bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Oketani Breast Massage on Successful Breastfeeding, Mothers’ Need for Breastfeeding Support, and Breastfeeding Self-Efficacy: an Experimental Study
Authors: Mahdizadeh-Shahri, MSc Maryam , Nourian, PhD Manijeh , Varzeshnejad, PhD Maryam , Nasiri, PhD Maliheh
Published: September 2021

Background: The negative effects of cesarean section on breastfeeding are a major global concern.

Purpose: This study aimed to determine the effect of Oketani breast massage on the maternal need for support during breastfeeding, breastfeeding success, and breastfeeding self-efficacy.

Setting: Three hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran, from April to July 2019.

Study Design: The participants in this experimental study were 113 pregnant women who were candidates for cesarean section. The mothers were selected using convenience sampling and randomly assigned. In addition to routine care, the mothers in the intervention group received Oketani breast massages twice. However, the mothers in the control group received routine care. The data were collected using the Infant Breastfeeding Assessment Tool (IBFAT), LATCH Assessment Score, and the Breastfeeding Self-Efficacy Scale (BSES). The data were analyzed with SPSS 20 software via the independent samples t test, the Mann–Whitney U test, and the chi-square test.

Results: The results of the study suggested that the breastfeeding success rate, which was evaluated with IBFAT in both the first two breastfeeding stages and the last pre-discharge breastfeeding, was significantly higher for the mothers in the intervention group (p < .001). In addition, the mother’s need for support, which was evaluated with LATCH in the first two breastfeeding stages (p = .044) and the last pre-discharge breastfeeding (p < .001) in the intervention group, was less. The total number of breastfeeding sessions from birth to discharge was higher in the intervention group (p = .002). Furthermore, the mothers in the intervention group breastfed their infants in a significantly shorter time interval (p = .002). Breastfeeding self-efficacy, according to the BSES, was significantly higher in the mothers of the intervention group (p < .001).

Conclusion: Oketani massage can be used as a care intervention by nurses to improve breastfeeding in mothers who undergo cesarean sections.
Proposal to recognise the tribes Adinobotryeae and Glycyrrhizeae (Leguminosae subfamily Papilionoideae) based on chloroplast phylogenomic evidence
Authors: Duan Lei , Han Li-Na , Sirichamorn Yotsawate , Wen Jun , Compton James A. , Deng Shuang-Wen , Arslan Emine , Ertuğrul Kuddisi , Schrire Brian , Chen Hong-Feng
Published: September 2021

Within the legume family, the taxonomic status of subtribe Glycyrrhizinae of tribe Galegeae and of the genus Adinobotrys has been re-assessed. Based on genome skimming data, we conducted phylogenomic analyses of the inverted repeat-lacking clade within subfamily Papilionoideae. The results support the sister relationship between Glycyrrhizeae and Adinobotrys. Glycyrrhizeae is resurrected based on Glycyrrhiza and Glycyrrhizopsis, and a new tribe, Adinobotryeae, is proposed to accommodate Adinobotrys.
Le burn-out à l’épreuve de la psychanalyse
Authors: Assoun Paul-Laurent
Published: September 2021

La métaphore du burn-out s’est imposée dans le discours médico-social : notion produite par la psychologie sociale, avec la bénédiction d’une certaine psychanalyse (Freudenberger) dans les années 7, elle s’est popularisée jusqu’à entrer dans le vocabulaire du vécu social. Elle dit l’implosion du sujet sous l’effet du « surmenage » et du stress et dès lors fait ritournelle. Signe du malaise de la culture, la notion exige d’être déconstruite au moyen d’une explicitation métapsychologique et clinique. Originairement pathologie du bénévolat, montrant de jeunes psychothérapeutes « carbonisés » par leur désir salvateur, elle met sur la piste de l’épuisement par la demande de l’Autre. Elle atteste ensuite la version mortifère d’un surmoi mortifère sinistré par son propre pousse-à-l’idéal qui va jusqu’à la promotion pathogène, voire à l’auto-destruction professionnelle
Augmented Gaussian random field: Theory and computation
Authors: Zhang Sheng , Yang Xiu , Tindel Samy , Lin Guang
Published: September 2021

We propose the novel augmented Gaussian random field (AGRF), which is a universal framework incorporating the data of observable and derivatives of any order. Rigorous theory is established. We prove that under certain conditions, the observable and its derivatives of any order are governed by a single Gaussian random field, which is the aforementioned AGRF. As a corollary, the statement "the derivative of a Gaussian process remains a Gaussian process" is validated, since the derivative is represented by a part of the AGRF. Moreover, a computational method corresponding to the universal AGRF framework is constructed. Both noiseless and noisy scenarios are considered. Formulas of the posterior distributions are deduced in a nice closed form. A significant advantage of our computational method is that the universal AGRF framework provides a natural way to incorporate arbitrary order derivatives and deal with missing data. We use four numerical examples to demonstrate the effectiveness of the computational method. The numerical examples are composite function, damped harmonic oscillator, Korteweg-De Vries equation, and Burgers' equation.
Automorphism group of the commuting graph of $ 2\times 2 $ matrix ring over $ \mathbb{Z}_{p^{s}} $
Authors: Zhang Hengbin ,   College of Mathematical Science, Yangzhou University, Yangzhou, Jiangsu 225009, China
Published: September 2021

Let $ R $ be a ring with identity. The commuting graph of $ R $ is the graph associated to $ R $ whose vertices are non-central elements in $ R $, and distinct vertices $ A $ and $ B $ are adjacent if and only if $ AB = BA $. In this paper, we completely determine the automorphism group of the commuting graph of $ 2\times 2 $ matrix ring over $ \mathbb{Z}_{p^{s}} $, where $ \mathbb{Z}_{p^{s}} $ is the ring of integers modulo $ p^{s} $, $ p $ is a prime and $ s $ is a positive integer.
A novel fault-tolerant privacy-preserving cloud-based data aggregation scheme for lightweight health data
Authors: Al-Zumia Fawza A. ,   Computer Science Department, King Saud University, Riyadh, Kingdom of Saudi Arabia, Tian Yuan , Al-Rodhaan Mznah ,   Nanjing Institute of Technology, Nanjing, China
Published: September 2021

Mobile health networks (MHNWs) have facilitated instant medical health care and remote health monitoring for patients. Currently, a vast amount of health data needs to be quickly collected, processed and analyzed. The main barrier to doing so is the limited amount of the computational storage resources that are required for MHNWs. Therefore, health data must be outsourced to the cloud. Although the cloud has the benefits of powerful computation capabilities and intensive storage resources, security and privacy concerns exist. Therefore, our study examines how to collect and aggregate these health data securely and efficiently, with a focus on the theoretical importance and application potential of the aggregated data. In this work, we propose a novel design for a private and fault-tolerant cloud-based data aggregation scheme. Our design is based on a future ciphertext mechanism for improving the fault tolerance capabilities of MHNWs. Our scheme is privatized via differential privacy, which is achieved by encrypting noisy health data and enabling the cloud to obtain the results of only the noisy sum. Our scheme is efficient, reliable and secure and combines different approaches and algorithms to improve the security and efficiency of the system. Our proposed scheme is evaluated with an extensive simulation study, and the simulation results show that it is efficient and reliable. The computational cost of our scheme is significantly less than that of the related scheme. The aggregation error is minimized from ${\rm{O}}\left( {\sqrt {{\bf{w + 1}}} } \right)$ in the related scheme to O(1) in our scheme.
The Effect of the Physical Factors of Parents and Children on Stunting at Birth Among Newborns in Indonesia
Authors: Sari Kencana , Sartika Ratu Ayu Dewi
Published: August 2021

Objectives: This study examined stunting at birth and its associations with physical factors of parents and children in Indonesia.Methods: This study analyzed secondary data from the national cross-sectional Indonesian Basic Health Survey 2018, conducted across 34 provinces and 514 districts/cities. Birth length data were available for 756 newborns. Univariable, bivariable, and multivariable logistic regression analyses were performed to determine associations between the physical factors of parents and children and stunting at birth.Results: In total, 10.2% of children aged 0 months were stunted at birth (10.7% of males and 9.5% of females). Stunting at birth was associated with the mother’s age at first pregnancy, parity, parents’ heights, parents’ ages, and gestational age. Children from mothers with short statures (height <145.0 cm) and fathers with short statures (height <161.9 cm) had an almost 6 times higher likelihood of being stunted at birth (adjusted odds ratio, 5.93; 95% confidence interval, 5.53 to 6.36). A higher maternal age at first pregnancy had a protective effect against stunting. However, other variables (firstborn child, preterm birth, and both parents’ ages being <20 or >35 years) corresponded to a 2-fold higher likelihood of stunting at birth compared to the reference.Conclusions: These findings provide evidence that interventions to reduce stunting aimed at pregnant females should also consider the parents’ stature, age, and parity, particularly if it is the first pregnancy and if the parents are short in stature or young. Robust programs to support pregnant females and monitor children’s heights from birth will help prevent intergenerational stunting.
Fossil Holocene Ostracoda from the Itapeva Lake, Southern Brazilian coastal plain
Authors: Campos Leonardo Timm Steiner , Nunes Lucas de Oliveira , Bergue Cristianini Trescastro
Published: August 2021

Holocene ostracods from a core obtained in the Itapeva Lake, Rio Grande do Sul coastal plain, are studied in this paper. Twenty-six species belonging to 22 genera and 13 families were registered in nine samples analyzed, two of them new: Cytherella eros sp. nov. and Loxoconcha itapevensis sp. nov. The taxonomic composition of the assemblages varies along the core, being Cyprideis multidentataHartmann the most abundant and frequent species (273 specimens), followed by Cytheretta punctata Sanguinetti (56 specimens) and L.itapevensis sp. nov. (51 specimens). Variation in richness and diversity observed along the core probably results from sedimentary and hydrological changes during the evolution of the Itapeva Lake. The results obtained in this work reinforce the importance of ostracods in the study of coastal paleoenvironments. Keywords: barrier-lagoon system, biostratinomy, micropaleontology, Quaternary.
Preliminary foraminiferal survey in Chichiriviche de La Costa, Vargas, Venezuela
Authors: Carvajal-Chitty Humberto , Navarro Sandra
Published: August 2021

A preliminary study of the composition and community structure of the foraminifera of Chichiriviche de La Costa (Vargas, Venezuela) is presented. A total of 105 species were found in samples from 10 to 40 meter-depth, and their abundance quantified in a carbonate prone area almost pristine in environmental conditions. The general composition varies in all the samples: at 10 m, Miliolida dominates the assemblages but, as it gets deeper, Rotaliida takes control of the general composition. The Shannon Wiener diversity index follows species richness along the depth profile, meanwhile the FORAM index has a higher value at 20 m and its lowest at 40 m. Variations in the P/(P+B) ratio and high number of rare species are documented and a correspondence multivariate analysis was performed in order to visualize the general community structure. These results could set some basic information that will be useful for management programs associated with the coral reef in Chichiriviche de La Costa, which is the principal focus for diver’s schools and tourism and could help the local communities to a better understanding of their ecosystem values at this location at Vargas State, Venezuela. Keywords: Miliolida, Rotaliida, foraminiferal assemblages, FORAM index, Caribbean continental shelf.
Evolution of the Semideciduous-Riparian Forest (ecotone Cerrado-Atlantic Forest) during the late Holocene, Southeast of Brazil
Authors: Souza Melina Mara , Ricardi-Branco Fresia
Published: August 2021

The floodplains of meandering rivers in southeastern Brazil represent places where the sedimentary record associated with the history of transition/ecotone areas and exchange of biomes accumulates, such as the Cerrado (Cerradão Forest) and Atlantic Forest (Semideciduous-Riparian Forest). The present study aims to use palynological, isotopic (δ13C, δ15N and 14C), and anthracological indicators in cores taken from three abandoned meander bends to make inferences about environmental evolution, vegetation reconstruction, and climatic inferences. The study area is located in the Mogi Guaçu River Basin, in the countryside of São Paulo State. The studies show that ~2,730 BP (stage I), the area underwent through a more humid climatic phase compared to the current one, which allowed the expansion of the Riparian Semideciduous Forest. After that date, in stage II (1,800 to 510 BP), the percentage of the Cerrado (Cerradão Forest) increased, due to a drier period. From 510 BP to the present day (stage III), humidity has taken place with a new expansion of the Riparian Semideciduous Forest, although elements of Cerrado are present. Microscopic charcoal fragments were found in all stages and may infer the incidence of paleo-wildfires during the Late Holocene. The results indicate that both phytophysiognomies remained for the studied period, varying their expansion depending on the humidity present in each stage. Although lakes formed by abandoned meanders are not areas with the best palynological record, they are frequent environments in the interior of the continents. If properly interpreted, they may provide relevant information to vegetation and climatic changes for the areas. Keywords: paleoenvironmental studies, Holocene, river dynamics, pollen grains, isotopic analysis, charcoal fragments.
First occurrence of the giant shark Carcharocles megalodon (Agassiz, 1843) (Lamniformes; Otodontidae) at Buenos Aires Province, Argentina
Authors: De Pasqua Julieta , Agnolin Federico , Rolando Alexis M. Aranciaga , Bogan Sergio , Gambetta Diego
Published: August 2021

Carcharocles megalodon is considered a macropredatory shark that inhabited the seas around the world from middle Miocene to late Pliocene. In Argentina, it has only been formally recorded at two localities. Here, we report the first record for this taxon in the Buenos Aires Province. This occurrence is based on an isolated tooth recovered on the beach at the Punta Médanos locality, which lacks clear stratigraphic context. Based on the regional geology, the specimen probably came from Pliocene beds. Its size indicates that it probably belongs to a juvenile individual. Keywords: Carcharocles megalodon, macropredatory shark, fossil teeth, Mar de Ajó.
Finding of a two-headed green turtle embryo during nest monitoring in Baa Atoll, Maldives
Authors: Köhnk Stephanie , Brown Rosie , Liddell Amelia
Published: September 2021

Green sea turtles are one of the two species of marine turtles known to nest in the Maldives. The prevalent time of nesting seems to be inconsistent throughout the island nation. In this study, sea turtle nesting activity was monitored on the island of Coco Palm Dhuni Kolhu in Baa Atoll over a period of 12 months. A total of 13 nests were confirmed with a median hatching success rate of 89.58% as ascertained by nest excavation. In one of the nests, a severely deformed hatchling with polycephaly, an opening in the neck area and a lordotic spine was found, and we investigated in detail with radiographic images and a necropsy. Our findings support the importance of consistent nesting activity and nest monitoring efforts in the country as a basis for conservation efforts.
Long-term outcomes of blebs repaired with scleral patch graft and conjunctival advancement in late-onset leak post-trabeculectomy
Authors: Pathak Ray Vanita , Badakere Swathi V
Published: September 2021

Purpose:

To report long-term outcomes in eyes that developed late-onset bleb leak post trabeculectomy, with or without hypotony and/or maculopathy, due to a scleral melt/fistula and who required a scleral patch graft and conjunctival advancement for repair.

Methods:

Retrospective, non-comparative, interventional case series over a decade (2010–2019), presenting with late bleb leak post-filtration-surgery. All cases required a scleral patch graft and conjunctival advancement for management via a standard technique, performed by an experienced glaucoma surgeon.

Results:

A total of 18 eyes were included. Mean age was 51.5 ± 10.2 years (95% CI [46.4–56.7]) and were followed up after repair for 52.4 ± 26.9 months, 95%CI [39.1–65.8]. 66.7% eyes (n = 12) had IOP ≦6 mmHg and also had hypotony maculopathy. None of the eyes presented with blebitis. 44.5% (n = 8) eyes underwent phacoemulsification as significant cataract was present. LogMAR best-corrected visual acuity (BCVA) was 0.8 ± 0.7 (95% CI [0.4–1.1]) prior to intervention and improved to 0.4 ± 0.6 (95% CI[0.1–0.6], P = 0.004). 22.3% (n = 4) eyes had persistent choroidal folds but BCVA was improved. Mean pre-intervention intraocular pressure (IOP) was 6.3 ± 3.8 mmHg (95% CI 4.4–8.2]) which increased to 12.1 ± 2.9 mmHg (95%CI[10.6–13.5], (P < 0.001). 27.8% (n = 5) eyes needed laser suture lysis post repair to control IOP; two needed further surgical intervention. Number of anti-glaucoma medications at last follow-up was 0.4 ± 0.9 (95% CI [−0.1–0.8], P = 0.09). No serious complications were encountered.

Conclusion:

Scleral patch graft and conjunctival advancement is a useful technique for repair of a scleral fistula post-filtering surgery, and this is recommended not only for the restoration of anatomy for prevention of infection and control of IOP, but also for visual rehabilitation.
Surgical outcomes and complications of sutureless needle-guided intrascleral intraocular lens fixation combined with vitrectomy
Authors: Shelke Komal , Rishi Ekta , Rishi Pukhraj
Published: September 2021

Purpose:

To analyze the surgical outcomes and complications of sutureless needle-guided intrascleral intraocular lens (IOL) implantation (Yamane technique) combined with pars plana vitrectomy.

Methods:

Retrospective study of 47 eyes of 46 patients that underwent scleral fixation of IOL by the Yamane technique combined with 3-port pars plana vitrectomy. Demographic data, primary indications for surgery, history of trauma, best corrected visual acuity (BCVA), intraocular pressure (IOP), duration of follow-up, and complications were analyzed.

Results:

Mean preoperative BCVA was 0.79 logMAR, which improved to 0.39 logMAR at mean 4.21 months (SD: 4.87 D) follow-up. Mean spherical equivalent pre and postoperative was + 7.64 D (SD: 7.74 D) and − 0.47 D (SD: 2.26 D), respectively. Early postoperative complications included hypotony with cyclodialysis cleft (n = 1; 2%), mild vitreous hemorrhage (n = 2; 4%), raised IOP (n = 2; 4%), and transient corneal edema (n = 2; 4%). Late complications included iris optic capture (n = 1; 2%), retinal detachment (n = 1; 2%), cystoid macular edema (CME; n = 2; 4%), IOL decentration (n = 1; 2%), and decentration and tilting of IOL (n = 1; 2%). Management of complications included laser treatment to cyclodialysis cleft, observation for vitreous hemorrhage, topical and oral IOP lowering agents for raised IOP. CME was managed with topical non-steroidal anti-inflammatory drugs. One eye was subjected IOL refixation. The mean number of surgeries per eye was 1.04.

Conclusion:

Combining needle-guided intrascleral IOL implantation with vitrectomy allows management of other posterior segment complications in the same sitting while obviating the need for the second surgery. It provides satisfactory outcomes that are comparable to published studies. However, a longer follow-up will allow a better understanding of the potential advantages of this approach.
Crossover randomized study comparing the efficacy and tolerability of preservative-free Tafluprost 0.0015% to Latanoprost 0.005% in patients with primary open-angle glaucoma
Authors: Hagras Sherein M , Al-Duwailah Omar KH , Nassief Mona A , Abdelhameed Ameera G
Published: September 2021

Purpose:

To compare the efficacy and the tolerability of preservative-free Tafluprost 0.0015% (TP) vs Latanoprost 0.005% (LP) in patients with primary open-angle glaucoma (POAG).

Methods:

Prospective, randomized, crossover study included patients with early POAG attending the outpatient clinic from July 2019 to February 2020. Patients were divided into 2 groups: group A included patients receiving TP and group B receiving LP. After 2 months, treatment was stopped for 1 month (washout period) then drops were switched between the groups for further 2 months. Intraocular pressure (IOP) was recorded at baseline and monthly until 5 months. Efficacy was measured by the IOP reduction at the end of each treatment period. Tolerability was assessed both subjectively (questionnaire on ocular comfort) and objectively (ocular findings) at the end of each period.

Results:

A total of 30 patients were allocated into two groups (15 patients each). There was no statistically significant difference between the 2 groups in baseline clinical examinations. All the eyes in both groups achieved IOP reduction >20% compared to baseline values, with no statistically significant difference in between. Corneal erosions and conjunctival hyperemia were significantly higher in LP-treated eyes throughout the study, regardless of the sequence. Tear break-up time scores significantly worsened after LP at the 2nd and 5th month (P < 0.001and P = 0.026 respectively) but not after TP treatment (P = 0.719 and P = 0.164). Significant exacerbation in all patients’ symptoms was noticed on switching from TP to LP.

Conclusion:

Tafluprost was proved to exhibit a comparable effect on IOP control in POAG patients, as Latanoprost drops resulted in marked alleviation in both subjective and objective ocular discomfort manifestations.
Segmented retinal analysis in pituitary adenoma with chiasmal compression: A prospective comparative study
Authors: Agarwal Rachna , Jain Vaibhav K , Singh Shalini , Charlotte Akshata , Kanaujia Vikas , Mishra Prabhakar , Sharma Kumudini
Published: September 2021

Purpose:

The aim of this study was to determine the alteration in ganglion cell complex and its relationship with retinal nerve fiber layer (RNFL) thickness as measured by spectral-domain optical coherence tomography (OCT) in pituitary adenoma cases and also its correlation with visual field (VF).

Methods:

This is a prospective comparative study wherein detailed neuro-ophthalmic examination including perimetry, RNFL and ganglion cell layer inner plexiform layer (GCL-IPL) thickness were measured preoperatively in the cases of pituitary adenoma with chiasmal compression with visual symptoms and field changes who were planned for neuro-surgical intervention. These parameters were repeated 1 year after the surgery. GCL-IPL, RNFL parameters were compared with controls and were correlated with VF mean deviation (MD). The diagnostic power of GCL-IPL was tested using the receiver operating characteristic (ROC) curve. Healthy age and sex-matched controls without any ocular and systemic abnormality were taken for comparison.

Results:

Twenty-four patients qualified the inclusion criteria. A significant thinning of GCL-IPL (P = 0.002) and RNFL (P = 0.039) was noticed in the pituitary adenoma group. GCL-IPL (r = 0.780 P < 0.001) and RNFL (r = 0.669, P < 0.001) were significantly correlated with the MD. The ROC curve values of GCL-IPL were 0.859 (95% confidence interval 0.744% to 0.973) and of RNFL were 0.731 (95% confidence interval 0.585–0.877). The diagnostic ability of GCL-IPL was more as compared to the RNFL analysis, although it was statistically insignificant (P = 0.122).

Conclusion:

GCL-IPL measurements on the OCT are a sensitive tool to detect early anterior visual pathway changes in chiasmal compression for pituitary adenoma patients.
A cross-sectional study to determine the normal corneal epithelial thickness in Indian population using 9-mm wide optical coherence tomography scans
Authors: Hoshing Abhishek A , Bhosale Seema , Samant Monica P , Bamne Aditya , Kalyankar Huma
Published: September 2021

Purpose:

To study the corneal epithelial thickness with 9-mm scans of optical coherence tomography in normal Indians with appropriate representation of all age groups.

Methods:

This was a cross-sectional observational study. 263 patients were divided into the age groups 5–20 years, 21–35 years, 36–50 years and more than 51 years were recruited for the study. All patients underwent a detailed ophthalmic examination. Patients found to have any ocular surface or intraocular disease condition (except cataract and refractive error), or who had undergone any ophthalmic surgery in the past, or had corneal topography changes suggestive of corneal ectasias (screened in patients with astigmatism more than 3 diopters) or had been continuously using any topical medication in either eye for a period of 3 months or more with the last instillation being within 1 month of inclusion in the study were excluded. All subjects underwent corneal epithelial thickness measurement with anterior segment optical coherence tomography (AS-OCT) on the Avanti OCT (Model RTVueXR1002, Optovue, USA). The corneal epithelial thickness (CET) data from 25 sectors in each eye were analyzed.

Results:

263 right and left eyes of 263 patients were analyzed in the study. Mean CETs in the central 2 mm zone were 54.13 ± 4.51 μm and 54.37 ± 3.75 μm for the right and left eyes, respectively. The superior peripheral sectors and inferior paracentral sectors were the thinnest and the thickest sectors, respectively, in both eyes.

Conclusion:

CET parameters for Indian eyes are comparable to those reported from racially distinct and geographically distant study subjects.
A simple surgical technique for splitting a single donor cornea for performing deep anterior lamellar keratoplasty and Descemet membrane endothelial keratoplasty without using a microkeratome
Authors: Siddharthan K S , Agrawal Anushri , Reddy Jagdeesh Kumar
Published: September 2021

Purpose:

To describe a simple manual surgical technique for splitting a single-donor eye for performing both deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK) without using a microkeratome.

Methods:

Twenty-three eyes with anterior stromal pathology and 23 eyes with irreversible endothelial dysfunction were evaluated for keratoplasty at a tertiary eye care referral center. Twenty-three healthy donor corneas were split into two parts. The Descemet’s membrane was stripped and used for DMEK. The stripped stroma was used for DALK. Best-corrected visual acuity (BCVA) of both DALK and DMEK, endothelial cell density, and endothelial cell loss in DMEK were noted at 1-year follow-up, along with any intraoperative or postoperative complications and failures.

Results:

In the DALK group, mean BCVA improved from 1.264 ± 0.25 log Mar preoperatively to 0.355 ± 0.27 log Mar at 12 months follow-up. There were no complications and failures. In the DMEK group, mean BCVA improved from 1.537 ± 0.61 log Mar preoperatively to 0.592 ± 0.67 log Mar and the mean donor ECD was 3071.66 (range, 2783–3487) cells/mm2 preoperatively, which was reduced to 1989.33 (range, 1546–2543) cells/mm2 at 12 months follow-up indicating a mean endothelial cell loss of 35%. The failure rate was 21.7%.

Conclusion:

This study demonstrates that with a single donor corneal tissue, both DALK and DMEK can be performed successfully without any complications. Our technique will help corneal surgeons in all developing countries to cost effectively perform more lamellar surgeries and help in reducing the magnitude of corneal blindness without the need for expensive microkeratomes.
Health-seeking behavior and the initial economic impact of patients with open globe injuries seeking treatment in a tertiary care center in India
Authors: Prajna Meera Lakshmi , Saxena Ankur , Balasubramanian Ashwin
Published: September 2021

Purpose:

The aim of this study was to assess the health-seeking behavior and the costs of primary treatment in the immediate aftermath of open globe trauma among patients seeking care at a tertiary eye care center in South India.

Methods:

This prospective observational study was carried out from June to December 2019. Details of the patient’s demographic profile, health-seeking behavior immediately following the trauma and total cost incurred till the completion of primary treatment were collected.

Results:

Eighty-five patients were recruited. Majority of patients were men (53, 82.8%), came from rural areas (65, 76.4%) and were the main breadwinners (44, 68%) of their family. After the initial trauma, a vast majority of the patients (68, 80%) visited the nearest eye care provider to obtain treatment and a majority of them (47, 69.1%) reached there within 3 h. The remaining patients (17, 20%) came directly to our center, the base hospital (BH). The mean distance travelled to the BH was 113.6 km. The mean total cost incurred was INR 20107.6 ± 10441.3. Approximately 84.8% of the patients reported a monthly income less than this amount.

Conclusion:

The economic impact of receiving primary definitive care following open globe injuries is higher than the average monthly income of more than 2/3rd of the patients. To replicate the success stories like the cataract outreach programs, there is a need to implement an integrated program encompassing workplace safety, legal protection to primary eye care providers and providing economic support for definitive treatment for the vulnerable population.
Gene therapy in retinal diseases: A review
Authors: Dhurandhar Deven , Sahoo Niroj Kumar , Mariappan Indumathi , Narayanan Raja
Published: September 2021

Over 2 million people worldwide are suffering from gene-related retinal diseases, inherited or acquired, and over 270 genes have been identified which are found to be responsible for these conditions. This review article touches upon the mechanisms of gene therapy, various enzymes of the visual cycle responsible for different genetic diseases, Luxturna—the first US Food and Drug Administration (FDA)-approved therapeutic gene product, and several ongoing trials of gene therapy for age-related macular degeneration. Gene therapy has tremendous potential for retinal conditions due to its ease of accessibility, immune-privileged status, and tight blood-retinal barriers, limiting systemic side effects of the drug. In recent years, advances in gene therapy in retinal conditions have increasing significantly, with progress in cell-specific targeting and transduction efficiency of gene products through the use of adeno-associated viral vectors (AAVs), suggesting that even greater success in future clinical trials is possible.
Role of spectral domain optical coherence tomography in the diagnosis and prognosis of papilledema
Authors: Panyala Rakesh , Sharma Pradeep , Sihota Ramanjit , Saxena Rohit , Prasad Kameshwar , Phuljhele Swati , Gurrala Sneha , Bhaskaran Karthika
Published: September 2021

Purpose:

The study of papilledema with a novel noninvasive technique such as spectral domain-optical coherence tomography (SD-OCT) provides minute and detailed cross-sectional changes thus giving an insight into the application of biomechanical principles and pathophysiology of disc edema.

Methods:

We measured average retinal nerve fiber layer (RNFL) thickness and the retinal pigment epithelium/Bruch’s membrane (RPE/BM) angle at the temporal and nasal borders of the neural canal opening (NCO) in 30 eyes with papilledema, 30 eyes with papillitis, and 80 control eyes. The inward angulation was considered as positive and the outward as negative. Follow-up was done at 1, 2, 3, and 6 months. The main outcome measures are the average RNFL thickness and the RPE/BM angle.

Results:

29 eyes (96.6%) with papilledema had a positive RPE/BM angle (+8.11 ± 3.13). 29 eyes (96.6%) with papillitis had a negative RPE/BM angle (−1.04 ± 3.27). On follow-up at 1 month, both RNFL thickness (P = 0.01) and RPE-BM angle (P = 0.001) reduced significantly in eyes with papilledema; in eyes with papillitis, there was a significant reduction in the RNFL thickness (P = 0.02), but not in the RPE-BM angle (P > 0.05). RNFL thickness in papilledema cases normalized at 3 months whereas RPE/BM normalized at 6 months of follow-up. To detect papilledema, OCT has a sensitivity of 96.66% and specificity of 99.09% on both nasal and temporal sides.

Conclusion:

After appropriate treatment, the RPE/BM angle in papilledema decreased much later than the RNFL thickness. Hence, the RPE/BM angle in papilledema (positive) can be used to differentiate it from papillitis (negative) and also to monitor the activity of the disease.
Whole-exome sequencing identifies multiple pathogenic variants in a large South Indian family with primary open-angle glaucoma
Authors: Shah Mohd Hussain , Kumaran Manojkumar , Chermakani Prakash , Kader Mohideen Abdul , Ramakrishnan R , Krishnadas Subbiah R , Devarajan Bharanidharan , Sundaresan Periasamy
Published: September 2021

Purpose:

To identify the pathogenic variants associated with primary open-angle glaucoma (POAG) using whole-exome sequencing (WES) data of a large South Indian family.

Methods:

We recruited a large five-generation South Indian family (n = 84) with a positive family history of POAG (n = 19). All study participants had a comprehensive ocular evaluation. We performed WES for 16 samples (nine POAG and seven unaffected controls) since Sanger sequencing of the POAG candidate genes (MYOC, OPTN, and TBK1) showed no genetic variation. We used an in-house pipeline for prioritizing the pathogenic variants based on their segregation among the POAG individual.

Results:

We identified one novel and five low-frequency pathogenic variants with consistent co-segregation in all affected individuals. The variant c.G3719A in RPGR-interacting domain of RPGRIP1 that segregated heterozygously with the six POAG cases is distinct from variants causing photoreceptor dystrophies, reported affecting the RPGR protein complex signaling in primary cilia. The cilia in trabecular meshwork (TM) cells has been reported to mediate the intraocular pressure (IOP) sensation. Furthermore, we identified a novel c.A1295G variant in Rho guanine nucleotide exchange factors Gene 40 (ARHGEF40) and a likely pathogenic variant in the RPGR gene, suggesting that they may alter the RhoA activity essential for IOP regulation.

Conclusion:

Our study supports that low-frequency pathogenic variants in multiple genes and pathways probably affect Primary Open Angle Glaucoma’s pathogenesis in the large South Indian family. Furthermore, it requires larger case-controls to perform family-based association tests and to strengthen our analysis.
Approach to optic neuritis: An update
Authors: Phuljhele Swati , Kedar Sachin , Saxena Rohit
Published: September 2021

Over the past few years, there has been remarkable development in the area of optic neuritis. The discovery of new antibodies has improved our understanding of the pathology of the disease. Antiaquaporin4 antibodies and antimyelin oligodendrocytes antibodies are now considered as distinct entities of optic neuritis with their specific clinical presentation, neuroimaging characteristics, treatment options, and course of the disease. Similarly, there has been a substantial change in the treatment of optic neuritis which was earlier limited to steroids and interferons. The development of new immunosuppressant drugs and monoclonal antibodies has reduced the relapses and improved the prognosis of optic neuritis as well as an associated systemic disease. This review article tends to provide an update on the approach and management of optic neuritis.
Outcomes of 25-gauge pars plana vitrectomy for cytomegalovirus retinitis-related retinal detachment
Authors: Moharana Bruttendu , Dogra Mohit , Tigari Basavaraj , Singh Simar Rajan , Katoch Deeksha , Arora Atul , Singh Ramandeep
Published: September 2021

Purpose:

The purpose of this study is to evaluate the anatomical and functional outcomes of 25-gauge (G) pars plana vitrectomy (PPV) in patients with cytomegalovirus retinitis (CMVR)-related rhegmatogenous retinal detachment (RRD).

Methods:

Single-center retrospective consecutive case series of patients who underwent 25-G PPV for CMVR-related RRD repair with a minimum follow-up of 3 months. Complete anatomic success was defined as the complete attachment of retina including the periphery. Best-corrected visual acuity (BCVA) of ≥20/400 was defined as functional success.

Results:

Sixteen eyes of 15 patients were included in the study. Eleven patients were human immunodeficiency virus positive, three patients had hematological malignancies, and one patient suffered from dyskeratosis congenita. The mean follow-up was 20.5 ± 17.4 months (range 3–60 months). Complete anatomical success was seen in 15 eyes (93.75%). One eye had a residual inferior detachment with attached macula. Silicone oil was used as tamponade in 15 eyes and C3F8 gas in one eye. The mean change in BCVA was statistically significant, preoperative LogMAR BCVA was 2.05 ± 0.94 while the final follow-up postoperative LogMAR BCVA was 1.03 ± 0.61 (P < 0.001). Thirteen eyes (81.25%) had final BCVA ≥20/400.

Conclusion:

Microincision vitrectomy surgery can achieve excellent retinal reattachment rates in post-CMVR RRDs without significant intraoperative and postoperative complications. The visual outcome varies depending on the status of the optic disc and macula. Majority of the patients maintained functional vision.
Slit-lamp measurement of anterior chamber depth and its agreement with anterior segment optical coherence tomography and Lenstar LS 900 in pseudoexfoliation and normal eyes
Authors: Pathak Ray Vanita , Ramesh Smitha B , Rathi Varsha
Published: September 2021

Purpose:

There is a considerable lack of awareness of slit-lamp measurement of anterior chamber depth (ACD) by the Redmond Smith method (SACD) in present day-to-day clinical practice, which may provide rapid assessment in pseudoexfoliation (PXF) when assessing for angle closure and planning for cataract surgery. This assumes importance not only in outreach clinics but also in the ongoing pandemic caused by the highly contagious novel coronavirus, where social distancing is advocated to contain the spread. We aimed to compare the axial ACD in PXF and normal patients by SACD, and its agreement with the anterior segment optical coherence tomography (ASOCT) and LenstarLS-900.

Methods:

A prospective comparative observational study was done at a tertiary eye care hospital. A PXF group and a normal group of controls were recruited. All eyes were phakic with normal cornea. Any eye with previous intraocular/refractive surgery and cause of other secondary or uncontrolled glaucoma was excluded. SACD was measured clinically via slit-lamp method and also via ASOCT and Lenstar; agreement between the methodologies was plotted.

Results:

Fifty patients were recruited in each group. Mean age was 66.82 ± 4.88 years in PXF patients and 65 ± 5.46 years in controls (P = 0.2). ACD was found to be greater in controls compared with the PXF patients; this difference was statistically significant (P < 0.001) across all methodologies. A good agreement with narrow 95% limits of agreement was found between these methodologies.

Conclusion:

Redmond Smith slit-lamp methodology of estimating the axial ACD is recommended as a rapid, quantifiable, noncontact screening technique during routine examination, especially in primary outreach centers, and is also advantageous during the ongoing pandemic by reducing expendable investigations.
Three-year outcomes of alcohol delamination of corneal epithelium for recurrent corneal erosions of traumatic etiology
Authors: Teh Boon Lin , Chua Paul Y S , Reddy Aravind R
Published: September 2021

Purpose:

Alcohol delamination of the corneal epithelium (ADCE) is a therapeutic option for patients with recurrent corneal erosion (RCE) who do not respond to nonsurgical management of lubricants and extended wear contact lens. The aim of the study is to report on three-year efficacy and safety of ADCE for RCE of traumatic etiology.

Methods:

This is a retrospective review of consecutive patients who underwent ADCE for traumatic RCE in a local hospital between January 2010 and January 2020. The outcomes at a 3-year follow-up review are included. Nonsurgical therapy used; intra- and postoperative complications were recorded. ADCE was only offered to those who remained symptomatic despite maximum topical lubrications and/or extended wear contact lens. Success was defined as the absence of recurrence of corneal erosion.

Results:

Twenty-six eyes of 26 patients with RCE caused by trauma underwent ADCE. The mean age of patients was 39 years. The follow-up period was a minimum of 36 months. Three eyes (11.5%) had recurrence of corneal erosion after ADCE at the 3-year follow-up. Recurrence was noted at months 2, 23, and 36 postoperatively in these patients. All patients reported significant improvement in symptoms associated with recurrent erosion. Ten eyes (38.5%) stopped all topical lubricants postoperatively. No intra- or postoperative complications were noted in our study.

Conclusion:

This study documents the long-term safety and efficacy of alcohol delamination of corneal epithelium at 3 years for patients with RCE of traumatic origin.
Use of cryopreserved donor corneal tissues first time in India for therapeutic penetrating keratoplasty during COVID-19 pandemic – A case series
Authors: Mane Seema K , Patwardhan Sourabh D
Published: September 2021

Coronavirus disease (COVID-19) pandemic caused restricted eye retrieval leading to acute scarcity of donor corneas. Nine patients with perforated corneas needed urgent donor tissues where we used 10 cryopreserved corneal tissues for therapeutic penetrating keratoplasty (TPK). Repeat TPK was done in one eye for recurrence of infection. The anatomical integrity of the eyeball was maintained in seven eyes, while two eyes were lost to phthisis. Thus, cryopreserved corneas can be taken into consideration for TPK when other donor tissues are not available.
Effect of melanocyte keratinocyte transplantation procedure, using ablative CO2 laser and followed by NB-UVB phototherapy, on the expression of E-Cadherin and matrix metalloproteinase-2 in acral vitiligo
Authors: Esmat Samia , Assaf Magda , Kadry Dina , El Hawary Marwa , Halim Dalia A. , Saleh Marwa , Bassiouny Dalia , Saad Heba , El-Hanafy Ghada
Published: September 2021

Background

Melanocyte keratinocyte transplantation procedure (MKTP) is a multi-procedural intervention that could hypothetically alter the environment surrounding grafted epidermal cells, helping melanocytes’ migration and adherence to keratinocytes in their basal position.

Objective

To evaluate the effect of MKTP in acral vitiligo skin prepared by total ablative CO2 laser resurfacing and followed by narrow-band ultraviolet B (NB-UVB) phototherapy on matrix metalloproteinase-2 (MMP2) and E-Cadherin expression and the reflection of these changes on repigmentation.

Patients and methods

Acral lesions in 20 stable nonsegmental vitiligo patients were prepared by full CO2 ablation down to the papillary dermis followed by MKTP and NB-UVB sessions. Two 4 mm punch biopsies were taken: the first at baseline and the second after the onset of repigmentation or after 6 months of phototherapy if no repigmentation occurred. Immunohistochemical staining for evaluation of E-Cadherin and MMP2 expression was performed.

Results

Eight patients (40%) achieved repigmentation ranging from 10 to 90% with a median of 62.5%. E-Cadherin intensity was significantly increased after treatment (P<00.1). There was also a significant total increase in epidermal (P<0.001) and dermal (P<0.001) MMP2 with diffuse nuclear pattern of staining. In lesions showing repigmentations, the percentage change in dermal MMP2 was significantly higher (P=0.012), while no such difference was present in epidermal MMP2 and E-Cadherin expression.

Conclusion

MKTP with recipient site prepared by full CO2 laser ablation followed by NB-UVB phototherapy increased the expression of E-Cadherin and MMP2 in acral vitiliginous skin. The increase of dermal MMP2 could play a favorable role in repigmentation.
Circulating ghrelin and apelin levels in nonobese psoriasis vulgaris patients
Authors: Farag Azza G.A. , Abdallah Heba M. , Ibrahem Reda A.L. , Elshaib Mustafa E. , Shehata Wafaa A.
Published: September 2021

Background

The metabolism and immune system are linked via a network of many mediators known as adipokines. Ghrelin and apelin-36 are unique adipokines; however, their role in psoriasis, an immune-mediated disease, remains unclear.

Objective

To detect the serum levels of ghrelin and apelin-36 in psoriasis vulgaris patients in comparison with controls and to correlate their levels with severity of psoriasis, BMI, lipid profile, and glycated hemoglobin (HbA1c).

Patients and methods

The present case–control study included 70 nonobese psoriasis vulgaris patients and 70 controls. The severity of psoriasis was assessed using the psoriasis area and severity index score. The ghrelin and apelin-36 serum levels, cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and HbA1c were measured.

Results

Psoriatic patients had significantly higher ghrelin (P<0.001), HbA1c (P<0.001), cholesterol (P<0.001), triglycerides (P<0.001), and low-density lipoprotein (P=0.001) levels and a lower apelin-36 (P<0.001) serum level than controls. Serum ghrelin was negatively correlated with psoriasis area and severity index score (r=−0.75; P<0.001), whereas serum apelin-36 was negatively correlated with HbA1c mean values (r=−0.44; P=0.004) and was found to be a good predictor of prediabetes in psoriatic patients (P=0.012). Nonsignificant correlation between ghrelin and apelin-36 serum levels was observed in psoriatic patients.

Conclusion

Ghrelin and apelin-36 are dynamic adipokines that might play a role in psoriasis vulgaris pathogenesis. The role of ghrelin and apelin-36 in psoriasis might be mediated through dyslipidemia and impaired glucose metabolism in psoriatic patients, respectively. Targeting both ghrelin and apelin-36 may be of value in management of metabolic syndrome associated with psoriasis. Serum apelin-36 assessment can predict prediabetic state in psoriatic patients.