bluuebunny/crossref_metadata_2025 huggingface dataset:
Gestion des déchets, recyclage et qualité de l’emploi
Authors: Baguelin Olivier , Beir Jean De , Sourisseau Sylvain
Published: July 2023

La gestion des déchets est centrale dans la transition écologique ; l’étude de ce secteur est donc particulièrement éclairante pour saisir les enjeux de cette transition, notamment en termes d’emploi. Le présent article applique les techniques de la statistique exploratoire aux données sectorielles de l’Insee (Ésane, Alisse) pour mener une analyse comparée, sur la décennie 2010, des diverses activités de gestion des déchets. On considère plus particulièrement deux activités aux implications écologiques opposées : le traitement-élimination (mise en décharge ou incinération, modalité brune) et la récupération-recyclage (modalité verte). En dépit d’interventions publiques favorables à la seconde activité, celle-ci présentait jusqu’en 2015 un emploi de moins bonne qualité. Cela tenait probablement aux économies d’échelle dont bénéficie le traitement-élimination. Elles lui permettaient une productivité du travail et une rémunération du capital supérieures, ces atouts encourageant l’investissement d’opérateurs privés. Sur la décennie 2010, si les deux activités ont en commun un emploi peu dynamique, le traitement-élimination concentre sa masse salariale sur des postes d’ouvriers qualifiés et de techniciens, en lien avec un effort d’équipement visant la production d’énergie. L’analyse met donc au premier plan le rôle de l’investissement dans la qualité de l’emploi.
Quelle professionnalisation dans le réemploi des déchets ?
Authors: Celle Sylvain
Published: July 2023

Les ressourceries sont aujourd’hui des acteurs importants du réemploi des déchets. Étant majoritairement des associations d’insertion par l’activité économique, elles participent aussi au réemploi des personnes (chômeurs, etc.). Dans ce secteur pionnier dans les solutions pour économiser et réemployer les ressources, la précarité du travail et de l’emploi est encore prédominante. Pour y remédier, les ressourceries revendiquent la professionnalisation du travail de réemploi. Cet article s’intéresse à cette professionnalisation à partir d’une étude de cas, les Ateliers de la Bergerette. Cette association a contribué à valoriser le travail de réemploi par son rôle précurseur dans l’invention du modèle de « recyclerie », mais aussi en défendant, en son sein, des emplois durables et l’autogestion du travail.
Exploratory Data Analysis in Python
Authors: Sruthi R. , Anuvarshini G. B. , Sujithra M.
Published: July 2023

Data science is extremely important because of the immense value of data. Python provides extensive library support for data science and analytics, which has functions, tools, and methods to manage and analyze data. Python Libraries are used for exploratory data analysis. Libraries in Python such as Numpy, Pandas, Matplotlib, SciPy, etc. are used for the same. Data visualization's major objective is to make it simpler to spot patterns, trends, and outliers in big data sets. One of the processes in the data science process is data visualization, which asserts that after data has been gathered, processed, and modelled, it must be represented to draw conclusions. As a result, it is crucial to have systems in place for managing and regulating the quality of corporate data, metadata, and data sources. So, this chapter focuses on the libraries used in Python, their properties, functions, how few data structures are related to them, and a detailed explanation about their purpose serving as a better foundation for learning them.
Python's Role in Predicting Type 2 Diabetes Using Insulin DNA Sequence
Authors: Sasidharan Aswathi , Arulkumar N.
Published: July 2023

This chapter examines how Python can assist in predicting type 2 diabetes using insulin DNA sequences, given the substantial problem that biologists face in objectively evaluating diverse biological characteristics of DNA sequences. The chapter highlights Python's various libraries, such as NumPy, Pandas, and Scikit-learn, for data handling, analysis, and machine learning, as well as visualization tools, such as Matplotlib and Seaborn, to help researchers understand the relationship between different DNA sequences and type 2 diabetes. Additionally, Python's ease of integration with other bioinformatics tools, like BLAST, EMBOSS, and ClustalW, can help identify DNA markers that could aid in predicting type 2 diabetes. In addition, the initiative tries to identify unique gene variants of insulin protein that contribute to diabetes prognosis and investigates the risk factors connected with the discovered gene variants. In conclusion, Python's versatility and functionality make it a valuable tool for researchers studying insulin DNA sequences and type 2 diabetes prediction.
Are There Hate Speeches on Spanish Television?
Authors: Costa Sandra Martínez , Cantarero Teresa Nozal , Pérez Antonio Sanjuán , Videla Rodríguez José Juan
Published: July 2023

Few academic studies focus on hate speech on television. That is partly due to the difficulty of obtaining and analyzing broadcast content. However, the spread of those hate messages implies a high reach. For this study, the researchers propose an experimental methodology to analyze the content broadcast on the 24 hours of the five Spanish free-to-air television channels over one year (2020). The authors examined the presence of abusive or hurtful vocabulary and quantified the insults aired. They extracted and studied a sample through content analysis to detect if those insults were accompanied, in any way, by expressions of hatred. Although the messages the researchers studied for this article cannot be considered speeches or hate crimes, there are some offensive comments related to gender, race, or religion, mainly on fictional products.
Hate Speech or Hate Shot?
Authors: Vitullo Alessandra
Published: July 2023

Nowadays, the Muslim community is one of the most discriminated groups in Europe. Anti-Islam hate speeches circulate online and offline especially through the intense use social media, fake news, bots, and click-baiting practices. However even if Muslim discriminatory practices have been gaining more media relevance in the recent years, anti-Muslim stereotypes date back far beyond our times. Using the theoretical frameworks developed by Said and Moscovici this research aims to analyze 31 semi-structured interviews conducted with the volunteers of the Amnesty International's Hate Speech Task Force, to investigate which are the most persistent anti-Muslim representations in Europe and Italy today. In bringing the theory into practice this work will explore the dynamics occurring on Facebook among users which show polarized and intolerant positions while engaging an Islam-related conversation. This specific case study will allow to show how and why old anti-Islam stereotypes persist almost unchanged from an offline to an online world.
Sea level variability at Colombo, Sri Lanka, inferred from the conflation of satellite altimetry and tide gauge measurements
Authors: Prasanna H.M.I. , Gunathilaka M.D.E.  Kanchana , Iz H.B.
Published: July 2023

Accurate long-term measurements of sea level are fundamental to evaluating coastal risks, such as the impact of sea-level rise on near-shore ecosystems, groundwater dynamics, and coastal flooding. This study examines sea-level variability at Colombo, Sri Lanka using satellite altimetry, tide gauge measurements separately and their conflated solution under a single model. Modelling of conflated satellite altimetry and tide gauge measurements shows a geocentric (absolute) local sea-level rise of 3.56 ± 0.32 mm/y without any signature of a uniform acceleration since 1981 at this locality. The measurements disclosed statistically significant periodic changes in sea level of luni-solar origin. The conflated model solution enabled the estimation of a statistically significant in-situ vertical land motion (0.58 ± 0.19 mm/yr) without the aid of global positioning measurements. The conflation model explains 98% of the sea-level variability, which makes it suitable for accurate seal level predictions for coastal risk assessments in Colombo, Sri Lanka.
Predictors of Consumer Creditworthiness: Evidence from Personal Loan Borrowers of a Leading Public Bank in Sri Lanka
Authors: Nadeesha R. P. S. , Madhushani P. W. G
Published: July 2023

Purpose: The motivation of this study is to explore the significant determinants of consumers’ creditworthiness which support the development of a credit scoring model as non-performing loans are a major problem in lending institutions.Design/Methodology/Approach: Data were collected from four branches of a leading Commercial Bank in the Gampaha District under the convenience sampling technique with 130 personal loan borrowers as the study sample.Findings: The logit model test resulted that age, level of education, and monthly income, are positively influencing the creditworthiness of the borrowers. Increasing the number of dependents and the tenure of the loan have more chances of default. 39% to 56% of the dependent variable was explained by the independent variables in the regression model and the model predicted default correctly by 85.4%.Originality: The study contributes to the existing literature in terms of identifying important predictors for developing a credit-scoring model while helping lenders to assess the creditworthiness of personal loan applicants. Hence the study will assist in taking effectual measures to enhance the quality of the credit approval process and ultimately reduce the losses of lending institutions from bad debt.
Banks’ Level Factors Affecting the Effective Implementation of Anti-Money Laundering Practices in Nepalese Banks: An Employee and Customer Perspectives
Authors: Biswakarma G. , Bhusal P.
Published: July 2023

Purpose: Money laundering can affect global macroeconomic projections, currency markets, and financial stability by fueling shadow economies. Thus, the efficiency of the Anti-Money Laundering (AML) procedure must be investigated. Understanding such elements may help prevent money laundering. This necessitates studies to raise awareness and emphasize its importance. This study sought to assess customer understanding and examine the factors that affect the efficient application of AML regulations in Nepalese banks.Design/Methodology/Approach: This study includes responses from 201 bank consumers and 156 bank employees. The study focused on customers' AML awareness and how bank employees implement AML regulations in their respective banks.Findings: According to the study, consumers apprehend money laundering, terrorist financing, and their implications. According to bank employees, customers are unaware of money laundering and its consequences. Banking and financial institutions should prioritize education and awareness to improve the implementation of anti-money laundering regulations. Control over company sophistication, business ethics, customer awareness, and the AML system all have a favorable influence on Nepali banks' AML policies. The analysis reveals that business sophistication control is quite important.Originality: The study focused on consumer and employee AML knowledge, revealing ground-level perspectives. The study found the variables related to the bank's management and compliance department's views on AML policy implementation. This research assists government agencies and policymakers in developing national anti-money laundering measures and aids academics in AML procedure implementation.
Corporate Governance and Corporate Social Responsibility Disclosures: Evidence from the Listed Companies in Sri Lanka
Authors: Sarmila K. , Niresh J. A.
Published: July 2023

Purpose: The primary objective of this study is to investigate the nexus between corporate governance and corporate social responsibility disclosure in Sri Lankan listed firms.Design/Methodology/Approach: Corporate governance was evaluated using the following criteria: board size, board independence, role duality, women representation, audit committee size, and ownership concentration. The Global Reporting Initiative (GRI) methodology was utilized to assess Corporate Social Responsibility Disclosure (CSRD) using content analysis. This study collects balanced panel data from 44 Sri Lankan listed firms over a five-year period, from 2018 to 2022. Because of their highly regulated nature, the banking, finance, insurance, and investment trust industries were omitted from the sample. All of the information was gathered from yearly reports published on the Colombo Stock Exchange's website in Sri Lanka.Findings: Test results suggest that board size, independence, and women representation have no significant relationship with CSRD. Role Duality, Audit Committee Size and Ownership Concentration exhibit a significant association with CSRD. Moreover, the mean value of the CSRD is 44.56 percent for the selected listed companies in Sri Lanka.Originality: This study contributes to determining the extent to which companies have adhered to the GRI as a widely acknowledged disclosure framework. It provides value to the company's management in order for them to make better judgments on whether the firms should involve them in more corporate governance disclosures in order to raise the degree of CSR to enhance transparency and to promote stakeholders' well-being. The outcome also has ramifications for regulatory agencies in developing obligatory reporting requirements for all listed firms to comply with the GRI framework.
The Interaction of Borrelia burgdorferi with Human Dendritic Cells: Functional Implications
Authors: Gutierrez-Hoffmann Maria , Fan Jinshui , O’Meally Robert N , Cole Robert N , Florea Liliana , Antonescu Corina , Talbot C Conover , Tiniakou Eleni , Darrah Erika , Soloski Mark J
Published: July 2023

Dendritic cells bridge the innate and adaptive immune responses by serving as sensors of infection and as the primary APCs responsible for the initiation of the T cell response against invading pathogens. The naive T cell activation requires the following three key signals to be delivered from dendritic cells: engagement of the TCR by peptide Ags bound to MHC molecules (signal 1), engagement of costimulatory molecules on both cell types (signal 2), and expression of polarizing cytokines (signal 3). Initial interactions between Borrelia burgdorferi, the causative agent of Lyme disease, and dendritic cells remain largely unexplored. To address this gap in knowledge, we cultured live B. burgdorferi with monocyte-derived dendritic cells (mo-DCs) from healthy donors to examine the bacterial immunopeptidome associated with HLA-DR. In parallel, we examined changes in the expression of key costimulatory and regulatory molecules as well as profiled the cytokines released by dendritic cells when exposed to live spirochetes. RNA-sequencing studies on B. burgdorferi–pulsed dendritic cells show a unique gene expression signature associated with B. burgdorferi stimulation that differs from stimulation with lipoteichoic acid, a TLR2 agonist. These studies revealed that exposure of mo-DCs to live B. burgdorferi drives the expression of both pro- and anti-inflammatory cytokines as well as immunoregulatory molecules (e.g., PD-L1, IDO1, Tim3). Collectively, these studies indicate that the interaction of live B. burgdorferi with mo-DCs promotes a unique mature DC phenotype that likely impacts the nature of the adaptive T cell response generated in human Lyme disease.
Venous thromboembolism and major bleeding in severe and critical COVID-19 hospitalized patients
Authors: Abate Veronica , Vergatti Anita , Casoria Aniello , Zarrella Aquilino Flavio , Muscariello Riccardo , Nuzzo Vincenzo , Vargas Maria , Servillo Giuseppe , Conca Paolo , D'Elia Lanfranco , Iannuzzo Gabriella , Venetucci Pietro , De Filippo Gianpaolo , Rendina Domenico , Tufano Antonella
Published: July 2023

Venous thromboembolism (VTE) and major bleeding (MB) are life-threatening complications described in COVID-19 hospitalized patients and they can be considered as two sides of the same coin. This retrospective study aims to evaluate the risk factors for VTE and MB in COVID-19 patients admitted to two Italian hospitals. The medical records of all COVID-19 patients (males 139; 62.3%, mean age 67.2±13.6 years, body weight 88.2±20.6 kg) hospitalized from March 11th to July 31st, 2020 to the Federico II University Hospital and to Sea Hospital, Naples, Italy, were analyzed. The COVID-19 patients were classified into four groups: COVID-19 patients developing VTE and/or MB, COVID-19 patients developing only VTE, COVID-19 patients developing only MB, and COVID-19 patients not developing neither VTE nor MB. During the hospitalization, 53 COVID-19 patients (24.7%; males 40; 75.5%, mean age 67.2±13.6 years, weight 88.2±20.6 kg) developed VTE, 33 COVID-19 patients (15.3 %; males 17; 51.5, mean age 67.3±14.9 years, weight 74.1±14.3 kg) developed MB, and 129 COVID-19 patients not developed neither TVP nor MB. No parameters to identify severe COVID-19 complicated by VTE and/or MB were found. However, some clinical and biochemical parameters can be evaluated to predict the risk of MB in order to modify the treatment and take prompt action to reduce mortality.
The real relationship: the Portuguese version of the Real Relationship Inventory-Client form
Authors: Rodrigues Ribeiro Pedro , Dias Neto David
Published: July 2023

The Real Relationship is a relational construct that has influenced other constructs, like the working alliance, although empirically neglected. The development of the Real Relationship Inventory provides a reliable and valid way of measuring the Real Relationship in research and clinical applications. This study aimed to validate and explore the psychometric properties of the Real Relationship Inventory Client Form with a Portuguese adult sample in the context of psychotherapy. The sample includes 373 clients currently in psychotherapy or concluded recently. All clients completed the Real Relationship Inventory (RRI-C) and the Working Alliance Inventory. The confirmatory analysis revealed the same two factors in the RRI-C for the Portuguese adult population, Genuineness and Realism. The observation of the same factor structure suggests the cross-cultural value of the Real Relationship. The measure demonstrated good internal consistency and acceptable adjustment. A significant correlation was found between the RRI-C and the Working Alliance Inventory and significant correlations between the Bond and Genuineness and Realism subscales. The present study reflects on the RRI-C while also contributing to the importance of the Real Relationship in different cultures and clinical contexts.
Factors associated with knowledge of diagnosis, prognosis & distress in cancer patients receiving palliative care – A retrospective cohort analysis
Authors: Deenadayalan Sathish Kumar , Balakrishnan Kalpana , Chidambaram Sundaramoorthy
Published: July 2023

Background & objectives:

Demographic attributes of cancer patients are associated with the awareness of diagnosis, the prognosis of cancer and their associated psychological distress. This study was aimed to assess the knowledge of diagnosis, prognosis and psychological distress among patients reporting to the pain and palliative care department in a tertiary cancer hospital, south India.

Methods:

Data of all patients visiting the palliative care outpatient department of a tertiary cancer centre in south India between January and June 2018 were included in the study (n=754). A structured pro forma was used to collect information on the sociodemographic details and clinical aspects and a distress thermometer was used to assess the level of distress. Information, thus collected, were analysed using descriptive statistics and logistic regression.

Results:

Around 16.2 per cent of the patients were unaware of their diagnosis while two third (68%) were unaware of the prognosis. More than half of the patients reported significant distress (54.1%). Gender, education, not working and being diagnosed with head-and-neck cancers were associated with knowledge of diagnosis, while educational level predicted the knowledge of prognosis. Younger age group, head-and-neck cancer, haematology cancer, state of being unaware of diagnosis and prognosis were found to be associated with distress.

Interpretation & conclusions:

Higher educational levels and better socio-economic status increase the likelihood of patients being aware of their diagnosis and prognosis. Being unaware of the prognosis remains associated with the higher level of distress.
Costs & outcomes of hospitalized scrub typhus infection in a tertiary hospital in south India
Authors: John Kevin John , George Tarun K. , Joy Melvin , John Bimi , Abraham O.C. , Prasad Jasmine
Published: July 2023

Background & objectives:

Scrub typhus is a rickettsial infection seen along the Asian-Pacific rim and imposes a considerable burden on affected people in low- and middle-income countries. The present study was aimed to determine the direct cost of hospitalization of scrub typhus and its trend over six years.

Methods:

This was a retrospective, observational, hospital based study of individuals admitted to the hospital, diagnosed with scrub typhus over six years, from January 2013 to December 2018. The potential out of pocket expenditure was evaluated.

Results:

A total of 198 patients were included in the study. The median cost of admission (adjusted to INR 2020) for the six years (2013 to 2018) was found to be

JOURNAL/ijmer/04.03/02223309-202306000-00010/559FF03/v/2023-09-02T030054Z/r/image-tiff

37,026 (US $ 490) [interquartile range (IQR) 22,996-64,992]. The median cost for patients admitted to the intensive care unit (ICU) was

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128,046 (US $ 1695) (IQR 71,575-201,171), while the cost for patients admitted to the ward-alone was

JOURNAL/ijmer/04.03/02223309-202306000-00010/559FF03/v/2023-09-02T030054Z/r/image-tiff

33,232 (US $ 440) (IQR 19,609-45,373). The multivariable analysis showed that ARDS and SOFA score were the independent predictors of ICU admission.

Interpretation & conclusions:

Hospitalisation for scrub typhus is associated with a substantial healthcare expense. The predictors of increased cost were the presence of acute respiratory distress syndrome (ARDS), shock, increasing sequential organ failure assessment (SOFA) score and duration of hospital stay.
Good anesthetic for good esthetic: Blocks in oculoplasty
Authors: Christy Marem Chionkhumi , Honavar Santosh G , Talloju Shiva Shankar
Published: July 2023

Background:

A good anesthesia not only makes the patient comfortable during surgery, but also has a huge impact on the postoperative recovery. It also makes the operating surgeon carry out each step of the surgery precisely and beautifully. The art of giving a good local anesthesia is to be learnt and practiced not only by anesthetists, but also by the practicing ophthalmologists.

Purpose:

This video gives an overview of anatomy in terms of the nerve supply of the orbit, the surface marking, and the techniques of giving regional and nerve blocks.

Synopsis:

In this video, we describe the anatomy, the surface marking, the technique of regional anesthesia including peribulbar, retrobulbar, and subtenon blocks and of nerve blocks, specifically of facial, frontal nerve and its branches, infraorbital, nasociliary, infratrochlear, and dorsal nasal nerves, with their application in ocular plastic surgery.

Highlights:

This video highlights the essence of providing appropriate and good anesthesia so that the surgeon works in an optimal field with maximum comfort to the patients.

Video link:
https://youtu.be/h8EgTMQAsyE

Key words: Blocks, oculoplasty, anaesthesia
Pigmented lesions of the conjunctiva: The sheep and the wolf
Authors: Christy Marem C , Honavar Santosh G , Mulay Kaustubh , Talloju Shiva Shankar
Published: July 2023

Background:

Pigmented lesions in the conjunctiva can be baffling to both the patients and the treating ophthalmologist because of their varied range of presentation and overlapping clinical features. The lesions range from incidental pigment deposition such as mascara and complexion-associated melanosis to malignant melanoma which poses a risk to life. Similarly, the management ranges from observation at regular intervals to aggressive surgery like exenteration.

Purpose:

We wanted to present a crisp and precise video of the good, bad, and ugly pigmented lesions of the conjunctiva, highlighting their specific clinical features important for the diagnosis and their management.

Synopsis:

This video describes the myriad of pigmented conjunctival lesions, their diagnostic characteristics, and management based on oncological principles.

Link:

https://drive.google.com/file/d/1BYJ51rQtqjwM6e73BwrrLqdC1EoXA8Eu/view?usp=sharing.

Highlights:

Pigmented lesions can have variable presentation and close mimics, therefore, it is important to differentiate and identify the lesions accurately. This video highlights different pigmented lesions and their individual characteristic features.

Video link:
https://youtu.be/m9tt7dx9SWc

Key words: Conjunctiva, melanosis, nevus
Mean rate of progression of visual fields in patients with primary open-angle glaucoma and ocular hypertension attending a tertiary care center in South India – A prospective cohort study using FORUM® Glaucoma Workplace software
Authors: Smithin S S , Manju M , Chandran Premanand , Dhavalikar Mrunali , Menaka S V , Balagiri K , Venkataraman Ganesh
Published: July 2023

Purpose:

To find out the mean rate of progression (MROP) of visual fields (VF) in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) using FORUM® Glaucoma Workplace.

Methods:

Two hundred and one eyes of 105 patients were included in this prospective cohort study. Patients with POAG and OHT were recruited, and VF analysis with 24-2 and or 10-2 was done using SITA standard strategy in Zeiss Humphrey Visual Field Analyzer (HFA). All the previous VFs were identified from FORUM software, and the baseline indices were recorded from the first reliable VF analysis. The present VF analysis was compared to the previous one using FORUM software, and the rate of progression (ROP) in VF was obtained by Guided Progression Analysis.

Results:

MROP of VF in the POAG group was − 0.085 dB/year, ranging from −2.8 to 2.8 dB/year with a standard deviation (SD) of 0.69. In the OHT group, the MROP of VF was −0.003 dB/year, ranging from − 0.8 to 0.5 dB/year with an SD of 0.27. The MROP of VF in medically treated eyes with POAG was −0.14 dB/year with an SD of 0.61 and in surgically treated eyes was −0.02 dB/year with an SD of 0.78. The overall baseline mean VF index (VFI) was 83.19% and the final mean VFI was 79.80%. There was a statistically significant decrease in the mean VFI value from baseline to the final visit (P-value 0.0005).

Conclusion:

The mean ROP of VF in the POAG group was −0.085 dB/year and in the OHT group was − 0.003 dB/year.
Role of hyaluronidase as an adjuvant in local anesthesia for cataract surgery
Authors: Mohankumar Arthi , Rajan Mohan
Published: July 2023

Cataract surgery ranks among the commonest procedures performed worldwide. Approximately 51% of blindness worldwide is related to cataracts, affecting about 65.2 million people worldwide and more so in developing countries. Over the years, there has been a significant evolution in the surgical techniques of cataract extraction. The advancement in phacoemulsification machines, phaco-tips, and the availability of ophthalmic viscoelastic devices have played a substantial role in cataract surgery such that they are faster and more controlled than before. Similarly, anesthetic techniques in cataract surgery have advanced significantly from retrobulbar, peribulbar, and sub-Tenon’s blocks to topical anesthesia. Though topical anesthesia eliminates the possible complications of injectable anesthesia, it is not suitable for use in uncooperative, anxious patients, pediatric age groups, and patients with cognitive disabilities. Hyaluronidase is an enzyme that breaks down hyaluronic acid in the retrobulbar tissue, facilitating uniform diffusion of the anesthetic drug and hastening the onset of anesthesia and akinesia. Hyaluronidase has been used in the last 80 years successfully as an adjuvant in retrobulbar, peribulbar, and sub-Tenon’s blocks. Initially, the hyaluronidase enzyme was animal-derived and of bovine and ovine sources. Recombinant human-derived hyaluronidase, which has lesser allergic reactions, impurities, and toxicity, is now available. There is conflicting evidence regarding the efficacy of hyaluronidase as an adjuvant in retrobulbar and peribulbar blocks. This article summarizes a brief review of the literature on the role of hyaluronidase as an adjuvant in local anesthetic blocks in ophthalmic surgeries.
Concomitant paracentral acute middle maculopathy and acute macular neuroretinopathy in eyes post-blunt trauma
Authors: Goel Nikita , D’ Souza Zubin , Tripathi Abhishek , Dey Amrita , Sen Ahana , Majumdar Bristi , Thounaojam Sanatombi , Roy Rupak , Saurabh Kumar
Published: July 2023

Purpose:

To analyze the imaging characteristics and the clinical course of patients showing concomitant paracentral acute middle maculopathy (PAMM) and acute macular neuroretinopathy (AMN) post-blunt trauma.

Methods:

PAMM and AMN lesions post-blunt trauma diagnosed on enhanced depth imaging optical coherence tomography (EDI-OCT) were recruited for the study.

Results:

Thirteen eyes of 13 individuals with a history of blunt trauma were included in the study, of whom 11 (85%) were males. Mean age of the patients was 33.62 (range 16–67) years. Mean visual acuity at presentation and the last visit was 1.67 log of minimum angle of resolution (logMAR) and 0.82 logMAR, respectively. Mean interval between trauma and imaging was 5.08 (range 1–15) days. All patients had unilateral involvement, with the right eye being involved in 10 patients (77%). All patients had concomitant PAMM and AMN lesions.

Conclusion:

Presence of coincident PAMM and AMN suggests a common pathophysiologic etiology, but the description of concomitant PAMM and AMN in the setting of blunt trauma to eye is hitherto unreported. Identifying AMN in a setting of PAMM requires meticulous examination of the OCT and OCTA images. It can be a cause of suboptimal visual recovery in such eyes.
Social-emotional issues among children with strabismus higher than among non-strabismus children in Western India
Authors: Prem Kumar SG , Ranpise Dhanaji , Vishwakarma Pankaj , Gend Pravin B , Chavan Shobhana , Kurian Elizabeth
Published: July 2023

Purpose:

Data on social-emotional aspects among children with strabismus in India are scanty. We compared the emotional symptoms (ES), loneliness and social dissatisfaction (LSD), and self-esteem (SE) and their associated risk factors among children with and without strabismus in India.

Methods:

A cross-sectional case–control study design was used to recruit 101 children with strabismus aged 8 to 18 years and a control group of 101 children that were age- and gender-matched. Interviews were performed using standardized scales to assess ES, LSD, and SE. Variations in the intensity of ES, LSD, and SE were assessed using multiple classification analysis (MCA).

Results:

A total of 202 children participated in the study. The mean ES, LSD, and SE scores were 3.4 (standard deviation [SD] 1.9), 48.4 (SD 3.2), and 22.1 (SD 3.8) for the strabismus group and 1.8 (SD 1.5), 33.3 (SD 3), and 31.3 (SD 2) for the non-strabismus group, respectively. Among the strabismus group, the highest levels of mean ES, LSD, and SE scores were observed among children facing problems in performing daily tasks. Amongst the non-strabismus group, children studying at the primary level and those facing neglect had the highest mean scores. In MCA, being affected with strabismus had the highest effect on the intensity of ES, LSD, and SE with a beta (b) value of 0.223 (P = 0.016), 0.922 (P < 0.001), and 0.853 (P < 0.001).

Conclusion:

A significantly high proportion of children with strabismus deal with elevated levels of ES, LSD problems, and low SE as compared with non-strabismus children, highlighting the need to address the poor social-emotional health of children.
Glauco-Claw: A novice implant for chronic angle-closure glaucoma
Authors: Singh Kiranjit , Singh Sukarma , Singh Kunwar Kiranjit , Vashist Urvish , Kaur Harmit , Jain Neha , Mittal Vikas
Published: July 2023

This article describes 1-year outcomes of a new intra-ocular implant, “Glauco-Claw,” in refractory chronic angle-closure glaucoma (ACG). Glauco-Claw is a novice polymethylmethacrylate implant with a central ring and five claws placed circumferentially. It was placed in the anterior chamber and the peripheral iris was tucked into the claws, thus causing goniosynechialysis and preventing the reformation of goniosynechiae. It was implanted in five eyes of five patients, and they were followed up for 1 year. Target intra-ocular pressure was achieved and maintained in all the patients till the last follow-up. Two patients did not require any anti-glaucoma medication. No significant complications were observed in any patient. Glauco-Claw could be another armamentarium in the management of refractory chronic ACG.
Optic nerve sheath fenestration: A second lease at sight
Authors: Sharma Mukesh , Chhabra Aishwarya , Raina Nupur
Published: July 2023

Purpose:

To study the safety and efficacy of optic nerve sheath fenestration surgery in patients with optic disc edema due to different etiologies.

Methods:

Records of 18 eyes of 15 patients who underwent optic nerve sheath fenestration for vision threatening optic disc edema were reviewed retrospectively, and results were analyzed. Improvement of visual acuity was the main measure of outcome. Improved visual fields, resolution of optic disc edema, diplopia, and headache were other benefits that were observed.

Results:

Fifteen patients between 13 and 54 years of age were included in the study. Three patients underwent successive bilateral surgery. Idiopathic intracranial hypertension was the most common cause for optic disc edema and was found in 80% of the patients. Mean preoperative logMAR acuity was -1.9789 ± 1.46270, which improved to -0.9022 ± 1.23181 (p < 0.005) in the operated eye, and mean logMAR acuity of contralateral eye improved from -1.3378 ± 1.50107 to -1.0667 ± 1.33813 (p < 0.05).

Conclusion:

Early optic nerve sheath fenestration is an effective modality for treating optic disc edema due to a wide myriad of causes and helps resolve the associated symptoms.
Retinoblastoma: A review of the molecular basis of tumor development and its clinical correlation in shaping future targeted treatment strategies
Authors: Rathore Shruti , Verma Aman , Ratna Ria , Marwa Navjot , Ghiya Yagya , Honavar Santosh G , Tiwari Anil , Das Sima , Varshney Akhil
Published: July 2023

Retinoblastoma is a retinal cancer that affects children and is the most prevalent intraocular tumor worldwide. Despite tremendous breakthroughs in our understanding of the fundamental mechanisms that regulate progression of retinoblastoma, the development of targeted therapeutics for retinoblastoma has lagged. Our review highlights the current developments in the genetic, epigenetic, transcriptomic, and proteomic landscapes of retinoblastoma. We also discuss their clinical relevance and potential implications for future therapeutic development, with the aim to create a frontline multimodal therapy for retinoblastoma.
“Pinch and Stretch” technique to overcome ocular hypotony during scleral suturing of recti muscles
Authors: Pujari Amar , Yadav Bhupender , Modaboyina Sujeeth
Published: July 2023

During extraocular muscle surgery, an uneventful scleral suture pass is very essential. In presence of normal intraocular tension, the surgery is quite predictable and safe. However, in the presence of significant hypotony, it becomes challenging. Therefore, to mitigate complication rate in these cases, we have adopted a simple technique, that is, the “pinch and stretch” technique. The surgical steps of this technique are as follows: In eyes with significant ocular hypotony, the surgery is initiated with a routine forniceal/limbal peritomy, following which the muscle is sutured and dis-inserted. Using three tissue fixation forceps, the scleral surface is stabilized. Using first forceps, the surgeon rotates the globe toward themself from the muscle stump, and with the remaining two forceps, the assistant pinches and stretches the episcleral tissue in an outward and upward direction just beneath the intended marks. This creates a flat scleral surface with significant firmness. Sutures are passed over this rigid sclera and the surgery is completed without any complications.
Accuracy of trained technicians in screening orbital and adnexal diseases at rural vision centers in South India
Authors: Velu Maneksha , Aparna K S , Shetty Kavya
Published: July 2023

Purpose:

To assess the agreement between the diagnosis made by trained technicians at vision centers (VC) and oculoplasty specialists at the base hospital, in patients referred from VC to the orbit and oculoplasty clinic of a tertiary eye care hospital in south India.

Methods:

This was a retrospective study that compared the findings of VC technicians and the specialists of the orbit and oculoplasty services in a base hospital. A total of 384 patients referred from 17 VCs between May 2021 and May 2022 were included. The diseases were categorized according to the site of involvement as diseases of the eyelids (43%), diseases of the lacrimal system (37.3%), orbital diseases (15.6), and others (4.1%). The mean age of the patients was 35.9 years and 50.6% were females. Medical records of all referred patients who attended the orbit clinic were analyzed.

Results:

Of the 384 patients, 378 (98.67%) were confirmed to have orbital and adnexal diseases. There was an overall 80% agreement between the diagnosis made by trained VC technicians and oculoplasty specialists; the kappa coefficient was 0.78 (95% confidence interval [CI]: 0.76 to 0.80), with a P value < 0.001. The agreement was the highest for diseases of the lacrimal system (90.9%, kappa coefficient 0.87), followed by eyelid pathologies (80%, kappa coefficient: 0.77). Of these, 54.8% of patients were managed with surgical procedures.

Conclusion:

There is good agreement between the findings of VC technicians and oculoplasty specialists. Trained technicians can help in the early detection and referral to higher centers. They also help to make sure adherence to treatment and periodic evaluation, especially in resource-constraint settings.
Bacterial orbital cellulitis – A review
Authors: Yadalla Dayakar , Jayagayathri Rajagopalan , Padmanaban Karthikeyan , Ramasamy Rajkumar , Rammohan Ram , Nisar Sonam Poonam , Rangarajan Viji , Menon Vikas
Published: July 2023

Infections of orbit and periorbita are frequent, leading to significant morbidity. Orbital cellulitis is more common in children and young adults. At any age, infection from the neighboring ethmoid sinuses is a likely cause and is thought to result from anatomical characteristics like thin medial wall, lack of lymphatics, orbital foramina, and septic thrombophlebitis of the valveless veins between the two. Other causes are trauma, orbital foreign bodies, preexisting dental infections, dental procedures, maxillofacial surgeries, Open Reduction and Internal Fixation (ORIF), and retinal buckling procedures. The septum is a natural barrier to the passage of microorganisms. Orbital infections are caused by Gram-positive, Gram-negative organisms and anaerobes in adults and in children, usually by Staphylococcus aureus or Streptococcus species. Individuals older than 15 years of age are more likely to harbor polymicrobial infections. Signs include diffuse lid edema with or without erythema, chemosis, proptosis, and ophthalmoplegia. It is an ocular emergency requiring admission, intravenous antibiotics, and sometimes surgical intervention. Computed tomography (CT) and magnetic resonance imaging (MRI) are the main modalities to identify the extent, route of spread from adjacent structures, and poor response to intravenous antibiotics and to confirm the presence of complications. If orbital cellulitis is secondary to sinus infection, drainage of pus and establishment of ventilation to the sinus are imperative. Loss of vision can occur due to orbital abscess, cavernous sinus thrombosis, optic neuritis, central retinal artery occlusion, and exposure keratopathy, and possible systemic sequelae include meningitis, intracranial abscess, osteomyelitis, and death. The article was written by authors after a thorough literature search in the PubMed-indexed journals.
Epidemic retinitis during the COVID-19 pandemic
Authors: Kawali Ankush , Srinivasan Sanjay , Mishra Sai Bhakti , Mahendradas Padmamalini , Shetty Bhujang
Published: July 2023

Purpose:

To study the impact of the novel coronavirus disease-2019 (COVID-19) pandemic on incidence, seasonal variation, clinical presentation, and disease outcome of epidemic retinitis (ER) and to compare clinical outcomes with positive and negative COVID-19 serology.

Methods:

This is a retrospective, observational study conducted at a tertiary eye care hospital from August 2020 to June 2022. A graph of ER cases against the month of presentation was compared with the graph of the COVID-19 pandemic in the same region. Cases presented before COVID-19 vaccination, with positive COVID-19 serology (Group 1) were compared with cases with negative serology (Group 2).

Results:

One hundred and thirty-two cases of ER were seen. The least number of cases were seen during and immediately after the peak of the pandemic (May 2021–August 2021). COVID-19 serology was positive in 13 (22 eyes)/60 (21.6%) unvaccinated cases. Along with COVID-19, positive serology for other ER etiologies was seen in 5/13 cases (38.4%). All patients received oral doxycycline with/without steroids. Groups 1 and 2 included 22 and 21 eyes of 13 cases each. Macular edema resolved in 43.6 and 32 days in groups 1 and 2, respectively. Retinitis resolved at 1 month in both groups. Corrected distant visual acuity was 20/50 and 20/70 at the presentation, which improved to 20/20 and 20/25 in groups 1 and 2, respectively. Mean and median follow-up was 6 months and 4.5 months, respectively, in both groups. No complications or recurrences were seen.

Conclusion:

No significant impact of the COVID-19 pandemic on ER was observed.
Pharmacological management of intra-operative miosis during cataract surgery
Authors: Kaur Savleen , Kumari Kiran , Gupta Parul Chawla , Sukhija Jaspreet
Published: July 2023

Cataract surgery requires a well-dilated and stable pupil for a good outcome. Unexpected pupillary constriction during surgery increases the risk of complication. This problem is more pronounced in children. There are now pharmacological interventions that help tackle this unforeseen happening. Our review discusses the simple and quick options available to a cataract surgeon when faced with this dilemma. As cataract surgical techniques continue to improvise and get faster, an adequate pupil size is of paramount importance. Various topical and intra-cameral drugs are used in combination to achieve mydriasis. Despite good pre-operative dilation, the pupil can be quite unpredictable during surgery. Intra-operative miosis limits the field of surgery and increases the risk of complications. For example, if the pupil size decreases from 7 mm to 6 mm, this 1 mm change in pupil diameter will lead to a decrease of 10.2 mm2 in the area of surgical field. Making a good capsulorhexis with a small pupil can be a challenge, even for an experienced surgeon. Repeated touching of the iris increases the risk of fibrinous complications. Removal of cataract and the cortical matter becomes increasingly difficult. Intra-ocular lens implantation in the bag also requires adequate dilation. When dealing with challenging cases like lens subluxation, pseudo-exfoliation, and zonular dehiscence, a small pupil further increases the risk and adversely affects the surgical outcome. Hence, achieving and maintaining adequate mydriasis throughout surgery is essential. This review highlights the risk factors for small pupils during surgery and current management strategies.
Prevention and management of childhood progressive myopia: National consensus guidelines
Authors: Saxena Rohit , Dhiman Rebika , Gupta Vinay , Phuljhele Swati , Mahajan Asmita , Rakheja Vaishali , Swaminathan Meenakshi , Jethani Jitendra , Kesarwani Siddharth , Kekunnaya Ramesh , Sukhija Jaspreet , Bhave Shubhangi , Sharma Pradeep , Sinha Rajesh , Verma Lalit , Sharma Namrata ,   Childhood Progressive Myopia Expert Group
Published: July 2023

Myopia is a major public health problem worldwide, including India, with the global prevalence of myopia increasing rapidly over decades. The clinical and socioeconomic impact of myopia is also expected to rise with rising prevalence. Therefore, the focus has now been shifted to prevent the incidence and progression of myopia. However, there is lack of any standardized guidelines for myopia management. This document aims to generate a national-level expert consensus statement on the management of childhood myopia in the Indian scenario. The expert panel of pediatric ophthalmologists consisted of 63 members who met in a hybrid meeting. A list of topics deliberating discussion in the meeting was provided to the experts in advance and they were instructed to provide their opinions on the matter during the meet. The panel of experts then gave their views on each of the items presented, deliberated on different aspects of childhood myopia, and reached a consensus regarding the practice patterns in the Indian scenario. In case of opposing views or lack of a clear consensus, we undertook further discussion and evaluated literature to help arrive at a consensus. A written document is prepared based on recommendations explaining definition of myopia, refraction techniques, components and methods of workup, initiation of anti-myopia treatment, type and timing of interventions, follow-up schedule, and indications for revised or combination treatment. This article formulates evidence-based guidelines for progressing myopes and pre-myopes and also establishes uniformity in the management of childhood myopia in the country.
Role of ripasudil as an adjunct treatment in the management of pseudoexfoliative glaucoma
Authors: Mohapatra Sumita , Thakur Subhodeep , Panda Bijnya B , Das Priti
Published: July 2023

Purpose:

Ripasudil is a class of drug which alters the trabecular meshwork to increase the aqueous outflow and has been shown to be effective in pseudoexfoliative glaucoma (PXF G). This study aimed at assessing the efficacy and safety profile of ripasudil as an adjunct treatment in patients with PXF G at maximal tolerated antiglaucoma medications.

Methods:

In this prospective, interventional study, 40 patients with PXF G were enrolled between May 2021 and Jan 2022. Ripasudil 0.4% was started as an adjunctive drug to the ongoing antiglaucoma medications. On follow-up visits at 1, 3, and 6 months, the visual acuity, intraocular pressure (IOP), anterior segment, and fundus findings were evaluated. The premedication and postmedication IOP values were compared by paired t-test, and a P-value <0.05 was considered statistically significant.

Results:

Average age at recruitment was 60.02 ± 8.74 years. Baseline premedication IOP was 25.375 ± 3.276 mmHg. IOP reduction at 6 months was found to be statistically significant in all patients, with the maximal response being 24.13%. Also, 87.5% (35/40) of patients reached target IOP or even lower IOP at the end of study. There was no statistically significant association between the PXF grade and IOP. However, the grade of inferior iridocorneal angle pigmentation was found to be higher in eyes with elevated IOP (P < 0.05). Only three patients developed conjunctival hyperemia as an adverse reaction, which was mild and transient.

Conclusion:

Ripasudil showed additional IOP-lowering effect with other antiglaucoma medications and exhibited no significant side effects.