Phenotypic Heterogeneity and its influence on visual and morphological outcomes in age-related macular degeneration

Age related macular degeneration (AMD) is a complex condition with significant heterogeneity in presentation, rate of progression and outcomes. The overarching aim of the studies in this thesis was to characterize the heterogeneity by conducting in-depth imaging and visual function tests to inform future clinical trial design in non-neovascular AMD, neovascular AMD (nAMD) and geographic atrophy (GA). In a prospective structure-function correlation study on 254 participants with normal fundus and varying severity of non-neovascular AMD, subretinal drusenoid deposits (SDD), hyperreflective foci and nascent GA were found to be imaging characteristics that are associated with visual function losses. In addition, quantitative fundus autofluorescence decreased with increasing AMD severity suggesting that decreasing lipofuscin load is of questionable therapeutic benefit in AMD. In a cohort study on 2,128 patients with new-onset nAMD that completed the loading phase of aflibercept injections, structure-function correlation identified non-white ethnicity, male and eyes with increased CST or those presenting with SRF only as determinants of residual fluid post-loading. Restricting early-phase interventional clinical trials to patients with these characteristics is more likely to provide an indication of benefit over aflibercept, the current comparator of clinical trials in nAMD. In a study on 50 patients with GA, multifocality, SDD, and junctional hyperautofluorescence were identified as features of fast progression and so targeting interventional trials to this GA group would likely yield more reliable results in a shorter period. Using a computer-aided tool on OCT scans on 13 GA patients also revealed that photoreceptor loss precedes GA growth and could be used as an early clinical endpoint for GA trials. In conclusion, various phenotypes were identified within each AMD stage that largely explains differences in visual function, treatment responses and disease progression. These findings could be used to design more efficient and effective clinical trials in AMD

Prediction of treatment response in patients with neovascular age-related macular degeneration

Neovascular age-related macular degeneration (nAMD) is a common cause of visual impairment, and is currently treated with intravitreal anti-vascular endothelial growth factor agents such as aflibercept. While these treatments may improve visual acuity (VA) in some patients, clinicians cannot currently predict who is likely to benefit before treatment starts. The aim of this study is to explore the effectiveness of using Deep Learning approaches to train models for predicting whether a patient’s VA will respond favourably to three months of aflibercept therapy, using pre-treatment OCT images and clinical/demographic variables. We train a number of models using standard machine learning, Deep Learning transfer learning, and fully trained Deep Learning approaches in two experiments using outcomes based on the VA at 4- 10 weeks after the final dose. In experiment one, we trained models to predict whether the VA will be at least 54 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, while in experiment two we trained them to predict whether the VA will have increased by 10 or more letters. Model prediction quality was assessed using the Area Under the Curve (AUC) of the Receiver-Operating-Characteristic (ROC) curves. We found that all models performed significantly better than chance in both experiments, except for the fully trained Deep Learning model using just images in experiment two. The best performing model for experiment one was the Deep Learning transfer model using images and clinical/demographic variables (AUC=0.901), while in experiment two, none of the Deep Learning approaches performed better than a random forest using only clinical/demographic variables (AUC=0.751). Our experiments suggest that different Deep Learning approaches are required for predicting the second outcome if we want the models to perform better than those that use clinical/demographic variables alone

Not Only WEIRD but "Uncanny"? A Systematic Review of Diversity in Human-Robot Interaction Research

Critical voices within and beyond the scientific community have pointed to a grave matter of concern regarding who is included in research and who is not. Subsequent investigations have revealed an extensive form of sampling bias across a broad range of disciplines that conduct human subjects research called "WEIRD": Western, Educated, Industrial, Rich, and Democratic. Recent work has indicated that this pattern exists within human-computer interaction (HCI) research, as well. How then does human-robot interaction (HRI) fare? And could there be other patterns of sampling bias at play, perhaps those especially relevant to this field of study? We conducted a systematic review of the premier ACM/IEEE International Conference on Human-Robot Interaction (2006-2022) to discover whether and how WEIRD HRI research is. Importantly, we expanded our purview to other factors of representation highlighted by critical work on inclusion and intersectionality as potentially underreported, overlooked, and even marginalized factors of human diversity. Findings from 827 studies across 749 papers confirm that participants in HRI research also tend to be drawn from WEIRD populations. Moreover, we find evidence of limited, obscured, and possible misrepresentation in participant sampling and reporting along key axes of diversity: sex and gender, race and ethnicity, age, sexuality and family configuration, disability, body type, ideology, and domain expertise. We discuss methodological and ethical implications for recruitment, analysis, and reporting, as well as the significance for HRI as a base of knowledge.Comment: Published at IJSR/SORO, Int J of Soc Robotics (2023

Adverse drug reaction monitoring in patients of hypertension at a tertiary care hospital, Aurangabad, Maharashtra, India

Background: Hypertension is one of the highest prevailing diseases worldwide. Due to long term therapy antihypertensive drugs are commonly associated with adverse drug reactions (ADRs). Therefore, the study was conducted with the objective to examine the incidence of different types of ADRs in drug treated hypertensive patients.Methods: Present study was a prospective cross sectional observational study carried out in the outpatient of department of medicine of MGM hospital, a tertiary care teaching hospital, in Aurangabad. 320 diagnosed hypertensive patients were studied. Questionnaire was asked and their prescription were analysed and follow up was done.Results: Among 320 patient’s 75 patients were reported ADR. Males accounted for higher percent of ADRs 46 (61%) than females 29 (38.6%). Most of the patients 147 (55.9%) were on mono therapy. Calcium channel blocker was the frequently used class of drug, showed maximum number of ADR (30.6%) followed by ACE inhibitor (28%) and ARB (21.3%). As per WHO-UMC scale, type of reactions and their percentage were as certain (9.3%), Probable/ Likely (64%), possible (22.6%), and unlikely (4%). According to Naranjo scale most of the reactions were possible (64%). severity assessment is done by Hartwig and Siegel scale. No lethal ADR were reported. 4% reactions were severe, 32% were of moderate category and 64% were mild reactions.Conclusions: Such type of studies are helpful in selection of appropriate medicines for hypertensive patients, enhancing patient adherence with the therapy by selecting medicines of lesser ADR profile, reducing unnecessary economic burden to the patients due to unwanted effects of the therapy

Does tailoring instructional style to a medical student\u27s self-perceived learning style improve performance when teaching intravenous catheter placement? A randomized controlled study.

BACKGROUND: Students may have different learning styles. It is unclear, however, whether tailoring instructional methods for a student\u27s preferred learning style improves educational outcomes when teaching procedures. The authors sought to examine whether teaching to a student\u27s self-perceived learning style improved the acquisition of intravenous (IV) catheter placement skills. The authors hypothesized that matching a medical student\u27s preferred learning style with the instructor\u27s teaching style would increase the success of placing an IV catheter. METHODS: Using the VARK model (i.e., visual [V], auditory [A], read/write [R] and kinesthetic [K]), third-year medical students reported their self-perceived learning style and were subsequently randomized to instructors who were trained to teach according to a specific learning format (i.e., visual, auditory). Success was gauged by: 1) the placement of an IV on the first attempt and 2) the number of attempts made until an IV line was successfully placed. RESULTS: The average number of attempts in the matched learning style group was 1.53, compared to 1.64 in the unmatched learning style group; however, results were not statistically significant. Both matched and unmatched groups achieved a similar success rate (57 and 58 %, respectively). Additionally, a comparison of success between the unmatched and matched students within each learning style modality yielded no statistical significance. CONCLUSIONS: Results suggest that providing procedural instruction that is congruent with a student\u27s self-perceived learning style does not appear to improve outcomes when instructing students on IV catheter placement

Examining the Impact of Personality on Teamwork-Based Simulations in Medical Student Emergency Medicine Clerkships

Purpose: As Medical Education evolves with team-based problem-solving and medical simulations, the importance of training teams is imperative to assure that students will be prepared to treat patients in multidisciplinary services. This concern necessitates the question of whether individual characteristics such as personality factors into the success and optimization of teams in team-based educational programs. Our project aims to determine whether individual personality traits can impact the success of teams in simulation-based education. Methods: Myers Briggs Typology Indicator (MBTI) personality data was collected from Third and Fourth-Year medical students during their Jefferson Emergency Medicine Clerkship. These students were observed during educational simulations and assigned a score with the Jefferson Teamwork Observation Guide (JTOG). Data will be analyzed with paired t-test and one-way ANOVA, with teams being designated into groups based on education level, number of introverts and extroverts, and dominant function pairs (ST, SF, NT, NF) in the team. Results and Conclusions: The data indicated that Fourth-Year teams obtained significantly higher JTOG scores than Third-Year teams, with scores of 3.15 and 2.91, respectively, with p\u3c0.002. The data also demonstrated no significant differences in teamwork scores between teams of different personality makeups. While personality type may affect inherent preferences, one can conclude from these data that this predilection does not hinder the teamwork capabilities of a group. Furthermore, these results suggest that clinical rotations completed in medical school may improve teamwork skills, which is certainly an exciting prospect in a field moving towards team-directed patient care

Comparative effect of mixture of ginger and honey with dextromethorphan in dry cough in children

Background: Cough is protective reflex caused by obstruction or irritation of airway. Many medication available for the treatment of dry cough. But it causes sedation and drowsiness in children. Considering the adverse effects produce by the medication, we consider this study as the ginger and honey is used in Indian family, and in Ayurveda ginger and honey is used for treatment of dry and productive cough.Methods: We include the patients who attended the pediatric OPD complaining dry cough. We design the questionnaire and for the measuring the severity of dry cough. We divide the patient into four groups received standard treatment and ginger and honey mixture. We compared the end result with standard treatment statistically by using unpaired student “t” test was used along with two-way analysis of variance (ANOVA) test.Results: We include 100 patient in this study. We got amazing result of this study ginger and honey required less time for recovery and also sedation and drowsiness not occurred in the ginger and honey group as compared to dextromethorphan (p value ˂0.005).Conclusions: After seeing above encouraging result, and along with advantage of natural product with no adverse we can advise the honey and ginger therapy for treatment of dry cough

A study of prescription pattern of the pharmacotherapy of patients of hypertension at a tertiary care hospital, Aurangabad,Maharashtra, India

Background: The overall prevalence for hypertension in India was estimated to be 29.8%. Patient’s optimal adherence with antihypertensive drug therapy is essential for preventing serious complications with hypertension over the long term. Therefore, the present study was undertaken to evaluate the prescription pattern of the drugs prescribed to hypertensive patients.Methods: Present study was a prospective cross sectional observational study carried out in the outpatient of department of general medicine of MGM Hospital, a tertiary care teaching hospital, in Aurangabad. Prescriptions of 120 diagnosed hypertensive patients were analysed. Data was recorded as mean±standard deviation.Results: The mean age of the patients was 57.13±10.94 years with range 18-80 years. 82.5 % (99) of patients were male and 17.5% (21) of patients were female. Mean duration of hypertension was 3.97±2.55. Most of the patients 57 (47.5%) were on Mono therapy significantly higher than dual therapy, triple therapy and poly therapy, 39 (32.5%), 15 (12.5%), 9 (7.5%) respectively. Calcium channel blocker was the frequently used class of drug for monotherapy (20%). Polytherapy was seen in 7.5% patient. Among 120 patients’ only 37 patients were reported ADR. Maximum no of ADRs were reported from patients receiving ACE inhibitor.Conclusions: This type of studies gives the base line idea of prescription pattern and ADRs of antihypertensive drugs. These help to design policy for rational use of drugs and motivation of physician for rational use of drugs

Effect of lisinopril and perindopril on serum lipid profile in Albino rabbits

Background: Hypertension with dislipidemia is becoming a common morbidity, since ACE inhibitors are the first line of antihypertensive drugs so present study was undertaken with the aim to evaluate the possible effects of ACE inhibitor on lipid profile in albino rabbits.Methods: The study was conducted in the Department of Pharmacology and Therapeutics, GSVM Medical College, Kanpur. Rabbits were divided into 2 groups with 6 in each group. Rabbits of Group I was given Lisinopril in dose of 0.25mg/kg and of group II was given Perindopril in dose of 0.20mg/kg for a period of 6 weeks. Lipid profile estimation (Serum Total cholesterol, serum HDL, serum LDL, serum Triglycerides and serum VLDL) was done at day 0, 7, 21 and 45 respectively.Results: After analysis Rabbits of group-I (Lisinopril) showed 3.1% decrease in serum cholesterol level at 45th day (P0.05). Serum LDL level decreases by 4.4% and 8.6% at day 21 and 45 respectively (P<0.001). There was no significant change in Serum VLDL level. Rabbits of group- II (Perindopril) showed decreased total cholesterol levels by 2.6% (P<0.05). There was an increase in HDL level by 6.8 % at day 45(P<.05). Triglycerides and VLDL levels were not significantly altered while serum LDL level decreases by 6.7% at day 45 (P<0.01).Conclusions: From our study it was concluded that Lisinopril had a favourable effect on serum lipid profile by decreasing total cholesterol, increasing serum HDL level. It may increase triglycerides, decrease LDL. Perindopril increase serum HDL and decreases LDL, there is no significant change in cholesterol, TG and VLDL levels

Evaluation of anti-asthmatic and anti-cholinergic activity of ethanolic extract of Tectina grandis Linn. bark

Background: Asthma is a chronic disease that affects approximately 300 million people worldwide. Tectona grandis Linn. bark, also known as Teak (English), is traditionally used to treat asthma. However, the scientific data on anti-asthmatic and anti-cholinergic of this plant has got little attention. An attempt has been based on ethanolic extract of bark of Tectona grandis Linn. shown a tremendous effect on asthma when comparative study was done with normal and treated group.Methods: The anti-asthmatic activity of a 95% ethanol and 5% distilled water extract of dried and fresh Tectona grandis Linn. bark, was evaluated against histamine and acetylcholine-induced preconvulsive dyspnea (PCD) in guinea pigs fasted for 24 h were exposed to an atomized fine mist of 2% histamine dihydrochloride and acetylcholine aerosol (dissolved in normal saline) using nebulizer at a pressure of 300 mmHg in the histamine chamber (24×14×24 cm, made of perplex glass. They were divided in groups Mepyramin (8 mg/kg) intraperitonially, atropine aerosol and Tectona grandis bark formulation (2.5, 5, 10 gm/kg) were administered orally 30 min prior to exposure. Animals, which did not develop typical asthma within 6 minutes, were taken as protected.Results: Ethanolic extract of Tectona grandis Linn. bark at 5 and 10 gm/kg significantly reduce bronchoconstriction as compared to control group along with significant mast cell stabilization activity.Conclusions: In conclusion, the present study shows that the ethanolic bark extract of Tectona grandis Linn. has potential antiasthamatic and antichlolinergic action in histamine and acetylcholine broncocontraction in guinea pigs