Clinical patterns of Uveitis in a Regional Eye Institute of North India

Background: Uveitis encompasses many conditions, all characterized by inflammation of the uvealtract either directly or indirectly. It can occur at any age but predominantly affects patients in theworking-age group. Objective: To report the clinical pattern of Uveitis in North India. Settings andDesign: A prospective study in a regional eye institute. Methods: After taking informed consent,100 patients with Uveitis aged 20–60 years were recruited from eye OPD between 2012- 2014.Detailed history, complete ophthalmic examination, standard diagnostic laboratory tests andradiographic studies wherever required were made. Statistical analysis used: Descriptive.Results: The mean age being 41.55 years. There were 57% males and 43% females with 32%acute uveitis and 68% chronic uveitis cases. Anterior Uveitis was seen in 83% of patients, followedby posterior Uveitis (7%), pan-uveitis (6%) and intermediate Uveitis (4%). A definite associationwith the systemic disease was determined in 27% of cases. The most frequently observed systemicdiseases were ankylosing spondylitis, Tuberculosis and herpes zoster ophthalmicus (6% cases each).This was followed by HIV (3%), sarcoidosis (3%), ulcerative colitis (2%) and endophthalmitis (1%).No specific aetiology or association with systemic diseases could be established in 73% of cases. Inmost cases, the systemic disease was not suspected before eye involvement and was recognizedonly after the subsequent diagnostic procedures. Conclusion: The etiological diagnosis of Uveitis isoften challenging as there are marked variations in ocular and systemic signs and symptoms. Asignificant number of cases may unfold with the evolution of advanced techniques.

Application of extracorporeal membrane oxygenation to treatment of serious tracheal stenosis caused by relapsing polychondritis: a case report and literature review

Relapsing polychondritis (RP) is a multisystemic rheumatic disease characterized by widespread and potentially destructive inflammatory lesions of the cartilage. The rarity of this disease and the lack of pathological diagnostic laboratory tests can occasionally lead to delayed diagnosis. We herein describe a 51-year-old woman with RP. She was sent to our hospital 4 days after the development of an upper respiratory tract infection with difficulty breathing. Her clinical condition significantly improved after the performance of extracorporeal membrane oxygenation support in an awake state, implantation of a tracheal stent, and administration of steroid therapy. Airway involvement of RP may be life-threatening. In this case, endotracheal intubation would have undoubtedly been very dangerous. Extracorporeal membrane oxygenation can be performed in an awake state to maintain oxygenation and improve the chance of survival.

SARS-CoV-2: An insight into detection tools

: The novel coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), was announced as a pandemic in March 2020. Different diagnostic laboratory tests have been used to detect the infection. Each diagnostic tool, such as Chest Computed tomography (CT) imaging, genome sequencing, nucleic acid amplification methods, whole genome sequencing, microarray, and serology testing have several advantages and disadvantages. Nucleic acid amplification methods are better diagnostic tools for the detection of SARS-CoV-2 in early stages of the infection, while serological tests are more appropriate for the recognition of previously infected patients. In this review, we will briefly consider each diagnostic method, and discuss its pros and cons.

Effects of the new diagnosis-related group-based payment system and the increased incentive policy rates on the utilization rate of diagnostic laboratory test in Korea

A new diagnosis-related group (DRG) based payment system has been implemented in most public hospitals in Korea. We investigated the effects of the new DRG system and its incentive policy on the utilization rate of diagnostic laboratory tests. Three groups were categorized; 36 hospitals under the new DRG system (participant group), 72 hospitals (control-1) matching with 36 participants according to the number of beds, and 42 tertiary hospitals (control-2). The patients of acute myocardial infarction, cerebral infarction, type 2 diabetes mellitus, and gonarthrosis receiving total arthroplasty were included. We analyzed the mean length of stay and the number of diagnostic laboratory tests conducted during hospitalization of the three groups according to the new DRG system and the incentive policy rates under the new DRG system. Before participating in the new DRG system, the number of diagnostic laboratory tests in the participant group was less than that in the two control groups for all four diseases. However, although the participant group’s length of stay decreased under the new DRG system, the number of diagnostic laboratory tests increased as the maximum incentive policy rate increased. The increment of the number of diagnostic laboratory tests was prominent in the period of a maximum of 35% incentive policy rates. Finally, the number of diagnostic laboratory tests of the participant group was similar to or exceeded that of the control-2 group. The new DRG system’s incentive policy rates played a driving force on the increased utilization rate of the diagnostic laboratory test. For preparing in advance for the change in incentive policy rates, monitoring and guidelines for the utilization of diagnostic laboratory tests are necessary.

Cost analysis of the management of brain metastases in patients with advanced ALK+ NSCLC: alectinib versus crizotinib

Aim: To estimate management cost of NSCLC ALK+ patients with and without brain metastasis (BM), and to compare annual costs in patients treated with alectinib or crizotinib. Methods: Management cost/year (€ 2018) in patients with and without BM was estimated with disaggregated resource consumption provided by local oncologists, including medical visits, hospitalizations, diagnostic/laboratory tests, imaging techniques and surgical procedures. The comparison of costs/year with alectinib and crizotinib, considered the cumulative 12-month incidence of BM in ALEX trial (9.4 and 41.4%, respectively). Results: Management cost was €6173.42/patient-year without BM and €21,637.50/patient-year with BM. With alectinib, average cost/patient was lower than crizotinib (€4948.51/patient-year) Conclusion: Prevention of BM with alectinib may result in reductions of cost/year in the management of advanced ALK+ NSCLC.

Four sexually transmitted diseases in one: a rare case report

<p class="abstract">Sexually transmitted diseases (STDs) often pose a diagnostic challenge especially in countries like India, where access to reliable diagnostic laboratory tests is minimal. The exact cause of the STDs has to be determined, so that appropriate therapy can be administered and the risk of transmission to others can be reduced. However, determining the etiology can be complicated by limitations of current diagnostic testing modalities and by the fact that more than one infection may coexist. Here, authors report a case who presented with genital ulcer disease and discharge with four etiologies.</p>

Communicating the Risk of Death from Novel Coronavirus Disease (COVID-19)

To understand the severity of infection for a given disease, it is common epidemiological practice to estimate the case fatality risk, defined as the risk of death among cases. However, there are three technical obstacles that should be addressed to appropriately measure this risk. First, division of the cumulative number of deaths by that of cases tends to underestimate the actual risk because deaths that will occur have not yet observed, and so the delay in time from illness onset to death must be addressed. Second, the observed dataset of reported cases represents only a proportion of all infected individuals and there can be a substantial number of asymptomatic and mildly infected individuals who are never diagnosed. Third, ascertainment bias and risk of death among all those infected would be smaller when estimated using shorter virus detection windows and less sensitive diagnostic laboratory tests. In the ongoing COVID-19 epidemic, health authorities must cope with the uncertainty in the risk of death from COVID-19, and high-risk individuals should be identified using approaches that can address the abovementioned three problems. Although COVID-19 involves mostly mild infections among the majority of the general population, the risk of death among young adults is higher than that of seasonal influenza, and elderly with underlying comorbidities require additional care.

Classification and prediction of frontotemporal dementia based on plasma microRNAs

Frontotemporal dementia (FTD) is a heterogeneous neurodegenerative disorder characterized by frontal and temporal lobe atrophy, typically manifesting with behavioural or language impairment. Because of its heterogeneity and lack of available diagnostic laboratory tests there can be a substantial delay in diagnosis. Cell-free, circulating, microRNAs are increasingly investigated as biomarkers for neurodegeneration, but their value in FTD is not yet established. In this study, we investigate microRNAs as biomarkers for FTD diagnosis. We performed next generation small RNA sequencing on cell-free plasma from 52 FTD cases and 21 controls. The analysis revealed the diagnostic importance of 20 circulating endogenous miRNAs in distinguishing FTD cases from controls. The study was repeated in an independent second cohort of 117 FTD cases and 35 controls. The combinatorial microRNA signature from the first cohort, precisely diagnosed FTD samples in a second cohort. To further increase the generalizability of the prediction, we implemented machine learning techniques in a merged dataset of the two cohorts, which resulted in a comparable or improved classification precision with a smaller panel of miRNA classifiers. In addition, there are intriguing molecular commonalities with cell free miRNA signature in ALS, a motor neuron disease that resides on a pathological continuum with FTD. However, the signature that describes the ALS-FTD spectrum is not shared with blood miRNA profiles of patients with multiple sclerosis. Thus, microRNAs are promising FTD biomarkers that might enable earlier detection of FTD and improve accurate identification of patients for clinical trials