bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolution of Cryptocurrency
Authors: Sharma Sambhav , Sood Ramayni
Published: March 2022

The avatar of currency has evolved over time, and 'cryptocurrency' is its latest incarnation. Cryptocurrency is a type of digital currency that allows peer-to-peer online payments without interference of financial institutions. Though experts are impressed with its growth trajectory, its decentralized and unregulated structure has stirred insecurity amongst governments across jurisdictions that has translated into bans and indecisiveness related to its status. While the concerns are not baseless and it is susceptible to cybercrimes, the focus must be to mitigate the issues rather than imposing a blanket prohibition that would be antithetical to the fundamental spirit and purpose of financial digitization, which is to promote the free flow of funds. In this chapter, the authors, firstly, analyze the practicality of cryptocurrency in light of the legal barriers and, secondly, assess the viability of a regulatory framework that ensures minimal control from the authorities but also checks concerns including cybercrime, illegal transactions, tax evasion, and lack of accountability.
Negotiating Across Cultures
Authors: Agua Pedro B , Frias Armindo S. , Correia Anacleto
Published: March 2022

The 21st century accentuated the globalization, regardless of some cases apparently returning to the previous regionalization paradigm. In both cases, human communication has been and will be key to overcome the major challenges ahead. Within the global context, communication is increasingly cross-cultural, which brings additional challenges related to misunderstandings and the potential to escalate conflicts, sometimes ending up at crises. Therefore, communication and negotiation across cultures has never been as relevant as now, and the purpose of this chapter is to provides a fundamental knowledge base to cross-cultural negotiation, taking into account the main culture models from the last 50 years. It will be based on several relevant culture models, taken from multiple lines of research from reference authors in the field of culture models, negotiation, leadership, and decision making.
The Effect of Feature Selection on Gray Level Co-Occurrence Matrix (GLCM) for the Four Breast Cancer Classifications
Authors: Mawarni Marrisaeka , Utaminingrum Fitri , Mahmudy Wayan Firdaus
Published: March 2022

Breast cancer is ranked first as the most common cancer case affecting women in the world. Early detection of breast cancer can increase the chances of survival in patients. The role of the radiologist is necessary for the detection of breast cancer, and the radiologists often have limitations in conducting disease consultations with so many patients. The detection gives a subjective result because the process is based on the decision-making of the radiologists. In this work, we proposed a system to detect and classify breast cancer accurately to anticipate delays in patient handling and subjective result. We proposed a digital image processing method using mammograms to classify breast cancer into four categories based on tissue density, namely BI-RADS I, II, III, and IV. The main stages carried out in this research are images processing, feature extraction, data normalization, feature selection, classification, and parameter optimization. This method uses GLCM to extract texture features and two feature selection methods namely, RFE-RF and Chi-Square. The method was tested with various classifiers such as SVM, KNN, Random Forests, and Decision Trees. The hyper-parameters of the classifier were optimized using GridSearch. The final result is measure using accuracy. In this work, Random Forest with the RFE-RF gives the highest accuracy of 99.7%. Feature selection offers a significant impact on improving accuracy. The results of this work prove that our system can classify breast cancer with high accuracy. So that our system can solve problems to assist radiologists in screening mammograms and help make decisions to diagnose patients with breast cancer based on density.
Toward Innovation and Policies: Mapping the Demand of Orthopedic Implants in Public Hospital Margono Purwokerto, Central Java, Indonesia
Authors: Nurisusilawati Isnaini , Yusro Muhammad
Published: March 2022

Most of the needs for orthopedic implants in Indonesia are met by the imported product. So that innovation is needed to produce local products that suit the needs of the Indonesian people. The first step before innovating is the need analysis. It is necessary to map and forecast certain implant products to understand which products that are important to be developed before they become a national innovation. In addition, there has not been an article yet that reported data regarding implant product and their forecasting. The main objective of this research is to capture the actual demand product by mapping and forecasting the orthopedic implants in a public hospital. The mapping process was carried out using the descriptive analysis method to organize and summarize the data to get more information about the orthopedic implants that were widely used. In addition, the mapping process is also carried out using the double moving average method to see the trend of demand for orthopedic implants in the future. The data used in this research was the number of orthopedic implants used by the Margono hospital for five years starting from 2016 to 2020. Based on the collected data, forty-two varieties of orthopedic implants had been mapped regarding implant demand. Furthermore, twenty-two of forty-two implants had been analyzed based on several applications that always appeared within five years. This research type of implant is classified into five categories which are screw, plate, wire, rod, and prosthesis. It is found that cortical screw, straight plate, K wire, rod union, and bipolar cemented were noted as the highest demand implant represent their category. The demand forecasting process is carried out for cortical screw, K wire, and rod union. By using the double moving average method and MAPE for measuring the accuracy, it was found that the method has a significant result because the MAPE value is still quite good. The value of MAPE for cortical screw, K wire, and rod union are 0.3985, 1.0726, and 0.4332, respectively. The trend of increasing demand occurs in the product cortical screw and rod union. This data could perform as the recommendation and references leading to the research road map, especially in the orthopedic research field in Indonesia.
Dengue Virus Detection in Dengue Hemorrhagic Fever Patients Using the NS1 Antigen-Based Test with Immunochromatography and SDS-Page Methods in the Regional General Hospital of Kendari City
Authors: Rasyid Sri Anggarini , Sugireng Sugireng , Nurnaningsih Nurnaningsih , Sanatang Sanatang , Suwarny Suwarny
Published: March 2022

Dengue Hemorrhagic Fever is one of the diseases that widely damages people; this disease is always found in tropical and subtropical regions, especially in Southeast Asia, Africa, and North Amerika [1]
Simulated Analysis Ti-6Al-4V Plate and Screw as Transverse Diaphyseal Fracture Implant for Ulna Bone
Authors: Sabrina Mustika Ainun , Hartati Sonia Adilina , Asmaria Talitha , Widiyanti Prihartini , Utomo Muhammad Satrio , Rokhmanto Fendy , Kartika Ika
Published: March 2022

Transverse diaphyseal fracture is one of the most common fractures caused by accidents. The fracture treatment needs surgery to apply the fixations that matched the bone geometry. This paper aims to reverse engineering of a published bone plate and screw criteria into a three-dimensional (3D) model and analyze them using the finite element method (FEM) in several factors, the bone, the plate, the screw, the unification of plate and screw, and combination all components. This paper conducts two main activities of designing plate and screw based on literature for ulna bone implant and running the FEM to achieve the von Misses stress in the plate, screw, and bone by placing load and constrained area based on the actual use of the implant in the patient. The maximum number in von Misses stress are 5.01855 MPa for bone only, 0.00918 MPa for plate only, 193.304 MPa for screws only, 6.28160 MPa for the assembly screws and a plate, and 761.07 MPa for all unification. All simulation results meet the expectation that the bone analysis is less than the compressive strength of the ulnar bone. Moreover, when applied to the bone, the plate and screw analysis and the assembly also demonstrate a lower number than the yield strength of the properties of the Ti6Al4V materials. All this biomechanical assessment confirms that designs could withstand ulnar bone’s ultimate flexural load and pressure. The finite element analysis (FEA) on the proposed recreated dimension on ulnar plate and screw is expected to accelerate the rehabilitation process of radius ulnar fracture, particularly in the transverse diaphyseal fracture in ulna bone.
Hand Exoskeleton Development Based on Voice Recognition Using Embedded Machine Learning on Raspberry Pi
Authors: Triwiyanto Triwiyanto , Yulianto Endro , Luthfiyah Sari , Musvika Syevana Dita , Miftahul Maghfiroh Anita , Mak'ruf M. Ridha , Titisari Dyah , Ichwan S.B.
Published: March 2022

The choice of using speech to control the exoskeleton is based on the number of exoskeletons that are controlled using the EMG signal, where the EMG signal itself has the weakness of the complexity of the signal which is influenced by the position of the electrodes, as well as muscle fatigue. The purpose of this research is to develop an exoskeleton device using voice control based on embedded machine learning on a Raspberry Pi minicomputer. In this study, two feature extraction types namely mel-frequency cepstral coefficient (MFCC) and zero-crossing (ZC), and two machine learning algorithms, namely K-nearest Neighbor (K-NN) and Decision Tree (DT) were evaluated. The hand exoskeleton development consists of 3D hand design, microphone, Raspberry Pi 4B+, PCA9685 servo driver, and servo motor. Microphone was used to record voice commands given. After model evaluation, it was found that the MFCC extraction combined with the K-NN algorithm and the best accuracy (96±7.0%). In the implementation, we found that the accuracy is 79±14.46% and 90±14.14% for open and close commands.
Identification of ß-Catenin Gene as a Colorectal Cancer Controller in Mice (Mus musculus) Induced by Azoxymethane (AOM) and Dextran Sulfate Sodium (DSS) Using PCR RFLP Method with EcoR1 and Hinif1
Authors: Rasyid Sri Anggarini , Muzuni Muzuni , Syarif Satriani , Renaldi Renaldi , Andika Andika , As'Ad Suryani , Miskad Upik A. , Minhajat Rahmawati , Purnama Titi
Published: March 2022

Colorectal cancer is cancer attacking the colon to the rectum. The pathophysiology of colorectal cancer occurs due to several causes, such as changes in normal colonic epithelial cells histopathologically through molecular processes. Another cause is that the adenomatous polyps become colorectal cancer due to the carcinogenesis process. Most colorectal cancers originate from adenocarcinomas. Colon cancer is characterized by the uncontrolled growth of cells in the epithelial lining of the large intestine. The type of this study was laboratory experimental research. The population was 2 mice that had been induced by Azoxymethane (AOM) and Dextran sulfate sodium (DSS) and 1 mouse did not get any treatment for 2 months. From the result, the results of RFLP on PCR products from 3 samples that had been used showed that only one sample showing the presence of the β-catenin gene by marking the formation of a 227bp Deoxy Nucleic Acid (DNA) band and testing the EcoR1 restriction enzyme did not show any cutting of DNA fragments with no DNA bands. The size of 81bp and 146bp for Hinf1 restriction showed a mutation in P3 with the formation of bands of 89bp and 138bp in the large intestine that had been induced by azoxymethane and dextran sodium sulfate. Through this study, it can be seen that the occurrence of mutations in the-catenin gene as a marker of colorectal cancer can be identified using the Hinif1 enzyme with the RFLP PCR method.
Near Infrared LEDs-Based Non-Invasive Blood Sugar Testing for Detecting Blood Sugar Levels on Diabetic Care
Authors: Badriah Siti , Bahtiar Yanyan , Andang Asep
Published: March 2022

Diabetes Mellitus, with its rapid development and various complications that have caused it, has become one of the deadliest diseases in the world. Early detection efforts to raise blood sugar levels can help to avoid a variety of complications. Measuring devices are needed to find out blood sugar levels detect how much sugar is in the blood. The blood sugar measuring device is invasive by taking blood from capillaries tested both in the lab and using portable testing instruments. The use of this tool results in discomfort, pain, and trauma for the patient. The purpose of this study was to determine the degree of sensitivity of the NIR LED sensor on the thumb to the little finger to the reading of light reflections coming out of body tissues.. Currently, the index finger is often used as a medium to find out how much blood sugar is in non-invasive blood sugar measurements. The other four fingers' sensitivity is unknown at this time. Because the use of the index finger, which is located in the middle, can make activities difficult at times, information on the sensitivity level of the other fingers is required. This paper discusses the sensitivity of placing the NIR LED sensor on the five fingers to determine the most sensitive finger with the best response. Based on the testing results of 15 samples, Although the index finger receives the most significant stress, the correlation and linear regression tests show that the thumb has the closest relationship with the R2 = 0.6841. With this research, a test instrument with higher sensitivity for Diabetes can be developed by placing the sensor in a comfortable area. The implication is that the results of this study can be recommended to use the thumb as an alternative to the placement of the NIR LED sensor to measure blood sugar levels non-invasively in DM patients.
A spatio-temporal study of state-wide case-fatality risks during the first wave of the COVID-19 pandemic in Mexico
Authors: Ramírez-Aldana Ricardo , Gomez-Verjan Juan Carlos , Bello-Chavolla Omar Yaxmehen , Naranjo Lizbeth
Published: March 2022

spatio-temporal analysis of the first wave of the coronavirus (COVID-19) pandemic in Mexico (April to September 2020) was performed by state. Descriptive analyses through diagrams, mapping, animations and time series representations were carried out. Greater risks were observed at certain times in specific regions. Various trends and clusters were observed and analysed by fitting linear mixed models and time series clustering. The association of co-morbidities and other variables were studied by fitting a spatial panel data linear model (SPLM). On average, the greatest risks were observed in Baja California Norte, Chiapas and Sonora, while some other densely populated states, e.g., Mexico City, had lower values. The trends varied by state and a four-order polynomial, including fixed and random effects, was necessary to model them. The most common risk development was observed in states belonging to two clusters and consisted of an initial increase followed by a decrease. Some states presented cluster configurations with a retarded risk increase before the decrease, while the risk increased throughout the time of study in others. A cyclic behaviour with a second increasing trend was also observed in some states. The SPLM approach revealed a positive significant association with respect to case fatality risk between certain groups, such as males and individuals aged 50 years and more, and the prevalence of chronic kidney disease, cardiovascular disease, asthma and hypertension. The analysis may provide valuable insight into COVID-19 dynamics applicable in future outbreaks, as well as identify determinants signifying certain trends at the state level. The combination of spatial and temporal information may provide a better understanding of the fatalities due to COVID-19.
Eplerenone–A novel Mineralocorticoid receptor antagonist for the clinical application
Authors: Wu Nan-Nan , Zhang Yuan-Yuan , Zhao Dong
Published: March 2022

Aldosterone is produced from the zona glomerulosa of the adrenal cortex in the adrenal gland, which is main mineralocorticoid hormone. Upon binding the mineralocorticoid receptor, it regulates sodium and potassium absorption, secretion, and retention, thereby maintaining stable blood pressure levels. However, abnormal aldosterone synthesis and metabolism could be pathogenic and contribute to multiple organ fibrosis and structural remodeling. For instance, hyperaldosteronemia is critically involved in the development of hypertension, heart failure (HF), and renal disease. Therefore, mineralocorticoid receptor antagonists (MRAs) that could fight against high concentrations of aldosterone play an important role in the treatment of diseases caused by hyperaldosteronism. Eplerenone, as a novel selective MRA, has better therapeutic efficiency and fewer side effects comparing to the classical drug spironolactone. In this review, first, we go through the biosynthesis and biologic properties of aldosterone and then introduce how hyperaldosteronemia facilitates certain diseases progression. Aldosterone is an important part of the renin-angiotensin-aldosterone system (RAAS), which plays a crucial role in essential hypertension, atrial tremor, and tissue fibrosis. Second, we summarize current evidence of clinical application of eplerenone in the control of primary aldosteronism, hypertension, HF, nephropathy, insulin resistance, and liver damage. It is exciting that many studies have shown that the use of eplerenone in these diseases yields good outcomes accompanied with fewer adverse effects such as hyperkalemia, metabolic acidosis, hypotension, and acute kidney failure, which indicates that eplerenone is a strong and safe MRA and inhibitor of RAAS system. This review focuses on therapeutic efficacy and disadvantages of eplerenone when treating a series of different diseases. Ultimately, we hope to shed light on future therapeutic strategies in diseases associated with hyperaldosteronemia.
Effect of high fresh gas flow and pattern of breathing on rapid preoxygenation
Authors: Mathew Gincy , Manjuladevi M. , Joachim Nayanthara , Kothari Apoorwa N.
Published: March 2022

Background and Aims:

Preoxygenation is supplementation of 100% oxygen prior to induction of general anaesthesia to increase the body’s oxygen stores. Efficacy of preoxygenation can be increased by optimising fresh gas flow (FGF) rate and pattern of breathing.

Methods:

Based on pattern of breathing—Tidal Volume Breathing (TVB) or Deep Breathing (DB) and FGF-10 L/min or 15 L/min—100 subjects of the American Society of Anesthesiologists physical status I/II posted for elective surgery were recruited and randomised into four groups: T10 - TVB with 10 L/min; D10 - DB with 10 L/min; T15 - TVB with 15 L/min; and D15 - DB with 15 L/min. A tight-fitting anaesthesia mask along with continuous positive airway pressure of 5 cm of H2O with 20° head-up was used for preoxygenation. The total time taken and the total number of breaths required to achieve end tidal oxygen concentration (EtO2) of 90% were noted. Exhaled tidal volume (Vte), end tidal carbon dioxide, fraction of inspired oxygen, and EtO2 were recorded at each breath. Analysis of variance (ANOVA) was used for inferential statistics and Tukey’s honestly significant difference (HSD) test was used to calculate mean difference in total time and number of breaths amongst the groups.

Results:

Total time taken was significantly low (P < 0.001) in DB compared to TVB (D10: 70.2 ± 19.91, D15: 68.4 ± 20.27 vs T10: 112.28 ± 47.96, T15: 113.6 ± 48.57 seconds). Number of breaths was significantly high (P < 0.001) in TVB with 22.84 ± 8.73, 23.76 ± 11.64, 10.56 ± 3.69, and 8.32 ± 1.8 in T10, T15, D10 and D15, respectively. Vte was significantly low in TVB (P < 0.001).

Conclusion:

Rapid preoxygenation can be achieved by DB at high FGF of a minimum of 10 L/min.
Anesthesia-related perioperative patient safety services in Indian public and private hospitals with or without teaching programs
Authors: Karim Habib Reazaul , Kumar Mayank , Sinha Mamta
Published: March 2022

Introduction:

The World Health Organization is emphasizing global patient safety for more than a decade. However, very less is known about the patient safety environment in the perioperative settings in developing countries. The present secondary analysis aimed to compare the anesthesia-related patient safety measures and services in Indian public versus private and teaching versus nonteaching hospitals.

Materials and Methods:

The present study is a post hoc, subgroup analysis of a previously conducted cross-sectional, questionnaire-based, online survey during February–May 2019. Responses from the postgraduate trainee and consultant/qualified practitioners were included. Data related to the practice pattern and availability of standard, advanced monitoring, and equipment were then categorized based on the hospital funding source and availability of teaching program; compared using the Fisher's exact test, and P < 0.05 was considered statistically significant.

Results:

Six hundred responses were included. The majority (60.7%) were from the private sector; 57.3% worked in teaching hospitals. Overall, anesthesia-related patient safety and equipment were deficient across the entire range of hospitals. However, there was no difference between matched public and private hospitals (P > 0.05 for most), except the anonymous incident reporting, which was significantly higher in the corporate teaching hospitals (P < 0.0001). Teaching hospitals had significantly better safety measures (P < 0.0001 for most parameters) than nonteaching hospitals.

Conclusion:

Public sector hospitals in India are not having significantly different anesthesia services related to patient safety monitoring and equipment than private sector hospitals. However, the safety measures are relatively low in many aspects across all sectors, which need attention.

The following core competencies are addressed in this article:

Patient care, Systems-based practice.
Impacting pediatric cardiologist burnout
Authors: Parsons Chelsea , Dasgupta Soham , Mohl Larry , Sachdeva Ritu , Border William
Published: March 2022

Introduction:

Burnout among physicians may impact productivity and result in suboptimal patient care. Studies looking at burnout in a specific pediatric subspecialty are extremely limited. In a previous study, the authors evaluated the work–life balance and burnout among pediatric cardiology attending at our institution. This demonstrated early signs of reduced work engagement and possible burnout in the near future. To address this, the authors implemented a number of targeted interventions and conducted a follow-up survey to assess the effects of such changes. The objective of this study was to evaluate the current status of work–life balance and burnout among pediatric cardiologists at the author's institution compared to the general population and to the prior survey.

Materials and Methods:

Pediatric cardiology attending physicians were surveyed at the author's institution to assess their perception of burnout and work–life balance using the Maslach burnout inventory and the areas of work–life survey.

Results:

Forty-seven of the 52 pediatric cardiologists responded to the survey. They were divided into groups by their respective subspecialty: interventional/electrophysiology (n = 2), cardiac intensive care unit/inpatient (n = 9), noninvasive imaging (n = 6), outpatient (n = 22), and other (n = 8). When compared to the previous survey, the Maslach burnout inventory scores were significantly lower in the area of emotional exhaustion. However, most scores in the areas of work–life survey were lower than the prior survey.

Conclusion:

This follow-up study focusing on pediatric cardiology attending physicians demonstrated worsening burnout and signs of reduced work engagement compared to the previous survey 4 years ago. Interventions did not include bolstering our physician support systems and developing resiliency training for our physicians, which is an area the authors are going to focus on going forward.

The following core competencies are addressed in this article:

Medical knowledge, Practice-based learning, Systems-based practice.
Efficacy of supplemental Occlu-pad therapy with partial occlusion in children with refractive anisometropic amblyopia
Authors: Jethani Jitendra , Kamat Anisha , Shah Kalpit , Thakkar Hansa , Sharma Sumedha
Published: March 2022

Purpose:

To study the efficacy of supplemental occlu-pad therapy with partial occlusion in children with refractive anisometropic amblyopia.

Methods:

Thirty-one children who did not improve after partial occlusion of 6 h for 6 months were supplemented with the use of occlu-pad for 1 h per day and three such sessions in a week.

Results:

The mean age was 6.8+/-1.4 years (range 5–9 years). A significant improvement of 3.2+/-1.3 lines in visual acuity was noticed at the end of 3 months of starting this supplemental therapy in children. Out of 31 children, 26 children improved at least 2 lines or more at the end of 3 months. All children (n = 9) having anisohyperopic amblyopia improved at the end of 3 months

Conclusion:

Occlu-pad is useful in supplementing occlusion therapy in cases of refractive amblyopia and is more effective in anisohyperopic amblyopia.
Eye screening can be used to perform anemia screening and treatment in adolescent girls using ToucHb
Authors: Gogate Bageshri , Phadke Supriya , Gogate Parikshit M
Published: March 2022

Purpose:

Anemia is common in adolescent girls. Apprehension while drawing blood to estimate hemoglobin concentration is a barrier for confirming anemia. ToucHb, a noninvasive instrument that estimates the hemoglobin by taking an image of the exposed conjunctiva, was used during eye screening to help diagnose and treat anemia.

Methods:

ToucHb was used during secondary school eye screening and during house-to-house eye screening to estimate the hemoglobin concentration in the body. Each of the girls was distributed a packet of 60 tablets of ferrous and folate and a tablet of albendazole. They were followed up after 3 months.

Results:

Exactly 1511 municipal school girls aged 10-19 years (mean 12.9; standard deviation [SD] 1.64) were examined. Of them, 949 (62.8%) had hemoglobin of ≤9 mg%. Among those girls with hemoglobin ≤9 mg%, the mean (SD) during the initial and follow-up examinations was 6.1 (1.4) and 9.6 (1.03), respectively, by paired t-test (P < 0.001). Another 588 girls (average age 14.4 years, SD 1.2) had their eyes examined and hemoglobin estimated during a house-to-house eye screening. Of them, 116 (19.7%) had hemoglobin level of ≤9 mg%. Their pre-Hb was 7.9 (SD 1.05) on average and after 3 months, it was 9.6 (SD 1.02). Among those girls with hemoglobin ≤9 mg%, the mean (SD) during the initial and follow-up examinations was 6.2 (1.4) and 7.9 (1.1), respectively, by paired t-test (P < 0.001)

Conclusion:

ToucHb was useful to diagnose anemia while doing eye screening and to ensure its treatment. Anemia diagnosis and management would enhance the health of adolescent girls.
Incidence and risk factors for post-penetrating keratoplasty glaucoma
Authors: Shree Neha , Gandhi Monica , Dave Abhishek , Mathur Umang
Published: March 2022

Purpose:

To carry out a prospective study to analyze the incidence and various preoperative, intraoperative, and postoperative risk factors for the development of PPKG.

Methods:

A total of 207 patients were analyzed prospectively, who were operated for penetrating keratoplasty (PK) in a tertiary eye care hospital between the time period of August 1, 2017 and February 28, 2018 and were followed up till the sixth month. Each patient was analyzed at every visit to determine the factors responsible for post-keratoplasty glaucoma.

Results:

Out of 207 eyes, post-PK glaucoma developed in 84 cases, which yielded an incidence of 41%. Incidence of PPKG (Post PK glaucoma) in various conditions was as follows: in repeat PK 62%, in perforated corneal ulcer 33%, in nonperforated corneal ulcer 29%, in corneal scar including adherent leukoma 37.2%, and in pseudophakic bullous keratopathy and aphakic bullous keratopathy, 14% and 80%, respectively. In age- and sex-adjusted multivariate analysis, the significant risk factors were age (P-value- 0.006), presence of PAS (P-value 0.001), and fellow eye glaucoma (P-value 0.04). Aphakia and combined surgery were not found to be significant

Conclusion:

Our study recommends a meticulous examination of the fellow eye to assess the presence of glaucoma as it can increase the suspicion of glaucoma in the eye to be operated. The presence of PAS and age are important risk factors for developing PPKG. The risk of developing PPKG increases exponentially as the number of risk factors increases, but the presence of more than three risk factors does not add to the development of PPKG.
Safety and efficacy of suprachoroidal triamcinolone acetonide for the management of serous choroidal detachment prior to rhegmatogenous retinal detachment surgery: A Pilot study
Authors: Kohli Gaurav Mohan , Shenoy Pratik , Halim Danish , Nigam Saurabh , Shetty Sachin , Talwar Dinesh , Sen Alok
Published: March 2022

Purpose:

To study the safety and efficacy of pre-operative suprachoroidal triamcinolone acetonide (SCTA) for achieving reduction/resolution of serous choroidal detachment (CD) associated with rhegmatogenous retinal detachment (RRD).

Methods:

This was a prospective, noncomparative, interventional pilot study. All consecutive patients presenting with RD and coexisting CD underwent transconjunctival injection of SCTA before proceeding with vitrectomy/scleral buckle surgery. Sequential ultrasound B scans were performed for assessing the change in height of the CD.

Results:

The mean age of the cohort was 53.8 ± 10.8 years (range: 39–72 years). The CD was present in a median of 3 quadrants; the cumulative mean CD height was 5.59 mm (range: 2.02–9.42 mm). Following SCTA, a successful response (>50% reduction) was seen in five eyes by day 3 and in two eyes by day 5. Three eyes failed to respond to SCTA and required surgical drainage before proceeding with vitrectomy. No intraprocedural injection-related complications were noted. A transient rise in the intraocular pressure (30 mmHg) was seen in one eye following vitrectomy and was managed successfully with topical antiglaucoma medications

Conclusion:

Suprachoroidal administration of triamcinolone appears to be a safe and effective technique to achieve CD resolution in eyes with RRD.
Combined treatment modality including topical 20% fluorescein dye in the management of phthiriasis palpebrarum – A case series
Authors: Mishra Chitaranjan , Kim Usha , Dheera Mulasthanam S , Krishnakumar Krishin
Published: March 2022

Purpose:

To study the clinical presentations and outcomes of phthiriasis palpebrarum (PP) managed with combined treatment modality comprising of 20% fluorescein dye, mechanical removal of the ectoparasites, and topical application of antibiotic eye ointment with paraffin base.

Methods:

This is a prospective interventional noncomparative hospital-based series of 13 patients of PP. All the patients underwent local application of 20% fluorescein dye over the eyelashes and eyebrows of both the eyes followed by the mechanical removal of all the ectoparasites and trimming of the eyelashes from the base followed by application of ophthalmic ointment.

Results:

Mean age of the patients was 28 ± 22 years (range 3–60 Years). Out of the total of 13 patients, 11 patients (85%) were having bilateral involvement. The mean duration of symptoms in 11 patients (rest 2 were accidental findings) was 4 ± 3 weeks (range 1–10 weeks). Three patients (23%) had a history of sexual contact with possible parasite-infested partners. Four patients (31%) had additional parasites in the pubic area or torso. All the patients were completely parasite free at the end of 1 month. There was no infestation of the treating medical personnel from the patient. The average follow-up was 8 ± 5 months (range 3–21 months)

Conclusion:

Itching and irritation of the eyes were the most common presentations of PP. Combined treatment modality comprising of 20% fluorescein dye, mechanical removal of ectoparasites, and topical application of antibiotic eye ointment with paraffin base is effective in the management of PP.
Diagnostic accuracy and clinical utility of bed side tests versus laboratory tests in the diagnosis of ocular myasthenia
Authors: Sivakumar Priya , Tagare Shivraj , Kumar Mahesh
Published: March 2022

Purpose:

To assess the diagnostic accuracy of forced eyelid closure test (FECT), ice pack test (IPT), repetitive nerve stimulation test (RNS), and acetylcholine receptor (AchR) antibody test in patients with suspected ocular myasthenia. To assess the clinical utility of AchR antibody test in predicting disease progression.

Methods:

Retrospective cohort study of patients diagnosed with ocular myasthenia at a South-Indian neuro-ophthalmology tertiary eye clinic. Baseline characteristics; ocular myasthenia symptoms; results of FECT, IPT, RNS, and AchR antibody test; and progression time to generalized myasthenia (GM) over 36 months from the time of diagnosis were recorded and analyzed using receiver operator curve analysis, multiple logistic regression, and Kaplan–Meier survival analysis.

Results:

FECT had a sensitivity of 96.7% (95% CI: 88.5–99.6) and a specificity of 75% (95% CI: 34.9–96.8). Combination of FECT and IPT, using the positivity of at least one test, increased the sensitivity to 98.3% (95% CI: 91–100), reducing the specificity to 50% (95% CI: 15.7–84.3), whereas using the positivity of both tests, we obtained a sensitivity of 71.7% (95% CI: 58.6–82.5) and a specificity of 100% (95% CI: 63.1–100). In the subset of patients with double negative RNS and AchR antibodies, the positive predictive value of combined FECT and IPT (double positive) was 100%. Patients who developed GM were more likely to have a positive AchR antibody test result (P = 0.001)

Conclusion:

Combined FECT and IPT (double positive) has high diagnostic accuracy even among patients with normal RNS and negative AchR antibodies. Despite low sensitivity, AchR-antibody test has a significant predictive value in disease progression.
Ologen implant versus mitomycin C in combined trabeculectomy and phacoemulsification
Authors: Paul Chandrima , Divya J , Kamal Richa , Paul Anujeet
Published: March 2022

Purpose:

To comparatively evaluate in Indian eyes with coexisting cataract and primary open-angle glaucoma the outcome of mitomycin C (MMC) and Ologen implant as adjunctives in combined phacoemulsification with trabeculectomy.

Methods:

Eyes with primary open-angle glaucoma that underwent trabeculectomy and phacoemulsification with IOL implantation with either MMC application or Ologen implant between June 2019 and February 2020 were followed up for 12 months. Thirty-four eyes of 34 participants were studied. The primary outcome was intraocular pressure (IOP), and the secondary outcomes were the number of ocular hypotensives, best distance visual acuity (BDVA), and bleb morphology.

Results:

In 16 eyes treated with MMC and 18 eyes treated with Ologen implant, it was observed that the mean postoperative IOP (14.62 ± 2.89 mm Hg with MMC and 14.56 ± 4.14 mm Hg with Ologen implant) was not significantly different in both groups (P = 0.47). Number of ocular hypotensives and BDVA were also comparable between the two groups. However, bleb morphology was better with Ologen implantation. One eye in the MMC group developed hypotony which was conservatively managed

Conclusion:

MMC and Ologen are both effective adjunctives in combined phaco-trabeculectomy. However, the Ologen implant provides better bleb health and safety.
Development and validation of an offline deep learning algorithm to detect vitreoretinal abnormalities on ocular ultrasound
Authors: Adithya Venkatesh Krishna , Baskaran Prabu , Aruna S , Mohankumar Arthi , Hubschman Jean Pierre , Shukla Aakriti Garg , Venkatesh Rengaraj
Published: March 2022

Purpose:

We describe our offline deep learning algorithm (DLA) and validation of its diagnostic ability to identify vitreoretinal abnormalities (VRA) on ocular ultrasound (OUS).

Methods:

Enrolled participants underwent OUS. All images were classified as normal or abnormal by two masked vitreoretinal specialists (AS, AM). A data set of 4902 OUS images was collected, and 4740 images of satisfactory quality were used. Of this, 4319 were processed for further training and development of DLA, and 421 images were graded by vitreoretinal specialists (AS and AM) to obtain ground truth. The main outcome measures were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under receiver operating characteristic (AUROC).

Results:

Our algorithm demonstrated high sensitivity and specificity in identifying VRA on OUS ([90.8%; 95% confidence interval (CI): 86.1–94.3%] and [97.1% (95% CI: 93.7–98.9%], respectively). PPV and NPV of the algorithm were also high ([97.0%; 95% CI: 93.7–98.9%] and [90.8%; 95% CI: 86.2–94.3%], respectively). The AUROC was high at 0.939, and the intergrader agreement was nearly perfect with Cohen’s kappa of 0.938. The model demonstrated high sensitivity in predicting vitreous hemorrhage (100%), retinal detachment (97.4%), and choroidal detachment (100%)

Conclusion:

Our offline DLA software demonstrated reliable performance (high sensitivity, specificity, AUROC, PPV, NPV, and intergrader agreement) for predicting VRA on OUS. This might serve as an important tool for the ophthalmic technicians who are involved in community eye screening at rural settings where trained ophthalmologists are not available.
Impact of tear optics on the repeatability of Pentacam AXL wave and iTrace in measuring anterior segment parameters and aberrations
Authors: Kundu Gairik , Shetty Rohit , Khamar Pooja , Gupta Sneha , Mullick Ritika , Ganesan Vaitheeswaran L , D’Souza Sharon
Published: March 2022

Purpose:

To assess impact of tear optics on repeatability of a Scheimpflug device with a Hartmann Shack aberrometer and a ray tracing aberrometer.

Methods:

One hundred healthy and 100 postrefractive surgery eyes underwent dry eye evaluation including Schirmer’s test and tear film break-up time (TBUT). They underwent optical quality analyzer (OQAS, Visio metrics S.L, Terrassa, Spain) to assess objective scatter index (OSI), three scans each on Pentacam AXL wave (OCULUS Optikgerate Gmbh, Wetzlar, Germany), iTrace (Tracey™ Technologies, Texas, USA) for flat, steep keratometry, thinnest corneal thickness, root mean square higher-order aberrations (RMS HOA), RMS lower-order aberrations (LOA), spherical aberrations, RMS COMA. Repeatability of Pentacam AXL wave and iTrace in healthy and postrefractive eyes (OSI >1 vs OSI <1) was studied using within-subject standard deviation (Sw) test–retest repeatability (TRT), coefficient of variation (COV).

Results:

OSI showed an inverse association with TBUT (P < 0.001). All measurements with Pentacam AXL wave with OSI < 1 had excellent repeatability, intraclass correlation coefficient (ICC) ranging from 0.88 for HOA, to 0.92 for LOA. The Sw, TRT, and COV of all aberration measurements were significantly lower (better) than those of iTrace. In eyes with OSI ≥1, the repeatability with Pentacam AXL wave dropped with ICC ranging from 0.77 for HOA, to 0.84 for LOA with lower Sw, TRT, and COV of all aberration measurements as compared to iTrace. Maximum variation was seen with HOA and minimum with LOA

Conclusion:

Tear optics affected repeatability of Pentacam wave and iTrace. Pentacam wave had better repeatability in eyes with a poor tear film as compared to iTrace. Thus, the tear film can impact repeatability of an instrument and it is important to assess the tear film prior to imaging patients, which can change the way we interpret and image these patients.
Comparative study on costs incurred for treatment of patients with bacterial and fungal keratitis - A retrospective analysis
Authors: Radhakrishnan Naveen , Pathak Neha , Raja Subramanian Krishnan , Das Daisy Rani , Ningombam Reagan , Khaitan Isha , Gandhi Neha , Rahul Ramesh , Prajna N Venkatesh
Published: March 2022

Purpose:

To compare the costs associated with medications and travel of patients with smear-proven bacterial keratitis and fungal keratitis in a tertiary care center in India.

Methods:

Retrospective analysis of case records of a cohort of patients who presented between April 2017 and March 2018 to a tertiary care center in India, with infectious keratitis who were smear-positive for bacteria or fungi, and whose costs of treatment and travel were supported by a philanthropic program.

Results:

In total, 672 case records of 177 smear-positive bacterial keratitis (BK) and 495 smear-positive fungal keratitis (FK) were included in the study. Further, 62% of BK and 75% of FK received more than one antimicrobial drug (P < 0.001). The mean total medication cost (INR) was significantly more in FK (959.1 ± 675.2) compared to BK (674.9 ± 463.7) (P < 0.0001). The mean medication cost (INR) per visit was also more for FK (201.1 ± 109.4) compared to BK (155.2 ± 84.1) (P < 0.0001). The mean total medication cost was significantly more for FK for both patients who healed with medical treatment (611.6 ± 395.6 for BK, 801.5 ± 599.9 for FK, P = 0.0005) and for patients who required TPK (953.7 ± 653.1 for BK, 1374.6 ± 701.5 for FK, P = 0.0023) compared to their respective counterparts in BK

Conclusion:

Patients with fungal keratitis incurred significantly more on medications compared to patients with bacterial keratitis irrespective of whether they had healed with successful medical treatment or required therapeutic keratoplasty. Prolonged duration of treatment and the high costs of antifungal medications account for the significant economic burden of fungal keratitis.
Joint pain liniments and gum lotion in the eye - A consecutive case series of mistaken identity
Authors: Jayaprakash Anju Ajitha , Aswin PR , Rathinam SR
Published: March 2022

Purpose:

Patient safety errors can arise due to similarity in packaging of medications. We aimed to describe the clinical features of patients presenting with accidental application of joint pain liniments and gum lotion in the eye due to confusion arising from similarity in packaging.

Methods:

This was a retrospective case series with eight consecutive patients presenting from December 2020 to August 2021 with history of accidental application of joint pain liniments or gum lotion in the eye instead of eye drops. All patients underwent visual acuity assessment and slit-lamp examination with fluorescein staining of the cornea to look for corneal involvement and was reassessed till complete resolution.

Results:

Of the eight patients, three were males and five were females. Seven had accidentally applied joint pain liniment, while one had applied gum lotion into the eye. Five of them had corneal involvement ranging from punctate erosions to near-total epithelial defects. Two patients needed referral to a tertiary center and hospital admission. Treatment duration ranged from 2 days to 1 month. Two patients were lost to follow-up

Conclusion:

This study highlights patient safety errors arising from confusion of medication due to similar labeling and packaging of different drugs. While there was no permanent morbidity, such confusions lead to needless discomfort and waste of time, money, and effort for the patient as well as the health-care system.
Transepithelial phototherapeutic keratectomy for post-traumatic recurrent corneal erosions
Authors: Zhang Riping , Wang Qiang , Li Jinyu , Sun Lixia , Jhanji Vishal , Jiang Jingjing , Zhang Mingzhi
Published: March 2022

Purpose:

To evaluate the outcomes of transepithelial phototherapeutic keratectomy (transepithelial PTK) for treatment of posttraumatic recurrent corneal erosions.

Methods:

Twenty-four eyes of 22 patients with posttraumatic recurrent corneal erosions who were treated with transepithelial PTK from April 2018 to July 2020 were included in this retrospective study. The rates of recurrent erosions and complications were evaluated during the follow-up after surgery. Visual acuity and refraction were recorded preoperatively and 1 year after surgery. Total corneal astigmatism, total corneal irregular astigmatism, and total corneal spherical aberrations were recorded using corneal tomography preoperatively and 1 year after surgery.

Results:

Mean postoperative follow-up was 13 months (range: 12–32 months). None of the patients suffered from any complications or further erosions. Uncorrected distance visual acuity, best-corrected distance visual acuity, spherical equivalent, and cylinder remained stable at 1-year postoperatively compared with the baseline (P = 0.214, P = 0.461, P = 0.084, and P = 0.879, respectively). Moreover, there was no significant difference in total corneal astigmatism, total corneal irregular astigmatism, and total corneal spherical aberrations between baseline and 1-year postoperative visit (P = 0.938, P = 0.136, and P = 0.981, respectively)

Conclusion:

Transepithelial PTK was an effective treatment for patients with posttraumatic recurrent corneal erosions.
Outcomes and favourable prognostic factors in patients of phacomorphic and phacolytic glaucoma managed by manual small-incision cataract surgery: A retrospective study
Authors: Chandrashekharan Shivkumar , Chakrabarty Sabyasachi , Tanwar Meghana , Madhuvarasu Bharadwaja , Uduman Mohammed Sithiq , Ramakrishnan Rengappa
Published: March 2022

Purpose:

To evaluate the outcomes and identify favorable prognostic factors in patients of phacomorphic (PMG) and phacolytic glaucoma (PLG) managed by manual small-incision cataract surgery (MSICS).

Methods:

The medical records of patients with PMG/PLG who had undergone MSICS in a tertiary eye hospital between September 2014 and August 2018 were retrospectively reviewed. Regression analyses were conducted to identify the predictors associated with intraoperative or postoperative complications and a favorable final outcome at 1 month, namely, a best-corrected visual acuity (BCVA) of 6/18 or better and an intraocular pressure (IOP) of <21 mm Hg. P < 0.05 was considered statistically significant.

Results:

The records of 209 patients with PMG and 279 patients with PLG were eligible for the review. The mean preoperative IOP for PMG and PLG were 43.15 ± 12.9 and 40.05 ± 12.0 mm Hg, respectively (P = 0.006). A younger age (<60 years) was associated with a lower risk of severe postoperative inflammation in both PMG and PLG [OR = 0.45 (0.21–0.99); P = 0.047 and OR = 0.44 (0.23–0.83); P = 0.011, respectively]. There was no significant difference in the final mean logMAR BCVA (P = 0.21) and IOP (P = 0.36) in the two groups. The likelihood of a final IOP of <21 mm Hg was significant for symptoms less than a week [OR = 3.52 (1.2–10.2); P = 0.02] in PMG and for absence of vitreous disturbance [OR = 35.0 (3.8–325.7); P = 0.002] in PLG. A BCVA of 6/18 or better was strongly associated with symptoms for less than a week [OR = 1.58 (1.0–2.4); P = 0.043] and absence of vitreous disturbance [OR = 23.53 (5.1–108.0); P < 0.001]

Conclusion:

Early diagnosis and management can translate to good outcomes in PMG and PLG.