Effects of cataract surgery on ocular hypertension

Purpose: The aim of the study was to analyze the effect of cataract surgery on ocular hypertension and to evaluate if type of surgery changes the postoperative intraocular pressure (IOP) outcome. Materials and Methods: A prospective longitudinal study of sixty patients out of which forty of them underwent phacoemulsification and twenty underwent manual small incision cataract surgery over a period of 2 years from December 2014 to October 2016. Data were entered in Microsoft Excel and analyzed using Strata version 13. We calculated the means and standard deviations for the linear variables and proportions for the categorical variables. The means between two groups were compared using the unpaired t-test (for different groups). The proportions were compared using Chi-square test or Fisher's exact test (for low expected cell counts). We used Mann–Whitney test for comparing the distribution of the variables and Wilcoxon matched-pairs signed-ranks test for equality of matched pairs. Conclusion: In our study, 22.7% fall is noted by the end of 3 months. Pressure-to-depth (IOP/anterior chamber depth) ratio is a valuable prognostic indicator in ocular hypertensives as well to predict postoperative IOP outcome. The type of surgery did not effect the reduction in IOP postsurgery by the end of 3 months

A Systematic Review and Meta-Analysis of Safety and Efficacy of Over the Scope Clips Versus Standard Therapy for High-Risk Non-Variceal Upper Gastrointestinal Bleeding

BACKGROUND AND AIMS: Upper gastro-intestinal bleeding is a common condition associated with significant morbidity and mortality. Endoscopic hemostasis remains the mainstay of therapy and is mainly aimed at effective hemostasis and prevention of rebleeding. Lesions with high-risk stigmata can have rebleeding rates of as high as 26.3%. Rebleeding is associated with increased mortality and reduced success rates of endoscopic retreatment. The over-the-scope-clip (OTSC) is a device with widespread endoscopic indications including hemostasis for non-variceal upper GIB (NVUGIB). The current study presents a systematic review and meta-analysis comparing OTSC versus standard therapy (STD) for NVUGIB. METHODS: Multiple databases were searched through April 2022 for studies comparing OTSC and standard therapy for NVUGIBs. The primary outcomes were clinical success rates, rebleeding rates, procedure times and secondary outcomes were mortality rates and length of hospitalization. Meta-analysis was performed to determine pooled odds ratios (ORs) to compare outcomes between the OTSC and standard therapy groups. RESULTS: Ten studies, including four randomized controlled trials, with 914 patients were included in the final analysis. 431 patients with NVUGIB\u27s were treated with OTSC and 483 patients were treated with STD. Patients treated with OTSC had an overall lower risk of 7-day (RR 0.41 (95% CI 0.24-0.68, I2 = 0%)) and 30-day rebleeding (RR 0.46 (95% CI 0.31-0.65, I2 = 0%)). Clinical success rates were higher with OTSC compared with STD (RR 1.36 (95% CI 1.06 - 1.75. Mean procedure time was shorter in the OTSC group by 6.62 min (95% CI 2.58 - 10.67) vs STD therapy. I2 = 84%. There was no statistically significant difference in terms of mortality between the OTSC and STD groups, RR 0.55 (95% CI 0.24-1.24, I2 = 0%). Length of hospitalization was comparable between both groups with the pooled mean difference for OTSC vs STD being 0.87 d (-1.62 d - 3.36 d, I2 = 71%). CONCLUSIONS: While our study is limited to high-risk NVUGIB\u27s, our analysis shows that hemostasis with OTSC is associated with a lower 7-day and 30-day rebleeding rate, higher clinical success rates and shorter procedure time with similar mortality rates and length of hospital stay as compared to standard therapy

Trends of loss of peripheral muscle thickness on ultrasonography and its relationship with outcomes among patients with sepsis

Abstract Background and aims Data regarding trends of muscle loss on ultrasonography (USG) and its relationship with various outcomes among critically ill patients is limited. This study aimed to describe the trends of loss of muscle thickness of the arm and thigh (assessed using USG) and to determine the relationship between loss of muscle thickness and in-hospital and post-discharge outcomes. Methods Muscle thickness of 70 patients with sepsis was measured at the level of the mid-arm and mid-thigh using bedside USG on days 1, 3, 5, 7, 10 and 14 and then weekly till discharge or death. Patients were followed up for 90 days after discharge. Results The muscle thickness (mean ± SD) at the level of the mid-arm and mid-thigh on day 1 was 23.13 ± 4.83 mm and 31.21 ± 8.56 mm, respectively. The percentage muscle thickness [median (min, max)] decline at the mid-arm and mid-thigh was 7.61 (− 1.51, 32.05)% and 10.62 (− 1.48, 32.06)%, respectively on day 7 as compared to baseline (p < 0.001). The decline in muscle thickness at the mid-arm and mid-thigh were higher among non-survivors compared to survivors at all time points. Also, the decline in muscle thickness was significantly higher among patients with worse outcome at day 90. Patients with ICU-acquired weakness also had significantly higher decline in muscle thickness (p < 0.05). Early decline (from day 1 to day 3) in muscle thickness was associated with in-hospital mortality. The probability of death by day 14 was higher for patients who had early decline (from day 1 to day 3) in muscle thickness of ≥ 6.59% and ≥ 5.20% at the mid-arm [HR 7.3 (95% CI 1.5, 34.2)] and the mid-thigh [HR 8.1 (95% CI 1.7, 37.9)], respectively. Decline in thickness from day 1 to day 3 was a good predictor of in-hospital mortality with area under the curve (AUC) of 0.81 and 0.86 for arm and thigh muscles, respectively. Conclusions Critically ill patients with sepsis exhibit a gradual decline in muscle thickness of both the arm and thigh. Decline in muscle thickness was associated with in-hospital mortality. USG has a potential to identify patients at risk of worse in-hospital and post-discharge outcomes

Endoscopic ultrasound-guided gallbladder drainage as a rescue therapy for unresectable malignant biliary obstruction: a multicenter experience

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is often unsuccessful in patients with duodenal stenosis or malignant ampullary infiltration. While endoscopic ultrasound-guided biliary drainage (EUS-BD) has been proposed as an alternative, EUS-guided gallbladder drainage (EUS-GBD) is an attractive option when both approaches fail. We aimed to assess the effectiveness and safety of EUS-GBD as rescue therapy for malignant distal bile duct obstruction. Methods A multicenter retrospective study was performed on patients with unresectable malignant distal bile duct obstruction who underwent EUS-GBD between 2014 and 2019 after unsuccessful ERCP and EUS-BD. Clinical success was defined as a decrease in serum bilirubin of > 50 % within 2 weeks. Results 28 patients were included, with a lumen-apposing metal stent used in 26 (93 %) and a self-expandable metal stent in two (7 %). The technical success rate was 100 %. The clinical success rate was 93 %, with an improvement in bilirubin (7.3 [SD 5.4] pre-procedure vs. 2.8 [SD 1.1] post-procedure; P  = 0.001). Delayed adverse events included food impaction of the stent (n = 3), with a further two patients developing cholecystitis and bleeding. Conclusion This study demonstrates the feasibility of gallbladder drainage to relieve malignant distal bile duct obstruction in patients with failed ERCP and EUS-BD

Primary needle-knife fistulotomy versus rescue precut: A systematic review and meta-analysis of outcomes

Background and Aims: Post-ERCP pancreatitis (PEP) is encountered especially after difficult and prolonged standard biliary cannulation (SBC). Access sphincterotomy techniques such as needle-knife fistulotomy (NKF) aid in biliary cannulation but carry risks of PEP, bleeding, and perforation. We conducted a systematic review and meta-analysis to assess the safety and success of primary NKF (p-NKF; before attempted cannulation) compared with rescue precut (precut techniques used if SBC failed). Methods: We searched multiple databases through December 2021 for studies comparing outcomes of p-NKF versus rescue precut. The primary outcome was risk of PEP in both groups, and secondary outcomes were rates of adverse events, rates of successful biliary cannulation, and time required for biliary cannulation. Results: Five studies, including 2 randomized controlled trials, with 1375 patients were included in the final analysis, with 541 patients in the p-NKF group and 834 in the control group. Patients undergoing NKF had an overall lower risk of PEP (odds ratio [OR], .33; 95% confidence interval [CI], .17-.66; I2 = 0%) and asymptomatic hyperamylasemia (OR, .58; 95% CI, .36-.96; I2 = 0%) compared with control subjects. The pooled rate of PEP with NKF was 1.85% (95% CI, .71-2.98), and the pooled rate of successful initial cannulation was 94.7% (95% CI, 92.7-96.7; I2 = 72%) in the p-NKF group. The time required for biliary cannulation was comparable between the 2 groups (difference in means, –2.48 minutes; 95% CI, –7.70 to 2.74; I2 = 99%). In terms of adverse events, there was no difference between the 2 groups for bleeding (OR, 1.19; 95% CI, .53-2.69; I2 = 0%), cholangitis (OR, .79; 95% CI, .23-2.79; I2 = 0%), or perforation (OR, .90; 95% CI, .17-4.75; I2 = 0%). Conclusions: Although our study was limited to data from expert advanced endoscopists, our analysis showed that performing p-NKF compared with rescue access sphincterotomy was associated with a lower risk of PEP, with similar successful biliary cannulation rates, cannulation times, and overall safety profile

Factors associated with unexplained sudden deaths among adults aged 18-45 years in India – A multicentric matched case–control study

Background & objectives: In view of anecdotal reports of sudden unexplained deaths in India's apparently healthy young adults, linking to coronavirus disease 2019 (COVID-19) infection or vaccination, we determined the factors associated with such deaths in individuals aged 18-45 years through a multicentric matched case–control study. Methods: This study was conducted through participation of 47 tertiary care hospitals across India. Cases were apparently healthy individuals aged 18-45 years without any known co-morbidity, who suddenly (<24 h of hospitalization or seen apparently healthy 24 h before death) died of unexplained causes during 1st October 2021-31st March 2023. Four controls were included per case matched for age, gender and neighborhood. We interviewed/perused records to collect data on COVID-19 vaccination/infection and post-COVID-19 conditions, family history of sudden death, smoking, recreational drug use, alcohol frequency and binge drinking and vigorous-intensity physical activity two days before death/interviews. We developed regression models considering COVID-19 vaccination ≤42 days before outcome, any vaccine received anytime and vaccine doses to compute an adjusted matched odds ratio (aOR) with 95 per cent confidence interval (CI). Results: Seven hundred twenty nine cases and 2916 controls were included in the analysis. Receipt of at least one dose of COVID-19 vaccine lowered the odds [aOR (95% CI)] for unexplained sudden death [0.58 (0.37, 0.92)], whereas past COVID-19 hospitalization [3.8 (1.36, 10.61)], family history of sudden death [2.53 (1.52, 4.21)], binge drinking 48 h before death/interview [5.29 (2.57, 10.89)], use of recreational drug/substance [2.92 (1.1, 7.71)] and performing vigorous-intensity physical activity 48 h before death/interview [3.7 (1.36, 10.05)] were positively associated. Two doses lowered the odds of unexplained sudden death [0.51 (0.28, 0.91)], whereas single dose did not. Interpretation & conclusions: COVID-19 vaccination did not increase the risk of unexplained sudden death among young adults in India. Past COVID-19 hospitalization, family history of sudden death and certain lifestyle behaviors increased the likelihood of unexplained sudden death

SAtellite-based Marine Process Understanding, Development, Research and Applications for Blue Economy (SAMUDRA): A Technology Demonstration Program in the Bay of Bengal

SAtellite-based Marine Process Understanding, Development, Research and Applications (SAMUDRA) for blue economy, a technology development program of the Space Applications Centre, is an umbrella program covering research and applications geared toward physical and biological oceanography making use of current and future satellite observations for developing the nation’s blue economy. The main motivation behind this project was to develop satellite and numerical model-based information and value-added products and to demonstrate the implementation of developed applications for operational requirements. The program also aimed at improving existing methodologies for various applications by utilizing space-based inputs. Several field campaigns with the use of NavIC-enabled instruments and NABHMITRA were conducted for measuring biophysical parameters and validation of developed applications in the coastal regions. One of the key aspects of this project was development of web-based customized tools/dissemination system for providing the information to the end users. Some of the key/notable achievements of SAMUDRA were development of a portal OceanEye (tailor-made web-portal for Shipping Corporation of India), storm-surge/inundation system, oil-spill trajectory modeling, level-next potential fishing zone algorithm and rip current alert system