Vitamin D deficiency in pregnancy and its effects on neonatal outcome

Background: India has one of the highest Vitamin D deficiency rates in pregnancy in the world and yet we have limited research to study its various effects from our country. We aim to study the prevalence of Vitamin D deficiency in pregnancy and effect on neonatal outcome after supplementation.Methods: 200 pregnant women were recruited at 26 weeks and more. They were divided into sufficient group (normal levels of the vitamin), supplemented group (recruited at 26 weeks and supplemented for 8 weeks) and unsupplemented group (recruited after 34 weeks and so could not be supplemented) based on time of recruitment and levels of vitamin D. They were followed up till discharge of newborn from the hospital. Neonatal outcomes were noted.Results: The prevalence of Vitamin D deficiency in pregnancy in present study was 94.5%. Vegetarians and urban residents were more likely to have this deficiency. Admissions to NICU were significantly less in neonates of vitamin D supplemented women.Conclusions: The prevalence of vitamin D deficiency is very high during pregnancy and further studies are needed to clearly define its role in neonatal outcome

Epidermoid cyst of the facial skin : an investigative case report

Funding Information: The authors are extremely grateful of the patient for consenting to publish this case report for scientific publication, dissemination, and educational purposes. The support of Riga Stradins University (RSU) is greatly acknowledged. The author(s) received no financial support for the research, authorship, and/or publication of this article. Publisher Copyright: © The Author(s) 2022.Orofacial epidermoid cysts are rare entities that present as encapsulated, subepidermal painless masses, usually slow growing and asymptomatic. They are mostly limited to the floor of the mouth, tongue, lips, palate or jaws. Herein, we present an atypical case of epidermoid cyst originating from the left cheek facial epidermis in a 27-year-old male patient. The cyst presented as a swelling that was slowly progressing in size since the past 1 year with no discharge. Complete excision of the mass was done, and the cyst cavity was found to be filled with a cheesy-white, granular, semi-solid proteinaceous exudate which completely occluded the punctum. The patient post-operatively revealed persistent mechanical trauma due to incorrect workplace habits he developed, which led to the formation of the epidermoid cyst. Patient education was done and was advised to use proper workplace instrumentation.publishersversionPeer reviewe

Antiviral activity of ethanolic extract of Nilavembu Kudineer against dengue and chikungunya virus through in vitro evaluation

Abstract Background Currently, no vaccines or modern drugs are available for dengue and chikungunya and only symptomatic relief is provided to the patients. Siddha medicine, a traditional form of indigenous medical system uses specific polyherbal formulations for the treatment of such infections with considerable success. One such polyherbal formulation for the treatment of chikungunya and dengue is Nilavembu kudineer (NVK). The mechanistic details of this drug as an antiviral for chikungunya virus (CHIKV) and dengue virus (DENV) is poorly understood. Objectives The current study was undertaken to study the efficacy of NVK as an antiviral formulation against CHIKV and DENV. Materials and methods Cytotoxicity assays (MTT) were performed to determine the role of NVK as an antiviral during chikungunya and dengue infections in the following conditions-i). post infection, ii). during active infections and iii) protective, not allowing virus infection. Results It was observed that NVK provides protection against CHIKV and DENV-2 during active infection as well can help to prevent virus infection in the cells and it mainly depends on the cellular availability of drugs for maximum protection against both the infections. Conclusion Our study establishes that extraction protocols are important to ensure maximum efficacy of NVK along with the time of addition of the drug during CHIKV and DENV infections in the cells. This study provides insights to the possible mode of action of NVK in in vitro condition during CHIKV and DENV infection

Effect of peribulbar block on emergence agitation in children undergoing strabismus surgery under desflurane anaesthesia

Background: Strabismus surgery in children may be associated with a high incidence of emergence agitation that may be related to pain and visual disturbances. The objective was to evaluate the effect of peribulbar block on the incidence of emergence agitation in children undergoing strabismus surgery under desflurane anaesthesia.Methods: Fifty-six healthy children aged 2–10 years, undergoing strabismus surgery under general anaesthesia, were recruited. Children were randomly allocated to receive fentanyl 2 μg/kg (Group F) or peribulbar block (Group PB) with 0.3 ml/kg of 0.25% bupivacaine + 2% lignocaine. The primary outcome of the study was incidence of emergence agitation; secondary outcome measures were time to first rescue analgesia, the incidence of oculocardiac reflex and vomiting.Results: Of 52 children, 14/25 (56%) children in Group F developed emergence agitation compared with 3/27 (11.11%) in group PB (p = 0.001). Postoperatively, the paediatric anaesthesia emergence delirium scores showed significantly lower emergence agitation in the PB group with a median (IQR) of 0.00 (0.00–2.00) compared with group F (5.5 (0.75–8.75) at all time intervals (p = 0.003 Mann–Whitney test). Pain scores were comparable between groups (group F 48% vs. group PB 25.9%). The time to first rescue analgesia was increased in group PB (126.875 ± 38.22 min vs. 88.08 ± 28.48 min in group F). The oculocardiac reflex occurred in 7/25 in Group F compared with 1/27 in Group PB (p = 0.015). There was no difference in the incidence of postoperative vomiting (24% in Group F vs. 22% in Group PB).Conclusion: Use of peribulbar block in children undergoing strabismus surgery under desflurane anaesthesia was associated with reduced incidence of emergence agitation and oculocardiac reflex but did not significantly increase the time to first analgesic or the incidence of pain and vomiting. A sub-tenon block may be safer and provide better operating conditions and equal analgesia.Keywords: agitation, children, anaesthesia, strabismus surgery, peribulbar bloc

Selective Alpha-Particle Mediated Depletion of Tumor Vasculature with Vascular Normalization

BACKGROUND: Abnormal regulation of angiogenesis in tumors results in the formation of vessels that are necessary for tumor growth, but compromised in structure and function. Abnormal tumor vasculature impairs oxygen and drug delivery and results in radiotherapy and chemotherapy resistance, respectively. Alpha particles are extraordinarily potent, short-ranged radiations with geometry uniquely suitable for selectively killing neovasculature. METHODOLOGY AND PRINCIPAL FINDINGS: Actinium-225 ((225)Ac)-E4G10, an alpha-emitting antibody construct reactive with the unengaged form of vascular endothelial cadherin, is capable of potent, selective killing of tumor neovascular endothelium and late endothelial progenitors in bone-marrow and blood. No specific normal-tissue uptake of E4G10 was seen by imaging or post-mortem biodistribution studies in mice. In a mouse-model of prostatic carcinoma, (225)Ac-E4G10 treatment resulted in inhibition of tumor growth, lower serum prostate specific antigen level and markedly prolonged survival, which was further enhanced by subsequent administration of paclitaxel. Immunohistochemistry revealed lower vessel density and enhanced tumor cell apoptosis in (225)Ac-E4G10 treated tumors. Additionally, the residual tumor vasculature appeared normalized as evident by enhanced pericyte coverage following (225)Ac-E4G10 therapy. However, no toxicity was observed in vascularized normal organs following (225)Ac-E4G10 therapy. CONCLUSIONS: The data suggest that alpha-particle immunotherapy to neovasculature, alone or in combination with sequential chemotherapy, is an effective approach to cancer therapy

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Climate change, malaria and neglected tropical diseases: a scoping review

To explore the effects of climate change on malaria and 20 neglected tropical diseases (NTDs), and potential effect amelioration through mitigation and adaptation, we searched for papers published from January 2010 to October 2023. We descriptively synthesised extracted data. We analysed numbers of papers meeting our inclusion criteria by country and national disease burden, healthcare access and quality index (HAQI), as well as by climate vulnerability score. From 42 693 retrieved records, 1543 full-text papers were assessed. Of 511 papers meeting the inclusion criteria, 185 studied malaria, 181 dengue and chikungunya and 53 leishmaniasis; other NTDs were relatively understudied. Mitigation was considered in 174 papers (34%) and adaption strategies in 24 (5%). Amplitude and direction of effects of climate change on malaria and NTDs are likely to vary by disease and location, be non-linear and evolve over time. Available analyses do not allow confident prediction of the overall global impact of climate change on these diseases. For dengue and chikungunya and the group of non-vector-borne NTDs, the literature privileged consideration of current low-burden countries with a high HAQI. No leishmaniasis papers considered outcomes in East Africa. Comprehensive, collaborative and standardised modelling efforts are needed to better understand how climate change will directly and indirectly affect malaria and NTDs

Low dose Mitomycin-C in severe vernal keratoconjunctivitis: A randomized prospective double blind study

<b>Purpose:</b> To study the efficacy and safety of low dose topical Mitomycin C (MMC) in severe Vernal keratoconjunctivitis (VKC). <b> Design:</b> Placebo controlled double masked randomized clinical trial. <b> Materials and Methods:</b> Twenty-eight patients with severe VKC were randomly assigned to receive either topical MMC (0.01&#x0025;) (n=17) or distilled water (n=11) three times daily for a period of two weeks. Signs and symptoms were recorded on day of presentation and at the end of treatment period (2 weeks). Mann Whitney test was used to analyze the signs and symptoms in the two groups. <b> Results:</b> No statistically significant difference was observed in terms of severity of symptoms at presentation. At two weeks patients in the MMC group showed significant decrease in tearing, foreign body sensation, discharge, hyperemia, punctate keratitis, limbal edema and trantas spots. No adverse effect of MMC was observed. <b> Conclusion:</b> Short term low dose topical MMC is an effective and safe drug to control acute exacerbations in patients of severe VKC refractory to conventional treatment

Rose-K contact lens for keratoconus

Aim: To report clinical experience and the comparative value of axial and instantaneous topography data in fitting Rose-K design contact lenses in moderate and severe keratoconus. Materials and Methods: Thirty-eight eyes (of 23 patients) with keratoconus were fitted with Rose-K design contact lenses and followed up for at least six months or more. Visual acuity with habitual vision correction available was measured. Axial and instantaneous topography maps for each eye were recorded. Contact lens wear comfort was graded on a ten point rating scale every three months. Results: Fourteen (100&#x0025;) moderate keratoconus eyes (average Sim K 48.61 &#x00B1; 1.24D) and 23 of 24 (96&#x0025;) of severe keratoconus eyes (average Sim K 60.88 &#x00B1; 5.31D) were successfully fitted with the Rose-K lenses. Final fit contact lenses in severe keratoconus had statistically significant steeper base curves compared to average axial corneal curvature than in moderate keratoconus eyes. Average simulated corneal curvature on axial maps predicted final fit contact lens base curves significantly better than on instantaneous maps. Thirty-three of the 37 eyes fitted with contact lenses maintained wear comfort over average follow up period of 13 &#x00B1; 3.5 months. Conclusions: Rose-K design rigid contact lenses are successful in visually rehabilitating 100&#x0025; of moderate and 96&#x0025; of severe keratoconus eyes. Most patients (90&#x0025;) maintained contact lens wear comfort. Corneal curvature on axial maps is a better predictive of base curve of final fit contact lens