Patients In Case Group Research Articles

A case–control study to evaluate the role of mean platelet volume and platelet distribution width in acute ischemic stroke

Background: Ischemic stroke is known to be one of the foremost causes of long-term disability and death, and platelets play a pivotal role in its pathophysiology. However, the platelet indices having a role in ischemic stroke are not routinely reported in the available literature. Objective: The objective of the study was to evaluate the potential role of mean platelet volume (MPV) and platelet distribution width (PDW) in the development of ischemic stroke, especially in the South Indian region. Materials and Methods: This case–control study was conducted on 80 patients who were broadly divided into two groups: the case group (patients with ischemic stroke) and the control group (patients without ischemic stroke). Platelet indices were measured using Mindray BC-5200 auto hematology analyzer, and the results were analyzed using Student's t-test and Wilcoxon rank-sum Test. Results: There was a statistically significant difference (P < 0.001) in the MPV and PDW values between the two groups. The difference between the area under the curve for both MPV and PDW was also found to be statistically significant (P < 0.001) in the receiver operating characteristic curve. However, the differences in the values of MPV and PDW across different age groups, genders, and various comorbid conditions were not found to be significant. Conclusion: The elevated platelet indices may be associated with the development of ischemic stroke. The MPV and PDW can be prospective biochemical markers for predicting the onset of ischemic stroke.

The association between primary open-angle glaucoma and helicobacter pylori infection

Background: Primary Open-Angle Glaucoma (POAG) the most common form of glaucoma is a neurodegenerative disease, which is the third most common cause of blindness worldwide. It is estimated that 60 million people in the world are affected by this disease and 8.4 million are bilaterally blind. Among the various factors that have been implicated in the pathophysiology of this disease is infection with Helicobacter pylori (HP), a Gram-negative bacterium that is commonly found in stomach and present in approximately one-half of the world’s population. Establishment of such a causal correlation will probably have important practical applications as the eradication of H. pylori might lead to developments in the treatment of glaucoma. Objectives: To investigate the association between Primary Open-Angle Glaucoma (POAG) and Helicobacter Pylori infection and to observe fluctuations in intra ocular pressure after Helicobacter Pylori infection eradication. Design: Duration based, prospective observational study. Participants: 50 patients with documented Primary Open-Angle Glaucoma (POAG) as case group and 50 non-glaucoma participants as control group. Methods: Upper gastrointestinal endoscopy was performed to evaluate macroscopic abnormalities, and gastric mucosal biopsy specimens were obtained for the presence of H. pylori infection tested by Rapid Urease Test (RUT). All subjects underwent detailed ocular examinations including visual acuity, slit-lamp examination, fundoscopy, intra-ocular pressure recording, gonioscopy, GHT to assess visual fields and OCT of optic nerve head. Results: In 90% of POAG patients of case group and in 68% of non-glaucoma participants of control group Helicobacter pylori infection was detected by RUT (P-Value=0.007). Conclusion: H. pylori infection is more frequent in glaucoma patients, perhaps more so in those of Indian ethnicity. It may play a role as a secondary aggravating factor or even may be the primary cause. The establishment of such a causal relationship will probably have important practical applications as the eradication of H. pylori might lead to developments in the treatment of glaucoma.

Clinical characteristics and rehospitalization in patients with schizophrenia with or without history of amphetamine abuse

Objective: In this study, we intended to study the differences of the clinical characteristics between patients with schizophrenia with or without history of amphetamine abuse and risk factors of rehospitalization. Methods: We used medical records and reviewed electronic database to collect the two schizophrenia groups discharged from the Taoyuan Psychiatric Center from January 1, 2012, to December 31, 2015. Patients with and without amphetamine abuse were defined as case group and control group, respectively. The patients' demographic data and clinical variables were extracted and examined. Results: We identified 80 patients in the case group and 142 patients in the control group. Up to 32.5% of the case group patients still showed a positive urine amphetamine test. The univariate analysis showed that significant differences existed in gender (p < 0.001), age (p < 0.001), marriage (p < 0.05), education (p < 0.001), psychiatric comorbidity (p < 0.05), family history of schizophrenia (p < 0.01), family history of illicit substance use (p < 0.001), history of suicide (p < 0.01), history of violence (p < 0.001), hospitalization days (p < 0.001), and rehospitalization rate (p < 0.05). The result of the logistic regression showed that the number of previous admissions was a positive predictor of rehospitalization and that with family history of schizophrenia was a negative predictor of rehospitalization. The Cox proportional hazards regression model analysis showed that the number of previous admissions was still a positive predictive factor for the rehospitalization. Conclusion: In this study, the characteristics of two study patient groups were different. Patients with schizophrenia and with a history of amphetamine abuse had a tendency of amphetamine abuse and a higher rate of rehospitalization. Further treatment for amphetamine abstinence in the community for this population is warranted to strengthen the study results.

Periodontitis: A Risk Factor for Preterm Labour

Objective: To determine the relationship between periodontitis and preterm labour in pregnant women presenting to a tertiary care hospital in Lahore. Methods: This case control study was conducted at Obstetrics &amp; Gynecology Unit 4 of Sir Ganga Ram Hospital, Lahore for six months. The delivering women, who consented to participate, were divided into two case and control groups. For each case one control was enrolled who met the inclusion criteria, so total sample size was 380 women. Women delivered before 37 weeks of gestation were case group and those delivered after 37 weeks were control group. A patient was considered having periodontitis if she had probing pocket depth of ≥3mm in at least 3 sites. Data was collected and analyzed on SPSS version 21. Results: In this study the mean age of the case group patients was 28.52±6.45 years while of the control group was 28.67±6.35 years. The mean value of probing depth pocket in the case group was 3.872±1.37 while the mean value probing depth pocket of the control group was 3.58±1.52. Out of 380 patients the periodontitis was found in 275 patients. The odds of having periodontitis in case group was 1.85 times higher than control group i.e. OR=1.85[1.17-2.92]. Conclusion: Periodontitis is a preventable risk factor of preterm labour in women presenting at a tertiary care hospital. Keywords: Preterm Labour, Periodontitis, dental hygiene, preterm delivery

Measurement of Left Atrial Function by Speckle Tracking Echocardiography in Atrial Fibrillation Patients after Percutaneous Coronary Intervention in Zagazig University Hospital.

Background: Echocardiography can provide comprehensive information concerning thromboembolic risk in patients with atrial fibrillation (AF). Global LA strain associated with a higher prevalence of left atrial stasis and is superior to conventional parameters of LA analysis as thromboembolic risk stratification of AF. The aim of this work is to demonstrate the importance of global LA Strain as predictor of stroke risk in patients with AF after PCI.Patients and methods: This work included 63 consecutive coronary artery disease patients who were admitted for elective PCI (42 with permanent AF as case group & 21 with sinus rhythm as control group). All patients were evaluated by history, examination, 2D and Doppler echocardiography and 2D-speckle tracking echocardiography (2D-STE). Patients with permanent AF only were evaluated by CHA2DS2-VASc Risk Score calculation, INR & TEE to detect echocardiographic features of high stroke risk.Results: The results showed that the global LA strain was highly statistically significantly lower in patients in case group than patients in control group (16.01±7.43 vs. 33.25±11.21, P< 0.001). 9 patients had abnormalities on TEE. The global LA strain was highly statistically significantly lower in patients with high risk features of stroke than patients without these features (6.8 ± 1.1 vs. 18.2 ± 6.5, P

Gingival Health Status In Patients With And Without Anterior Crossbite: A Case Control Study

Anterior crossbite is an anteroposterior malocclusion resulting from an abnormal axial inclination of maxillary anterior teeth. Anterior crossbite can cause periodontal damage leading to gingival recession.To assess the gingival health status in patients with an anterior crossbite, and also compare with patients without anterior crossbite.The present study consisted of 56 patients divided into two groups: patients with anterior crossbite and patients without anterior crossbite. 89000 Case sheets were reviewed from the dental treatment records for DMFT index in children with and without anterior crossbite from June 2019 to March 2020. In both groups, the following parameters were recorded - Oral Hygiene Index - Simplified (OHI-S) and Plaque Index (Silness and Loe).Mean Plaque Index for case group (patients with anterior crossbite) is 0.89, and Mean Plaque Index for the control group (patients without anterior crossbite) is 0.68. Mean OHI-S Index for case group (patients with anterior crossbite) is 0.46 and Mean OHI-S Index for the control group (patients without anterior crossbite) is 0.45. On the Mann-Whitney test, the difference was not statistically significant (P-value - 0.088 and 0.096).In this study, gingival health status in patients with anterior crossbite is poor compared with patients without anterior crossbite.

Dental caries experience in patients with and without anterior crossbite: A case-control study

Anterior crossbite is a type of malocclusion involving anteroposterior alignment, which results from an abnormal axial inclination of the anterior maxillary teeth. Dental caries is a chronic disease affecting patients and adults. Due to improper oral hygiene management in individuals with a crossbite, the incidence of caries could be higher. Hence a study was conducted to assess the dental caries status in patients with anterior crossbite and also compare with patients without anterior crossbite. The present study consisted of 56 patients divided into two groups: patients with anterior crossbite and patients without anterior crossbite. 89000 Case sheets were reviewed from the dental treatment records for DMFT index in patients with and without anterior crossbite from June 2019 to March 2020. In both groups, parameters such as Decayed- Missing - Filled (DMFT) score was recorded. Data were subjected to the Mann Whitney U test in SPSS software. Results showed higher DMFT score was seen in patients without anterior crossbite. Mean DMFT Index for case group (patients with anterior crossbite) is 2.04, and Mean DMFT Index for the control group (patients without anterior crossbite) is 2.93. The difference was not statistically significant (P-value - 0.072). Within the limitations of the study, dental caries status in patients with anterior crossbite is good compared with patients without anterior crossbite.

Analysis on risk factors of lung cancer complicated with pulmonary embolism

Pulmonary embolism (PE) is a potentially fatal complication and its morbidity together with fatalness will further increase when in patients with malignant tumors. Fast and accurate early diagnosis of PE thus seems considerably important. To explore the risk factors of lung cancer complicated with PE. A retrospective cohort study consisted of 40 lung cancer patients with PE (PE group) and 60 lung cancer patients without PE (non-PE group) were analyzed. The white blood cell (WBC) count, D-dimer and low-density lipoprotein (LDL) were higher in PE group than those in non-PE group (P<0.05), whereas the arterial partial pressure of oxygen (PaO2 ) in PE group was lower than that in non-PE group (P<0.05). Carcinoembryonic antigen (CEA) level between two groups also exhibited statistical difference (P<0.05). Those lung adenocarcinoma patients with stages III and IV tumor, coupled with deep venous thrombosis (DVT), having experienced bevacizumab treatment or platinum-based chemotherapy more likely suffered from PE (P<0.05). The multivariate analysis revealed that high D-dimer, chemotherapy, DVT, stages III to IV, adenocarcinoma were independent risk factors associated with PE (P<0.05). The overall survival time of patients in case group was significantly shorter than that in the control group with a median survival duration being 10.5months (95%CI, 8.95-12.05) and 16.8months (95%CI, 14.62-18.98), respectively, (P<0.01). High D-dimer, chemotherapy, DVT, stages III to IV and adenocarcinoma might have a positive correlation with PE, meanwhile, PE always predicted a poor prognosis in lung cancer patients.

Gingival health status in patients with and without anterior open bite: A case-control study

Open bite is the absence of vertical overlap of lower incisors by upper incisors when posterior teeth are in occlusion. An anterior open bite can cause periodontal damage which leads to gingivitis and periodontitis. To assess the gingival health status in patients with anterior open bite and also compares with patients without an anterior open bite. Retrospective data collected from 89,000 case records from June 2019 to March 2020. The present study consisted of 76 patients divided into two groups: patients with anterior open bite and patients without an anterior open bite. In both groups, the following parameters were recorded - Oral Hygiene Index - Simplified (OHI-S) and Plaque Index (Silness and Loe). OHI-S index and plaque index was similar in patients with and without an anterior open bite. Mean Plaque Index for case group (patients with anterior open bite) is 0.76, and Mean Plaque Index for control group (patients without the anterior open bite) is 0.78. Mean OHI-S Index for case group (patients with anterior open bite) is 0.51, and Mean OHI-S Index for the control group (patients without the anterior open bite) is 0.53. The difference was not statistically significant (P-value &gt; 0.05). In this study, gingival health status in patients with and without an anterior open bite is low.

Association Between Magnesium and Oxidative Stress in Patients with Obesity

Background: The role of minerals in preventing the generation of oxidative stress in obese individuals has been evaluated. Magnesium is an antioxidant nutrient and a cofactor of enzymes involved in the cell membrane stabilization, attenuating the effects of oxidative stress. Objective: To evaluate the association between magnesium and concentrations of thiobarbituric acid reactive substances (TBARS) in patients with obesity and eutrophic women. Methods: A cross-sectional study was conducted with 73 women, divided into two groups: case group (patients with obesity, n=27) and control group (eutrophic women, n=46). Measurements of body mass index and waist circumference were performed. Dietary magnesium intake was assessed by the three-day food record using the NutWin software. Urinary magnesium concentration was measured by atomic absorption spectrophotometry method. Plasma concentrations of thiobarbituric acid reactive substances (TBARS) were also determined. Results: Mean values of dietary magnesium intake were 161.59 ± 60.04 and 158.73 ± 31.96 for patients with obesity and control group, respectively, with no significant difference between the groups studied (p &gt;0.05). The value of urinary excretion of magnesium was lower than the reference values in both groups, with no significant difference between the groups studied (p &gt;0.05). The plasma concentration of thiobarbituric acid reactive substances was significantly higher in patients with obesity compared to the control group (p &lt;0.001). There was no correlation between levels of magnesium biomarkers and the concentration of TBARS (p &gt;0.05). Conclusion: Patients with obesity showed a reduced dietary magnesium intake which seems to induce hypomagnesuria as a compensatory mechanism. The marker of oxidative stress evaluated in this study was not influenced by magnesium.

Nonepileptic, Stereotypical, and Intermittent Symptoms (NESIS) in Patients With Subdural Hematoma: Proposal for a New Clinical Entity With Therapeutic and Prognostic Implications.

Transient neurological symptoms (TNS) are frequent in patients with subdural hematomas (SDH) and many will receive a diagnosis of epilepsy despite a negative workup. To explore if patients with TNS and a negative epilepsy workup (cases) evolved differently than those with a positive EEG (controls), which would suggest the existence of alternative etiologies for TNS. We performed a single-center, retrospective, case-control study of patients with TNS post-SDH. The demographics and clinical and semiological features of cases and controls were compared. The outcome and response to antiepileptic drugs were also assessed and a scoring system developed to predict negative EEG. Fifty-nine patients with SDH-associated TNS were included (39 cases and 20 controls). Demographic characteristics were comparable in both groups. Dysphasia and prolonged episodes were associated with a negative EEG. Clonic movements, impaired awareness, positive symptomatology, complete response to antiepileptic drugs, and mortality were associated with a positive EEG. Using semiological variables, we created a scoring system with a 96.6% sensitivity and 100% specificity in predicting case group patients. The differences observed between both groups support the existence of an alternative etiology to seizures in our case group. We propose the term NESIS (NonEpileptic, Stereotypical, and Intermittent Symptoms) to refer to this subgroup and hypothesize that TNS in these patients might result from cortical spreading depolarization. We describe NESIS as a syndrome experienced by SDH patients with specific prognostic and therapeutic implications. Independent validation of this new entity is now required.

Reduction of blood loss after total knee arthroplasty by tranexamic acid

Background: Total knee arthroplasty is associated with significant peri-operative blood loss. Various studies have shown that the use of tranexamic acid reduces post-operative blood loss and need for allogeneic blood transfusion in total knee arthroplasty. &#x0D; Objectives: To assess the effect of tranexamic acid in the reduction of the postoperative blood loss in total knee arthroplasty.&#x0D; Methodology: An analytical cross-sectional study was carried out in 14 patients who underwent primary total knee arthroplasty during the study period of 12 months at Kathmandu Medical College. Seven patients were allocated to the case group and received one gram (gm) of tranexamic acid thirty minutes prior to the incision and five hundred milligram (mg) orally three times a day till the drain was removed. Tranexamic acid was not given to the seven patients in control group. The haemoglobin of the patient was recorded on the day of surgery and the total amount of drain output was recorded on postoperative period until the drain was removed.&#x0D; Results: Out of 14 patients operated, it was found that the average amount of drain in the patients in case group was 628 ± 234 millilitre (ml) which was significantly lower than the control group 1028 ± 183 ml (p&lt;0.05). Though there was a difference in the amount of drain output, there was no significant change in the postoperative haemoglobin level in both the groups (p = 0.381). &#x0D; Conclusion: Tranexamic acid, an antifibrinolytic agent, can be effective to reduce blood loss in patients who undergo major surgeries like total knee arthroplasty.

Effectiveness of an Educational Program on Patients’ Knowledge Concerning care of Vascular Access of Hemodialysis in Al-Muthana Teaching Hospitals

Objectives: The study aims to identify the effects of an educational program on patients’ knowledge about vascular access care and to find out the relationship between patients knowledge scores and their selected demographic variable. &#x0D; Methodology: A quasi –experimental design of study was carried out at hemodialysis units of AL-Muthana teaching hospitals started from October 11th, 2018 through March 19th 2019. Non-probability purposive sample of (50) patients,who were in hemodialysis units, was selected from AL-Muthana teaching hospitals. The data were collected through the use of constructing a questionnaire, which consisted of three parts (1) Demographic data form that consisted of (6) items and (2) patient history consisted of (7) items, (3) patients' -care Knowledge consisted of (29) items. Reliability of the questionnaire was determined through a pilot study and the validity through a panel of (13) experts. Descriptive statistical analysis procedures (frequency, percentage, mean of score) and inferential statistical analysis procedures (T-TEST) and (ANOVA) were used for the data analysis Data is collected by a structured interview with patients.&#x0D; Results: The results of the study indicated that more of half of the study sample were male, their age within 41-50 years, most of them were married and most of the level of education were read and. The study results of pre-test for the case and control groups revealed that there is knowledge deficit for the patients' regarding care toward vascular access for hemodialysis . While the results of post-test showed that the knowledge of case group patients were improved due to the positive effect of the educational program upon them. There is no significant association between the effectiveness of educational program and demographic data involved age, gender, level of education, occupation and family number, except the level of education there is significant association with effectiveness of an educational program at P≤0.05 level.&#x0D; Recommendations: The researcher recommended to establish special health education programs for the patient through mass media about the danger End Stage Renal Disease, Special and continuing education program should be applied to all patients in hemodialysis ward, Engaging patients to participating in special activity to increase patients' knowledge.

Frequency, Risk Factors, Clinical Characteristics and Outcomes of Spontaneous Pneumothorax in Patients with COVID-19 Results of the UMC-19-S7

Objective: We investigated the incidence, risk factors, clinical characteristics and outcome of spontaneous pneumothorax (SP) in COVID-19 patients attended in emergency departments (ED) before hospitalization. Methods: We retrospectively reviewed all COVID patients diagnosed with SP (case group) in 61 Spanish EDs (20% of Spanish EDs), during the first two months of the COVID outbreak and compared them with two control groups: COVID patients without SP (control group A) and non-COVID patients with SP (control group B). Relative frequencies of SP were estimated in cases and control group B. Unadjusted comparisons between cases and controls included 52 clinical, analytical and radiological characteristics and 4 outcomes. Results: We identified 40 SP in 71,904 patients with COVID-19 attending EDs (0.56‰, 95%CI=0.40-0.76‰). This incidence was higher than that observed in non-COVID patients (387/1,358,134, 0.28‰, 95%CI=0.26-0.32; OR=1.93, 95%CI=1.41-2.71). In COVID patients the characteristics associated with a higher risk of SP were: male sex, shorter symptom length, less fever, greater dyspnea, tachycardia, tachypnea and hypoxia, higher hemoglobin, leukocyte count, D-dimer and LDH, and lower lymphocyte count. Compared to control group B, case group patients were older, more frequently had obesity, asthma, dyspnea, tachycardia, tachypnea, hypoxia and analytical disturbances, and less frequently diabetes mellitus, hypertension, smoker habit, and chest pain. All the outcomes measured, including in-hospital death, were worse in cases than in control groups A and B. Conclusions: SP as a form of COVID presentation is unusual (<1‰ cases) but is associated with worse outcomes than SP developed in non-COVID patients and in COVID patients without SP. Funding Statement: The present work was performed without any direct or indirect financial support. Declaration of Interests: No author reports any conflict of interest directly or indirectly connected with this manuscript. Ethics Approval Statement: The UMC-19 project was approved by the Ethics Committee of the Hospital Clinic of Barcelona (Spain), with the reference number HCB/2020/0534, and acted as the central ethical committee. Under the exceptional circumstances generated by the COVID-19 pandemic, the urgent need to obtain feasible data related to this new disease, and the non-interventional and retrospective nature of the project, the requirement of obtaining written patient consent to be included in the study was waived.

Can Ellipsoid Sign be One of the Earliest Findings of the Medial Femoral Condyle Chondromalacia of Knee Antero Posterior X-Ray?

Aim of the study was to investigate whether ellipsoid sign (ES) in the region corresponding to the cartilaginous facet of the medial femoral condyle (MFC) indicates early cartilage lesion. The finding has not been defined in the literature yet. The study was performed retrospectively with 50 patients who underwent articular cartilage examination and arthroscopy between 2015 and 2018. Patients were divided into two according to the presence or absence of ES. There were 24 patients in case group (Group A) and 26 patients in controls (Group B). Weight-bearing cartilage areas of MFC in the region where ES was found in both groups were classified according to arthroscopic Outerbridge classification (OC) and compared statistically with each other. There was no significant difference in terms of age, gender and alignment between Group A and Group B (p > 0.05). All OC grades were higher in Group A (p < 0.001). Positive correlation between ES and MFC chondromalacia grade was detected (r: 0.671, t: 6.266, p < 0.05). ES, which refers to the difference in bone density in MFC seen in antero-posterior (AP) X-Ray, is a result of changes in subchondral bone due to chronic cartilage loss. ES detected on AP X-Ray may help in early diagnosis of medial femoral articular cartilage chondromalacia, even at grade 0 or 1. We recommend searching for ES, as the earliest symptom of chondromalacia, which occurs even before MRI lesions. Future studies may reveal additional information about ES.

Abstract 243: Long-term Effects of ACC/AHA Cholesterol Control on Cardiac Function

Background: The impact of long term strict cholesterol control on reservoir function and outcome in heart failure is unclear. Methods: We retrospectively analyzed 2939 patients (31.9% female, mean age 65.1±11.8 years) whom strict application of ACC/AHA cholesterol management with an average length of 9.4 years of follow-up. We also evaluated the ventricular ejection fraction, mass, and Global sore (Framingham-CVD), as well as 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk score. Results: Overall, 64.3% of patients were identified as strictly cholesterol control (case group). As compared to age-gender-race matched control group, patients in cases group have higher LV mass (152.9±34.4g vs. 143.6±34.4 g, p=0.0005) as well as an LV mass index (90.5±18.1 vs. 85 ±17 g/m2 vs. g/m2, P=0.0002) and Framingham Global CVD Risk score (18.9±17.7 vs. 8.6±17.3, P&lt;0.001), but not for LVEF (68.5%±7.5% vs. 69.1%±6.6%, p=0.263). The average percentage decrease in LVEF in patients with mild coronary artery calcification (CAC score&lt;100) in cases is 6.2%, and when CAC score&gt;400, the LVEF decreased up to 15.3% regardless of the cholesterol control status. Major coronary arteries with severe calcification are associated with increasing the risk of abnormal ejection fraction (LVEF&lt;50%) 4.84 times after adjusting for traditional CAD risk factors. Long-term ACC/AHA cholesterol control can not prevent the ASCVD risk score increase (Table 1). Conclusions: The strict long-term application of ACC/AHA cholesterol control can effectively LV mass change. However, this strategy does not adequately prevent LV systolic function attenuation. The 10-Year ASCVD risk score is one of the robust indicators of cardiac function for long-term lipid control outcomes. Abbreviations: LAD: left anterior descending, LCX: circumflex coronary arteries, RCA: right coronary artery. CTA: coronary computed tomography angiogram. LVEF:Left Ventricular Ejection Fraction

ASSESSMENT OF QUALITY OF LIFE IN PRIMARY OPEN ANGLE GLAUCOMA PATIENTS: A CASE-CONTROL STUDY.

Aim: to evaluate quality of life in primary open angle glaucoma patients using a standard questionnaire.&#x0D; Material and methods: The present prospective case-control study was conducted in the department of Ophthalmology, Patna Medical College and Hospital, Patna, Bihar, India. The study included 200 subjects who were divided into (case group n=100) and (control group n=100). Quality of life was assessed using Glaucoma Quality Of Life-15 Questionnaire (GQOL-15). &#x0D; Results: Mean age of patients in case group (n=100) and control group (n=100) was 57.97 years, and 57.84 years respectively. Overall QOL score was significantly between the two groups (p&lt;0001). QOL score increases as the Glaucoma Severity score increases.&#x0D; Conclusion: QOL of patients with glaucoma was found poor as compared to control group. It showed a clear trend of worsening QOL scores with increasing severity of disease.&#x0D; Keywords: Glaucoma, Quality of life, QOL-15

Early Neuromuscular Blockade in Children with Pediatric Acute Respiratory Distress Syndrome.

Pediatric acute respiratory distress syndrome (PARDS) is a challenging problem with high mortality. Role of neuromuscular blockade in the management of ARDS to date has been controversial, and this study was done to study the role of neuromuscular blockade in children having PARDS and development of associated complications, if any. This was a prospective, case-control study conducted in the pediatric intensive care unit (PICU) of a tertiary care teaching hospital, over a period of 24 months. Patients of age 1 to 18 years who presented with or developed PARDS during their course of hospitalization were included after written informed consent was obtained from their parents and/or guardians. Patients with PARDS requiring invasive mechanical ventilation were partitioned into a case group and a control group. Case group patients were sedated and paralyzed using midazolam (1 µg/kg/min) and vecuronium (1 µg/kg/min), respectively, along with institution of definitive management. Control group patients were given definitive and supportive therapy, but no neuromuscular blocking agents (NMBAs). All patients were followed up for signs and symptoms of myopathy or neuropathy during the entire duration of hospital stay and up to 3 months after discharge. During the study period, 613 patients were admitted to the PICU of which 91 patients qualified as having PARDS. Sepsis was the main etiology in 67 of the 91 patients (73.6%) with PARDS. Fifty-nine patients were included in the study, of which 29 patients were included in the case group and 30 patients were included in the control group. Among the 29 case group patients, 25 patients (86.2%) were successfully extubated. Four patients from the case group expired, while 14 out of 30 control group patients (46.7%) expired. Hypotension was present in 26 case group patients (89.6%), of which all showed resolution within 48 hours of definitive treatment. The mean time to resolution of hypotension was 41.6 hours (standard deviation [SD]: 5.759; range: 24-48) for case group patients, significantly lower ( p < 0.0001) than the mean time to resolution of 103 hours (SD: 18.995; range: 90-126) for the 10 control group patients with hypotension that survived. Mean oxygenation index (OI) following 48 hours of vecuronium therapy was significantly lower ( p < 0.0001; 95% confidence interval: 5.9129-9.9671) than mean OI at admission for case group patients. None of the patients receiving vecuronium exhibited neuromuscular deficit during their hospital stay, at time of discharge, or at follow-up evaluation up to 3 months after discharge. In this study, pediatric cases diagnosed with PARDS and managed with mechanical ventilation and vecuronium therapy had improved mean OI following 48 hours of NMBA therapy and a lower mortality when compared with matched control group patients. Incidence of NMBA-related weakness was not commonly observed in these patients.

Lower Circulating Levels of Soluble TNF-Like Weak Inducer of Apoptosis and Chromium in Treated Brucella Infection

Brucellosis is a common infectious disease around the globe. The aim of the present investigation was to evaluate the effect of brucellosis on the serum levels of chromium (Cr), lead (Pb), soluble TNF–like weak inducer of apoptosis (sTWEAK) as well as high-sensitivity C-reactive protein (hs-CRP) and homocysteine in patients suffering from brucellosis. The present case-control study was executed on 40 treated brucellosis patients (case) and 40 healthy individuals (control). Blood samples were obtained from all the participants for the measurement of the desired indices. The serum levels of chromium in the case group (0.109±0.025 μg/L) was significantly lower compared with that in the control group (0.121±0.027 μg/L, P=0.047). The levels of lead in serum were almost unchanged between the two groups (12.58±1.94 vs. 12.28±2.42 μg/dL, P=0.533). The sTWEAK levels were significantly lower in the case group as compared to the control subjects (235.20±48.45 pg/mL vs. 262.00±67.25 pg/mL, P=0.044). The levels of hs-CRP were significantly higher in the case group (2.23±0.34 mg/L) than that in the control group (2.05±0.32 mg/L, P=0.016); similarly, homocysteine levels were higher in the serum of patients in case group as compared to the control ones (16.18±4.47 µmol/L vs. 14.36±3.06 µmol/L, P=0.038). The current investigation underlined that brucellosis causes alterations in serum chromium and sTWEAK levels, the markers that are considered as the predictors of cardiovascular disease.

Relationship between Small Intestinal Bacterial Overgrowth and Peripheral Blood ET, TLR2 and TLR4 in Ulcerative Colitis.

To investigate the relationship between small intestinal bacterial overgrowth (SIBO) and Endotoxin (ET) concentration in peripheral blood, and levels of toll-like receptors (TLR) 2 and TLR4 expression on surface of peripheral blood mononuclear cells (PBMCs) in patients with ulcerative colitis. An experimental study. The First Hospital of Hebei Medical University, from July 2018 to October 2019. The 130 patients with ulcerative colitis were included in case group. Another 72 healthy cases were selected as control group. SIBO, ET, TLR2, and TLR4, were determined, and compared. Positive rate of SIBO in case group was higher than that in control group (p <0.001). Lactulose hydrogen breath test (LHBT) intestine set value, peripheral blood ET concentration, and TLR2 and TLR4 expression levels on surface of PBMCs in case group were higher than those in control group (all p <0.001); the above indexes in SIBO-positive patients in case group were higher than those in SIBO-negative patients in case group (all p <0.001). Pearson's correlation analysis showed that LHBT intestine set value of SIBO-positive patients in case group was positively correlated with ET concentration, and TLR2 and TLR4 expression levels on surface of PBMCs (r= 0.910, p <0.001; r = 0.970, p <0.001; and r = 0.965, p <0.001 respectively). ET concentration of SIBO-positive patients in case group was positively correlated with expression levels of TLR2 and TLR4 on surface of PBMCs (r=0.962, p <0.001; and r = 0.829 p <0.001 respectively). Patients with ulcerative colitis are easy to occur SIBO, and SIBO increases blood endotoxin, TLR2 and TLR4 levels. Synergistic effects of endotoxin and endotoxin receptors TLR2 and TLR4 overexpression mediate body inflammation and may be involved in progression of ulcerative colitis. Patients with ulcerative colitis with excessive growth of small intestinal bacteria are more likely to have hypertoxemia.