restarting elective out-patient (OP) and operating (OT) services after relaxation of lockdown for COVID-19. Methods: An online survey, containing 31 questions, was conducted among medical doctors using a secure Google forms link. The survey was open for 48 hours from 16th-18th April 2020. Results: Responses were received from 556 physicians (including 266 ophthalmologists). About a third (n = 205) wanted to start OP immediately after lockdown. In OP, mask of any kind for patient (60.8%), 3-ply for assistants (52.7%) and N95 for doctors (72.7%) were most common preferences. In OP, 31.5% and 46.6% felt full PPE and gloves alone were sufficient respectively. Ophthalmologists were more likely to start immediately after lockdown compared to other specialists (P = 0.004). Among 299 surgeons, an almost equal number (27%) wanted to start routine OT services immediately and 2 weeks post lockdown. A large majority (76.9%) would mandate COVID-19 tests before elective surgeries. In OT, 34.1% wanted N95 for surgical team and 3-ply for patient, 23.4% wanted 3-ply masks for everyone. 40.5% felt additional personal protective equipment (PPE) is not required and 33.1% felt that full PPE is required for everyone in OT. Ophthalmic surgeons preferred 3-ply masks and were less inclined to use full PPE (P < 0.001). Conclusion: Perspectives of doctors vary, especially with regarding to timing of restarting services and precautions to be taken in the OT. Ophthalmologists may tend to err on the side of taking lesser stringent precautions when restarting services post lockdown.

Cervical lymphadenopathy is a clinical feature of vast spectrum of diseases. It includes infections, malignancy, lymphoma, and connective tissue diseases. All cases need to be evaluated in detail with proper laboratory investigations and a tissue cytology/biopsy to unmask the etiology. Here, we present a young woman who was admitted for multiple painful neck swellings associated with fever for 3 months. She was primarily investigated to rule out infectious causes. The patient was evaluated in detail including blood investigations and biopsy and finally turned out to be systemic lupus erythematosus (SLE)-associated lymphadenopathy. This case shows that painful neck nodes can be a presenting feature of SLE and needs to be considered as one of the differential diagnosis in patients presenting with lymphadenopathy along with constitutional symptoms.

The ongoing pandemic of COVID-19 is a global public health emergency. This has led to challenges for healthcare facilities to optimally manage other important medical emergencies. Stroke is an important public health emergency with significant mortality and morbidity. Timely treatment of acute stroke is critical to prevent disability. The current expert consensus statement on behalf of the Indian Stroke Association outlines the issues and suggestions related to the management of stroke during this ongoing COVID-19 pandemic.

Introduction: Dermatoses are common among schoolgoing children, more so in a tribal area and cause significant morbidity. Objective: The present study was conducted to study the point prevalence and pattern of dermatoses in Jenukuruba tribal children in Mysore district. Materials and Methods: A cross-sectional study was conducted on 4207 Jenukuruba tribal children in Mysore district. Diagnosis of various dermatoses was made on the basis of detailed clinical examination. Results: The point prevalence of dermatoses was 71.5%. Majority had single skin lesion. Nearly 43% had more than one skin lesion. Among skin infections and infestations, pyoderma (33.4%) and scabies (19.8%) were most prevalent. Among the noninfective conditions, xerosis (71.5%), pityriasis alba (16.7%), acne (8.6%), and hyperpigmentation (54.5%) were most prevalent. Conclusions: The point prevalence of dermatoses in tribal schoolchildren in Mysore district is very high. Health education of children and caregivers regarding the signs and symptoms of dermatoses is warranted for early detection, timely intervention, and prevention.

Participatory methods, which rely heavily on community-based data collectors, are growing in popularity to deliver much-needed evidence on violence and mental health in low- and middle-income countries. These settings, along with local researchers, encounter the highest burden of violence and mental ill-health, with the fewest resources to respond. Despite increased focus on wellbeing for research participants and, to a lesser degree, professional researchers in such studies, the role-specific needs of community-based researchers receive scant attention. This co-produced paper draws insights from one group's experience to identify rewards, challenges, and recommendations for supporting wellbeing and development of community-based researchers in sensitive participatory projects in low-resource settings. Twenty-one community-based researchers supporting a mixed-methods study on youth, violence and mental health in Sri Lanka submitted 63 reflexive structured journal entries across three rounds of data collection. We applied Attride-Stirling's method for thematic analysis to explore peer researchers' learning about research, violence and mental health; personal-professional boundaries; challenges in sensitive research; and experiences of support from the core team. Sri Lanka's first study capturing experiences of diverse community-based researchers aims to inform the growing number of global health and development actors relying on such talent to deliver sensitive and emotionally difficult work in resource-limited and potentially volatile settings. Viewing participatory research as an opportunity for mutual learning among both community-based and professional researchers, we identify practice gaps and opportunities to foster respectful team dynamics and create generative and safe co-production projects for all parties. Intentional choices around communication, training, human and consumable resources, project design, and navigating instable research conditions can strengthen numerous personal and professional capacities across teams. Such individual and collective growth holds potential to benefit short- and long-term quality of evidence and inform action on critical issues, including violence and mental health, facing high-burden, low-resource contexts.

BackgroundLack of TB incidence data is an important evidence gap among Saharia-a high TB burden indigenous community in Madhya Pradesh, central India. The present study was undertaken to calculate the incidence of pulmonary tuberculosis in this tribe.ObjectiveTo calculate the incidence of pulmonary tuberculosis (PTB) among the Saharia tribal population in Madhya Pradesh, central India.MethodsA prospective cohort study was conducted among the Saharia tribal population (aged 15 years and above) of Shivpuri district in Madhya Pradesh state in central India. A total of 9,756 individuals were screened for TB in the baseline TB prevalence survey during 2012-13. All available household members were screened for symptoms suggestive of pulmonary TB (presumptive TB). Two sputum specimens were collected from persons having symptoms suggestive of TB and examined by smear and culture tests. A cohort of all non-TB individuals in the baseline survey was followed-up for one year and re-screened for the sysmptoms of PTB in the year 2014-15. Based on the data collected, the incidence of TB over one year period was estimated per 100,000 population.ResultsA total of 9756 and 9044 individuals (≥ 15 years) were screened for symptoms suggestive of PTB during baseline and endline surveys respectively. The sputum specimens of presumptive TB cases were collected and examined by smear and culture tests. The overall incidence of bacteriologically positive (smear and/or culture) PTB over one year period was 1504 (95% Confidence Interval (CI): 1273-1776) per 100,000 in the study population, the incidence of smear-positive PTB was 1106 (95% CI: 910-1343), and the incidence of culture-positive PTB was 1084 (95% CI: 890-1319) per 100,000 population. The incidence for both smear and culture-positive PTB was 686 (95% CI: 535-878) per 100,000 population in the year 2014-15. The incidence of PTB was 2.8 times higher in males compared to females (2259 vs 807 per 100,000) and was positively correlated with age.ConclusionThe findings of the study, the first of its kind in the Saharia tribal population, indicate a high incidence of TB in this tribal community thereby highlighting the urgent need for focused and intensified efforts to achieve the goal of TB elimination in the country.

The management of drug-resistant (DR) tuberculosis (TB) remains a challenge particularly in remote rural areas of the country. Although the treatment with wholly oral drug regimens, including bedaquiline (BDQ) and delamanid, is rolled out under the National TB Elimination Program, little is known about its coverage and the effectiveness in hard-to-reach tribal areas. The present report describes the early identification and successful management, through team effort, of a case of extensively DR TB belonging to the Saharia tribe – a Particularly Vulnerable Tribal Groups (PVTGs) of Madhya Pradesh, which has a very high prevalence of TB. The BDQ-containing regimen was well tolerated and found effective with minimal side effects and contributed to the reduced time to culture conversion and radiological improvements. The concerted efforts and strategies need to be adopted for effective implementation of Programmatic management of DR TB (PMDT) guidelines in remote tribal areas of the country.

Silicone oil (SO) is a commonly used tamponading agent in retinal detachment surgeries. Inadvertent anterior migration of SO and complete anterior chamber (AC) oil fill in an aphakic or pseudophakic eye is occasionally encountered. This can cause secondary glaucoma with very high intraocular pressure and pain. In this scenario, an urgent silicone oil removal (SOR) is warranted. Since SO is buoyant, in the supine position, it tends to rise anteriorly. Hence, removal of SO trapped in the AC will invariably lead to further migration of oil from the posterior segment into the AC to replace the volume removed. Simultaneous replacement of AC volume is necessary to prevent this. We describe a modified technique of partial SOR that employs air to prevent recurrent migration of SO into AC.

The aim of study was to evaluate the morphological and immunohystochemical characteristics of aspirated thrombi in patients with ST-elevation myocardial infarction undergoing precutaneous coronary intervention to find the possible platelet activation and inflammatory cell involvement in coronary thrombi. Materials and methods. Thrombi collected from 67 patients with ST-elevation myocardial infarction were studied. Macroscopic and immunohystochemical analyses were performed to reveal the cellular components of thrombi. The peroxidase - antiperoxidase immunohystochemical method was applied with monoclonal antibodies to CD4+, CD8+, CD15+, CD63+ and CD105+ using diaminobenzidine agent as a visualization agent to investigate the potential involvement of different cellular subpopulations. Results. The macroscopic examination revealed friable thrombi with apparent laminations (lines of Zahn). Microscopic analysis of thrombi revealed a loose meshwork of fibrin fibers with compact accumulation of activated platelets. The platelets were surrounded by neutrophilic granulocytes.The immunohystochemical analysis confirmed that cell aggregates are consisting of CD 63+ activated platelets and leucocytes. The granulocytes also tested positive for CD15 antigen. The immunohystochemical analysis revealed the presence of CD8+ cytotoxic T-lymphocytes and CD4+ helper T-lymphocytes. No expression of iNOS, CD105 and VEGF was found in the analyzed thrombi. Conclusions. The hystopathological evaluation of thrombi in patients with acute ST-elevation myocardial infarction revealed the presence of activated CD63+ platelets and CD15+ neutrophilic granulocytes. Activated platelets and neutrophils may play a role in thromboinflammatory activation course leading to destabilization of atherosclerotic plaque and development of acute thrombosis in patients with ST-elevation acute myocardial infarction.

Aim. To study the risk factors, symptoms and outcomes of candidemia caused by C. albicans and C. non - albicans in patients with hematological malignancies. Materials and methods. The study included patients with hematological malignancies and candidemia. The diagnosis of candidemia was established according to the single isolation of Candida spp. from blood culture and the presence of symptoms of infection. Results and discussion. Over 12 years (2006-2017), candidemia was diagnosed in 75 patients aged 17 to 77 years (median 48 years). The causative agents of candidemia were C. albicans in 34.7% of patients, C. non - albicans - in 65.3%. Candidemia caused by C. albicans prevailed in patients of the older age group (median 56.5 years, p=0.04) and in patients with lymphoma (61.5%, p=0.01) with colonization of the gut by the same species of Candida (88.5%, p=0.002). Isolation of C. non - albicans from blood culture was more common in patients with acute leukemia (51%, p=0.01) and in recipients of allogeneic hematopoietic stem cells (22.5%, p=0.01). The ability to form biofilms was observed more frequently among C. non - albicans (59.2%) than C. albicans (19.2%, p=0.001). The clinical symptoms of candidemia were non - specific (fever was in 97%). Septic shock developed in 25 (33%) patients with comparable frequency in both groups. Concomitant infections was also comparable (73% vs. 73.5%). Overall 30-day survival in patients with candidemia caused by C. albicans and C. non - albicans was 61.2% and 61.5%. Treatment with echinocandin was associated with increase of survival compared to other antifungal agents among patients with C. albicans candidaemia (88.9% versus 40%, p=0.02) and among C. non - albicans (77.3% versus 47.8%). Conclusion. C. non - albicans constituted a high proportion among causative agents of candidemia. High mortality rate was observed in both groups. Initial therapy with echinocandin was associated with increase of survival.

The paper describes the results of 15 consecutive Russian clinical trials in the treatment of different types of acute leukemias, conducted by Russian cooperative group within the last 27-years and included more than 25 hundred patients. It was shown that the 5-years overall survival in AML younger than 60 years patients improved from 20 to 33%, in ALL - from 38 to 65%, in APL - from 0 to 95%. The cooperative work resulted in balanced clinical recommendations and protocols, reproducible in regional hospitals. Though till now there is a big difference in the long term outcome in acute leukemias patients treated in coordinating or regional centers mostly due to much higher early death rate: 7.5-9.5% vs 18-25%. This parameter should be used as criteria of the total efficacy of hematological service in each region of Russia. It became possible within the last years to integrate the minimal residual disease monitoring into clinical trials thus providing a clue parameter for choosing the further therapy - allogeneic stem cell transplantation. Non - chemotherapeutic approach with arsenic trioxide and all - trans retinoid acid had dramatically changed the toxicity and duration of treatment with very high efficacy. The Russian cooperative group was the first that started to include pregnant women with acute leukemias into clinical trials. This prospective and prolonged experience has shown that pregnancy in acute myeloid leukemia is an extremely poor prognostic factor, but it does not influence the outcome in acute lymphoblastic leukemia.

Aim. Remission induction can be associate, with the life threatening complications and transfer to ICU of de novo acute myeloid leukemia (AML) patients (pts). We evaluate influence of transfer to ICU and life threatening complication on early mortality and long - tram survival of de novo AML pts. Materials and methods. Retrospective study. All de novo AML pts younger than 60 years old admitted in the National Research Center for Hematology from 2013 to 2016 years were enrolled in the study. Patients were divided into 2 groups: pts who were required ICU admission during remission induction (ICU-pts) and pts who did not require ICU admission and received chemotherapy only in hematology ward (non-ICU pts). The reasons for ICU admissions and results of life support were analyzed. Overall survival (OS) were assessed by the Kaplan-Meier method, long rank value p

Aim: to compare the results of tumor visualization when using 18F-FDG and 11C-methionine PET/CT after auto-HSCT in MM patients. Materials and methods. A prospective study included 27 MM patients subjected to 18F-FDG and 11C-methionine PET/CT on day 100 after auto-HSCT. Obtained images were visually and semi - quantitatively analyzed. Focal areas of increased uptake for every radiopharmaceutical agent (hypermetabolic foci) not associated with its physiological distribution were registered. Maximum Standardized Uptake Values (SUVmax) in pathological foci were automatically calculated for every radiopharmaceutical agent separately. PET/CT findings were compared to antitumor response achieved after auto-HSCT according to International MM Working Group criteria. Results. After auto-HSCT, the majority of patients (16/60%) achieved a complete response. Abnormal 18F-FDG uptake was registered in 37% (n=10) of patients, negative PET findings were obtained in 63% (n=17) of patients. 11C-methionine PET/CT revealed hypermetabolic foci in 67% (n=18) of patients, and there was no 11C-methionine uptake in 33% (n=9). Pathological foci of radiopharmaceutical agent uptake were 1.8 times more frequently revealed using PET/CT with 11C-methionine (p

This review outlays the biological chemistry of vitamin C (ascorbic acid) that explains its increasing therapeutic use in orthomolecular medicine. Even in mega doses that are often mostly and safely administered as intravenous infusions, the vitamin, as such or in its potent transportable form dehydroascorbic acid, does not affect healthy cells and targets only cancerous cells. The review proposes the need for clinicians in mainstream medicine to explore more intimately vitamin C’s integrative use in treating many modern-day health problems, such as non-hormone dependent cancers, diabetes, Alzheimer’s disease and sepsis, based on a proper appreciation of the strengths and limitations of both RCTs (efficacy studies) and observational studies (effectiveness studies). Vitamin C is a first line antioxidant. Its known pro-oxidant effects in killing cancer cells, along with its ubiquitous roles as an enzyme cofactor, offer much potential to be tapped in cancer therapy, either alone or in combination with other therapies. An adequate intake of dietary and supplemental vitamin C (90-120 mg/day), is seen as a pivotal need for both young and old to ward off a plethora of health problems.

Mediastinal gray-zone lymphoma (MGZL, lymphoma with features intermediate between classical Hodgkin lymphoma and diffuse large B-cell lymphoma) was declared as a separate entity in WHO classification of Tumors of Haematopoetic and Lymphoid Tissues in 2008 and 2017 years. Despite of similar pathomorphological characteristics between primary mediastinal B-cell lymphoma and Hodgkin lymphoma, clinical features and optimal therapeutic approach to MGZL are not clearly defined. Usually MGZL manifests with mediastinal lymphadenopathy, although extranodal lesions often occur (grey-zone lymphoma, GZL). Patients with MGZL have unfavorable prognosis, taking into account high rate of relapse. This article describes two cases of MGZL. First case manifested by arrhythmias due to primary heart involvement. In spite of cardiac failure antracycline-containing chemotherapy (6 courses of R-DA-EPOCH) it allowed to achieve a complete remission and resolving of arrhythmias. Second case was represented by metachronous tumors: primary mediastinal B-cell lymphoma at the time of disease onset and classical Hodgkin lymphoma, NS II, diagnosed after disease progression. Thus, we demonstrated two examples of MGZL that differ by clinical manifestation, response to chemotherapy, which emphasizes an importance of pathogenesis studying, and using of new therapeutic approaches.

Aim. To evaluate standard 12-lead ECG indices for the differential diagnosis of wide QRS tachycardias with right bundle branch block (RBBB) pattern. Materials and methods. Study analyses the 244 ECG indices in 111 patients (79 males and 32 females, age 53±17 years) with RBBB tachycardias, who underwent electrophysiological studies. First step includes retrospective analysis of QRS characteristics in 20 patients with ventricular tachycardias (VT), 24 pts with aberrant supraventricular tachycardias (SVT+RBBB) and 14 pts with antidromic SVTs (WPW). ROC- and multifactorial analyses were performed to develop diagnostic ECG algorithms. The prognostic accuracy of the algorithms was subsequently evaluated on a prospective group of patients with RBBB tachycardias (n=53). Results and discussion. ECG criteria of RBBB VTs were: 1) the presence Q-wave in lead II, 2) the duration interval R(peak)-S(end) >100 ms in lead V5. ECG criteria for antidromic SVTs with RBBB were: 1) the duration of the R wave in lead I ≥80 ms, 2) the absence of split (M-sharp) R-waves in lead V2, 3) the absence notch in ascending S wave in lead aVL. The accuracy of the algorhythm for diagnostic of VTs with RBBB was 83% (sensitivity 100%, specificity 73%). The accuracy of the algorhythm for diagnostic of antidromic SVTs with RBBB was 91% (sensitivity 85%, specificity 96%). Conclusion. The proposed algorithms are based on new ECG criteria for the differential diagnosis of wide QRS complexes tachycardias with RBBB pattern, unlike the previous algorithms.

Materials and methods. 253 patients with chronic hepatitis C (CHC) and liver cirrhosis were included in the study. Assessment of gene polymorphisms of genes involved in inflammatory reactions and antiviral immunity (IL-1β-511C/T, IL-10 -1082G/A, IL28B C/T, IL28B T/G, TNF-α -238G/A, TGF-β -915G/C, IL-6 -174G/C), activators of local hepatic fibrosis (AGT G-6A, AGT 235 M/T, ATR1 1166 A/C), hemochromatosis (HFE C282Y, HFE H63D), platelet receptors (ITGA2 807 C/T, ITGB3 1565 T/C), coagulation proteins and endothelial dysfunction (FII 20210 G/A, FV 1691G/A, FVII 10976 G/A, FXIII 103 G/T, eNOS 894 G/T, CYBA 242 C/T, FBG -455 G/A, PAI-675 5G/4G, MTHFR 677 C/T) was carried. Using Bayesian networks we studied the predictor value of clinical and laboratory factors for the following conditions - end points (EP): development of cirrhosis (EP1), fibrosis rate (EP2), presence of portal hypertension (EP3) and cryoglobulins (EP4). Results and discussion. In addition to traditional factors we have shown the contribution of the following mutations. Predicting EP1- liver cirrhosis - HFE H63D, C282Y, CYBA 242 C/T, AGT G-6G, ITGB31565 T/C gene mutations were significant. We also found a link between the rate of progression of liver fibrosis and gene polymorphisms of AGT G-6G, AGT M235T, FV 1691G/A, ITGB31565 T/C. Among the genetic factors associated with portal hypertension there are gene polymorphisms of PAI-I-675 5G/4G, FII 20210 G/A, CYBA 242 C/T, HFE H63D and Il-6 174GC. Cryoglobulins and cryoglobuliemic vasculitis (EP4) are associated with gene mutations MTHFR C677T, ATR A1166C and HFE H63D. Conclusion. The results obtained allow to detect the major pathophysiological and genetic factors which determine the status of the patient and the outcome of the disease, to clarify their contribution, and to reveal the significance of point mutations of genes that control the main routes of HCV course and progression.