Publications

INTRODUCTION: In recent times, neutrophil-to-lymphocyte ratio (NLR) has garnered interest from all over the world as a multisystemic marker for ongoing inflammatory processes. It has been found to be independently related to poor clinical outcomes among patients with liver cirrhosis due to any cause.

AIM: To determine any significant correlation between NLR with Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD)-Na score among patients with decompensated liver cirrhosis in a tertiary referral center in Ahmedabad, India.

MATERIALS AND METHODS: The cross-sectional study involved patients diagnosed with liver cirrhosis at SMS Multispeciality Hospital, Dr. M.K. Shah Medical College and Research Centre in March 2023. The study enrolled 16 cirrhotic patients, regardless of the etiologic agent. The CTP score was fulfilled by using two methods; bilirubin, albumin and international normalized ratio (INR) were noted from medical record registry, while ascites and encephalopathy were assessed using interview and physical examination on the day of patient admission. MELD-Na score was calculated by an online calculator after collecting data on all the patient's serum bilirubin, creatinine, sodium levels, and INR on the day of admission. The Spearman correlation test was performed to determine the correlation between two sets of variables, while the demographic characteristics were presented in a single table with mean or median and standard deviations.

RESULTS: A significant correlation between NLR and CTP score was obtained (p = 0.002), and it was positively correlated (r = 0.722). No significant correlation between NLR and MELD-Na could be established with a p-value = 0.149 and r = 0.378.

CONCLUSION: The NLR ratio may be used as an independent parameter to prognosticate the severity of decompensated liver disease. However, it still needs further study to acknowledge its potential.

BACKGROUND: Iron deficiency anemia (IDA) is the most common cause of anemia and represents a significant global health problem. While the role of endoscopy in diagnosing IDA is well-established, the frequency and types of lesions identified vary widely across different regions. Factors such as symptomatology, complications, age, and geographic location significantly influence diagnostic outcomes. This study was conducted to evaluate the diagnostic yield of various endoscopic techniques in patients with IDA in an Indian cohort.

METHODS: This retrospective analysis included all patients evaluated for IDA in the Department of Gastroenterology and Hepatology from January 2016 to March 2023. Data collection included patient demographics, clinically significant endoscopic findings, and laboratory parameters such as hemoglobin levels, serum ferritin, total iron-binding capacity, and serum iron concentrations.

RESULTS: A total of 554 patients were initially enrolled, of whom 435 underwent upper gastrointestinal (GI) endoscopy, and 309 underwent colonoscopy after applying exclusion criteria. The diagnostic yield for detecting clinically significant lesions via upper endoscopy was 43.6%, while colonoscopy demonstrated a yield of 52.4%. Dual lesions were identified in 2.4% of all patients. The most common finding on upper endoscopy was peptic ulcer disease (13.3%), followed by esophageal varices (8.3%). On colonoscopy, colonic ulcers were the most prevalent finding (25.24%), followed by colonic malignancies (12%). Symptom presence was significantly associated with higher endoscopic diagnostic yield (p < 0.05).

CONCLUSION: GI endoscopy should be considered an essential diagnostic tool for all patients with IDA. The selection of the initial endoscopic modality should be guided by the presence of symptoms. Given the favorable risk-benefit ratio, GI evaluation is recommended across all age groups, including premenopausal women.

Maturity-onset diabetes of the young (MODY) was first described by Tattersall and Fajans in their classic paper published in 1975.1 At that time, the classification of diabetes was based purely on the age at onset of diabetes. Those diagnosed with diabetes below 40 years of age were labeled as "growth onset diabetes," while those with onset at or above the age of 40 years were referred to as "maturity onset diabetes." At that time, these types were believed to be equivalent to what are known as type 1 diabetes (T1D) and type 2 diabetes (T2D) today.

PURPOSE: The purpose of this study was to investigate the field of fluidic effect (FOE) at the vitrectomy port in a range of artificial vitreous solutions (AVS) with varying rheological characteristics to add insight into the effects surgeons observe during vitrectomy and how they change with a variety of console settings.

METHODS: Laboratory-based investigation using in vitro testing was carried out at Newcastle University, United Kingdom. Testing was conducted using an Eva Nexus Vitrectomy system (D.O.R.C. Dutch Ophthalmic Research Center [International] B.V., Zuidland, The Netherlands) using dual cutting action vitrectomy probes in 3 gauge sizes (23G, 25G, and 27G). Using AVS, particle image velocimetry (PIV) measurements were conducted for various console settings and AVS concentrations.

RESULTS: Rheological analysis of AVS with varying hyaluronic acid concentrations showed shear thinning and viscoelastic properties, resembling the liquid component of human vitreous humour. PIV during vitrectomy revealed that a dual cutting probe created a focused, elongated jet stream in AVS, contrasting with the symmetrical flow in balanced salt solution (BSS). Key findings included peak fluid velocity magnitude in AVS was 0.5 to 1 mm from the port, broadening with increased vacuum, higher vacuum led to inferior jet deviation, cut rates increased peak velocities, with viscoelasticity influencing fluid flow dynamics, and increasing hyaluronic acid concentration transitioned flow from BSS-like to elongated jet profiles.

CONCLUSIONS: Using an AVS with similar rheological properties to the liquid component of human vitreous and a high-speed PIV technique, we evaluated the FOE around vitrectomy probes with a range of surgical relevant variables. Further research into the influence of different vitreous substitutes and surgical parameters is crucial to enhance our understanding and refine vitrectomy procedures.

TRANSLATIONAL RELEVANCE: Our findings provide valuable insights into the fluid dynamics during vitrectomy, helping to optimize surgical techniques and improve patient outcomes.

Multisensory processing is important for studying and understanding typical and atypical development; however, traditional paradigms involve numerous conditions and trials, making sessions long and tedious. A technique referred to as "continuous-tracking" has been introduced which can assess perceptual thresholds in a shorter time. We tested this technique in an audiovisual context by asking participants to track 1-minute audiovisual stimuli moving in a random walk. The stimuli could be visual, auditory, or audiovisual. In the last case, we had a congruent and incongruent condition with a spatiotemporal shift between the two stimuli, so either vision or audition led the walk by a given time. We further modulated the reliability of the visual stimulus to shift the weight toward the audio. We found a straightforward visual dominance regarding motion perception in audiovisual contexts. Regardless of its state, visual information interferes with auditory perception. Moreover, the continuous tracking yielded a new measurement of motion perception, the lag, giving information on the delay between visual and auditory information processing. Indeed, we observed that the tracking of auditory motion lagged relative to visual motion.

Background/Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a recent update in defining fatty liver disease, emphasizing its strong connection to metabolic factors and reflecting a shift in understanding its causes and progression. The principal aim of this investigation was to scrutinize the conceivable association between the poverty income ratio (PIR) and the incidence of MASLD, specifically focusing on liver fibrosis. Materials and Methods: In this study, a cross-sectional analysis was carried out utilizing data obtained from the National Health and Nutrition Examination Survey dataset covering the period from 2017 to 2020. To explore the relationship between the PIR and the prevalence of MASLD as well as liver fibrosis, a robust multivariable analytical method was adopted. This approach integrated a wide range of variables, such as sociodemographic characteristics, lifestyle habits, and individual health conditions. Results: In this study, a comprehensive analysis was conducted using logistic regression models and found a significant decline in the likelihood of MASLD in the highest PIR quartile (Q4) (odds ratio [OR] = 0.634, 95% CI: 0.446-0.903, P = .012) as well as liver fibrosis (OR = 0.682, 95% CI: 0.503-0.925, P = .014). Conclusion: The findings obtained from this research strongly demonstrate that higher PIR levels are significantly associated with a reduced prevalence of both MASLD and liver fibrosis, suggesting that higher socioeconomic shighertatus, as reflected by higher PIR, may decrease the risk of these conditions. These findings underscore the need for targeted interventions, such as better nutrition education, lifestyle support, and healthcare access to reduce the MASLD burden in low-income populations.

PURPOSE: The purpose of this study was to evaluate the effectiveness of different machine-learning models in predicting retinal sensitivity in geographic atrophy (GA) secondary to age-related macular degeneration (AMD) and compare the progression of sensitivity loss using observed versus inferred data over time.

METHODS: Thirty patients with GA (37 eyes) were recruited for the OMEGA study. Participants underwent fundus-controlled perimetry (microperimetry) and spectral-domain optical coherence tomography (SD-OCT) imaging at baseline and follow-up visits at weeks 12, 24, and 48. Retinal layers were segmented using a custom-written deep-learning algorithm. We used various machine-learning models, including random forest, LASSO regression, and multivariate adaptive regression splines (MARS), to predict retinal sensitivity across three scenarios: (1) unknown patients, (2) known patients at later visits, and (3) interpolation within visits. Predictive accuracy was evaluated using the mean absolute error (MAE), and the models' ability to reduce test variability over time was analyzed using linear mixed models.

RESULTS: The random forest model demonstrated the highest accuracy across all scenarios, with an MAE of 3.67 decibels (dB) for unknown patients, 2.96 dB for known patients at follow-up, and 3.10 dB for within-visit interpolation. The inferred sensitivity data significantly reduced variability compared to the observed data in longitudinal mixed model analysis, with a residual variance of 2.72 dB² versus 8.67 dB², respectively.

CONCLUSIONS: Machine-learning models, particularly the random forest model, effectively predict retinal sensitivity in patients with GA, with patient-specific baseline data improving accuracy for subsequent visits. Inferred sensitivity mapping presents a reliable, functional surrogate endpoint for clinical trials, offering high spatial resolution without extensive psychophysical testing.

The pupil constricts in response to visual stimuli that keep net luminance unchanged but that do introduce local luminance increments and decrements-a reaction here called "isoluminant constriction." This response can form a pupillometric index of visual processing, but it is unclear what kind of processing it reflects; some authors have suggested that the constriction arises from subcortical, luminance-based neural signals, whereas others have argued for an origin at cortical, feature-based processing stages. We tested the involvement of cortical neural activity in isoluminant constrictions. To this end, we measured constrictions to stimuli presented after contrast adaptation, an adaptation procedure thought to lessen cortical stimulus responses. If cortical processing is involved in the isoluminant constriction, then such adaptation should lead to reduced isoluminant constriction amplitudes. We tested this prediction in the course of three experiments. We found no evidence for the prediction in any of the experiments, and did find Bayesian evidence against the prediction. These results suggest that, at least in the conditions of our experiments, isoluminant constrictions may not reflect visual cortical processing.

PURPOSE: Accurate assessment and surveillance of retinoblastoma (RB) require more efficient and objective measurements. This study aims to develop an artificial intelligence (AI) system, named RB-Care, for automatic classification and quantitative assessment of RB.

METHODS: A total of 3730 wide-field fundus images were included for the development and validation of 2 models in RB-Care. The first model was trained to automatically classify the images into "normal," "unseeded RB," and "seeded RB." The second model performed quantitative assessment on unseeded RB by detecting and segmenting tumors and optic discs.

RESULTS: The classification model of RB-Care can accurately classify fundus images into 3 categories with an accuracy of 0.9734 and an area under the curve (AUC) of 0.9970. The segmentation model can make precise boundary detection and quantitative measurement on tumors and optic discs, achieving mean Intersection over Union (mIoU) of 0.9670 and Dice similarity coefficient (DSC) of 0.9780 for tumor segmentation, and mIoU of 0.9999 and DSC of 0.9999 for optic disc segmentation, which reaches a comparable level with ophthalmologists.

CONCLUSIONS: The RB-Care achieved excellent performance in both RB classification and segmentation. Consequently, the tumor size and the distance between tumor and optic disc can be quantified, which provides an objective measurement tool for quantitative assessment and surveillance of RB in clinical settings.

TRANSLATIONAL RELEVANCE: Developing a clinically relevant technologies for objective quantitative assessment of RB.

The visual system takes advantage of redundancy in the world by extracting summary statistics, a phenomenon known as ensemble perception. Ensemble representations are formed for low-level features like orientation and size and high-level features such as facial identity and expression. Whereas recent research has shown that the visual system forms intact ensemble representations even when faces are partially occluded via solid bars, how ensemble perception is impacted with the addition of naturalistic objects such as face masks or sunglasses is largely unknown. To investigate this, we conducted a series of experiments using continuous report tasks in which faces (either varying in identity or expression) were partially occluded with a surgical mask or sunglasses and participants had to report the average face using a face wheel. We found evidence that participants could still accurately extract the average even when a significant portion of it was occluded with either face masks or sunglasses. In a second experiment, however, we found performance was worse when the face wheel was variable trial to trial. Thus part of the preservation of performance in occlusion arises from the visual system learning the features of the particular face wheel being used. Overall, our results suggest that the visual system is able to establish robust ensemble representations for faces with naturalistic occlusions, but that robustness appears to be supported at least partially by learning information about the particular features that are informative for a given set of faces.