bluuebunny/crossref_metadata_2025 huggingface dataset:
Perspectives on Inclusion in Early Childhood
Authors: Schofield Lindsay Michelle , Takriti Rachel , Pearson Emma
Published: July 2022

Traditionally, early childhood education and special education needs policy developments have held a low status in national and international political agendas. However, over the recent decade, there has been an intense surge of political interest at international and national levels. This surge has resulted in an unprecedented number of educational policy reforms, policy documents, and opportunities for practice to develop and respond to these changes. Due to the considerable international interest in early childhood, paralleled with similar international interest in inclusive policies, this chapter aims to examine the way early childhood care and education (ECCE), early childhood education and care (ECEC), and/or early childhood education (ECE) policy shapes the attitudes and actions of those working with babies and young children. The chapter will open by introducing early childhood provision in the international context before moving to inclusion, defining inclusion, assumptions, attitudes, perceptions, and including children.
Rethinking Inclusion of Gifted and Twice-Exceptional Children
Authors: Bonti Eleni , Sofologi Maria
Published: July 2022

In the chapter, the complex nature of giftedness and twice-exceptionality is being addressed, with the emphasis given on the challenges these two conditions pose upon the whole age spectrum of these individuals (i.e., from childhood to adolescence and adulthood). More precisely, as the literature suggests, these children often demonstrate socioemotional difficulties or challenging behaviours in classroom settings. Hence, the emphasis in the current chapter is given to several intervention strategies that teachers might utilize for effectively dealing with challenging behaviours of gifted and twice-exceptional children with specific reference to the school environment.
Recommended Interventions for the Promotion of Language Development for Children With Learning Difficulties
Authors: Argyriadi Agathi , Argyriadis Alexandros
Published: July 2022

This chapter describes the influence of an innovative type of activities called “aesthetic flow activities” in enhancing the holistic functionality οf first graders in the five domains of language—phonology, morphology, syntax, semantics, pragmatics—as well as in attention processes along with enhancing motivational responses. The sample consisted of 98 children aged 6-7 years with learning difficulties and disabilities. Participants were divided into experimental groups taking part in 30 experiential “aesthetic psychological flow activities” and control groups who received a traditional approach. Data were obtained from a pre-test/post-test design, participant observation, and interviews with children and their teachers. Pre- and post-intervention measures suggest that the children of the experimental groups demonstrated higher scores in language post-tests and greater engagement in the learning process. Τhe chapter highlights ways for educators to support language and literacy skills development of all children, whether they belong to a vulnerable group or not.
Role and Responsibility of Effective Educational Leadership in Transforming Inclusive Education
Authors: Dar Mohammad Amin , Mir Mohammad Ishfaq , Aziz Shaheena
Published: July 2022

Educational leadership is an important component that attempts to improve education at all levels because it engages, encourages, and integrates with all stakeholders, including students, parents, and educators. Effective educational leadership has a significant impact on inclusive educational practices as it strongly contributes to student performance both inside and outside of the institution. The formulation of effective collaboration and the implementation of tailored educational programmes in an inclusive framework are indeed the primary concerns of effective educational leadership. This chapter presents evidence from the existing literature that focuses on educational leaders' role and responsibility in promoting and implementing inclusive practices, educational leaders as change agents for inclusive education, transformational leadership and inclusive education, and finally, the initiatives and actions taken by educational leaders in transforming inclusive education.
Inclusive Strategies and Screening of Autism Spectrum Disorder (ASD) in the Gulf Cooperation Council (GCC) Countries
Authors: AlQahtani Omniah
Published: July 2022

Children face different potential problems during their development that may concern their parents. The parents usually want to emphasize whether their child is growing normally. An early childhood assessment can help indicate the child's strengths and weaknesses, which helps to answer parents in indicating their child's development. This early assessment is significant in determining the child's need for support and early intervention at an early age. Autism spectrum disorder (ASD) shows a high record prevalence in GCC countries ranging from 1.4 to 29 per 10,000 persons, representing a significant health concern. This chapter aims to provide an overview of autism states in the GCC Arab region, focusing on ASD cases, the barriers to early diagnosis, and the screening instruments.
Accepting Diversity Before Fighting for Inclusion
Authors: Argyriadis Alexandros , Efstratopoulou Maria , Argyriadi Agathi
Published: July 2022

Announcing the diagnosis of a disability constitutes a psycho-traumatic experience for parents. At the stage of diagnosis, the family experiences emotions that range from surprise and doubt to awareness of the situation. This chapter presents the case study of a family that receives the announcement of the diagnosis of their child with autism, which is automatically placed in the spectrum of diversity. At this point, it is worth noting that the social approach of disability places the individual in the context of the diversity so, adopting the above rationale, this chapter presents the diagnosis process in detail, the events as narrated by the parents but also the feelings that the parents had at that time. The results of this study demonstrated issues related to family stress levels, quality of life, the couple relationships, and a number of needs that arose.
Time-Series Models for Crime Prediction in India
Authors: Gupta Sonali
Published: July 2022

The dark web is termed as the concealed content hidden behind interfaces offering secure chats or mailing applications on the WWW, and exploiting it for illegal practices is termed cybercrimes. As the dark web is enormously big compared to the surface web, cyber-crimes have become one of the biggest challenges to tackle. Predicting them before they actually happen is almost impossible. The work thus deals with predicting the number of cognizable crimes (physical and cybercrimes reported collectively) by National Crime Record Bureau (NCRB), the government-approved agency for maintaining crime records in India. Predicting crimes has become important as they advance to new levels of intelligence and diversification with the increased use of information and communication technology (ICT). This work presents the research based on evidences with ARIMA and LSTM time series models for predicting the cognizable crimes in India. The authors have used root mean squared error and mean absolute error as loss functions for error evaluation, and the results obtained from both the models are presented.
Variational Autoencoder for IoT Botnet Detection
Authors: C. U. Om Kumar , Pranavi Dharmala , Laxmi B. R. Aishwarayaa , R. Devasena
Published: July 2022

IoT devices are naturally vulnerable to security issues such as botnet attacks that lead to compromised data. Due to the proliferation of network traffic, the existing system demonstrated a mean FPR of 0.007±0.01, but it needs to be updated to be on par with swiftly growing bots. In the proposed system, the authors have deployed various autoencoders for the detection of IoT botnets. This proposed system helps to differentiate malicious attacks from benign ones. To validate the proposed method, they have used NbaIoT dataset infected with the two most widely known IoT-based botnets: Mirai and Gafgyt. The autoencoders are trained using the optimization dataset generated by various smart devices, and when tested, they achieved formidable accuracy for various autoencoders: 96.158% for sparse autoencoder, 86.775% for deep Autoencoder, 96.157% for variational autoencoder, 96.156% for under complete autoencoder, and 79.789% for denoising autoencoder. Compared to many other state-of-the-art botnet detection methods, variational autoencoder has achieved better accuracy with lower false predictions.
Cyber Security for IoT-Enabled Industry 4.0
Authors: Chauhan Deepika , Singh Chaitanya , Kudande Dyaneshwar , Hu Yu-Chen
Published: July 2022

The dark web is a portion of the deep web that's hidden away from the ordinary user. It contains various tools and techniques that cyber criminals can use to carry out their attacks. The increasing popularity of the internet of things has raised the concerns of various security organizations regarding the security of the systems connected to it. The rapid emergence and success of internet of things devices and their associated services have raised the number of attacks against these devices and services to the alarming level. The need to secure this rapidly changing industry has become a top priority in the cyber defense industry. This chapter aims to provide a comprehensive view of the various threats and attacks targeting the infrastructure of the IoT and to analyze the various cyber defense techniques and solutions that are being used to secure the connected objects.
Artifical Intelligence and Machine Learning Algorithms in Dark Web Crime Recognition
Authors: Gawali Neha Nitin , Bendale Shailesh
Published: July 2022

Even with the dark web (DW) being accessible only through special software, global law enforcement agencies are considering it a major problem. The fact that activities happening on DW are completely untraceable has become the main point of attraction for the perpetrators. Also, in certain years, there has been improvement and advancement in the artificial intelligence (AI) as well as machine learning (ML) fields. Therefore, digital security based on AI is of immense benefit for the security industry. Thus, in response to the increasing use of AI and ML technologies, actions were taken against DW crimes, and applications for crime recognition were developed. This chapter is an attempt to discuss and showcase all the different aspects of applications of AI and ML in DW crime recognition. The author sheds light on the enormous benefits of these applications to the security industry as well as the investigators. Considering AI and ML work as double-edged swords in the cyber world, the author also mentions the importance for investigators to understand and practice them carefully.
Systematic Approach for Detection and Assessment of Dark Web Threat Evolution
Authors: William P. , Jawale M. A. , Pawar A. B. , Bibave Rahul R. , Narode Priyanka
Published: July 2022

Cyber thieves and terrorists use the dark web as one of the most difficult channels to achieve their nefarious goals. There are many similarities between cyber-crimes and real-world crimes taking place on the dark web. However, the dark web's sheer breadth and anonymity are key to tracing the offenders. The first step in finding effective solutions to cybercrime is to assess the different dark web criminal hazards. The investigation of the dark web includes a review of crimes to minimize crime issues. To assist cyber security specialists, the authors used the systematic literature review approach and extracted data from 65 publications from the most relevant internet resources to meet research aims. As a result of an exhaustive investigation, systematic literature review is able to provide a clear picture of how criminal activity on the dark web is expanding and examine the strengths and weaknesses of existing methods for tracking down criminals. This study has showed, to aid law enforcement in the apprehension of criminals, digital evidence must be analyzed as per established standards.
A Contemporary Research on Learners' Expectations
Authors: Luarn Pin , Jhan Ya-Cing , Lin Hong-Wen
Published: July 2022

The study has chosen perhaps the most well-known serious game in the field of supply chain management: The Beer Game and using the means-end chains theory in an attempt to explore the innovative attributes that learners may wish to experience while playing. The study will also construct the psychological hierarchical structure of “innovative attribute – anticipated learning consequences – terminal value” so as to boost the assistive benefits of the Beer Game as an educational tool. Findings of the study revealed that the learners were expecting to attain the major paths including “Include 3D dynamic images - Increase fun of playing - Fun and enjoyment of life”, “Configure limited time rounds - Improve time management - Excitement”, “Include dialogue box - Facilitate effective decision-making - Sense of accomplishment”, “Include key events and Include teaching feedback - Train independent thinking - Sense of accomplishment” from the Beer Game.
Moving Target Detection Strategy Using the Deep Learning Framework and Radar Signatures
Authors: M. Bharat Kumar.  , P. Rajesh Kumar
Published: July 2022

This paper presents deep RNN based FBF approach for the detection of moving target using the radar signatures. The FBF method is developed by the integration of fuzzy concept in the Bayesian fusion method. The FBF combines the results from the deep RNN, STFT, Fourier transform and matching filter to generate the final detection output from the received radar signal. The radar signatures are given as the input to the deep RNN for the detection of the target. Finally, the FBF combines the results from the deep RNN, STFT, Fourier transform and the matched filter to obtain the final decision regarding the detected target. The performance of the proposed deep RNN based FBF method is evaluated based on the metrics, like detection time, MSE and Missing target by varying the number of targets, antenna turn velocity, pulse repetition level, and the number of iterations. The proposed deep RNN based FBF method obtained a minimal detection time of 2.9551s, minimal MSE of 2683.80 and minimal Missing target rate of 0.0897, respectively.
Enhanced Optical and Ragged Metamaterials Properties of Silver Silica Nanocomposite Thin Film via Sol-Gel and Electrophoresis Deposition Technique
Authors: Taib Taifunisyam , Johan Mohd Rafie , Basirun Wan Jefrey
Published: July 2022

Various filling fractions of silver silica nanocomposites (Ag-SiO2 NC) were successfully synthesized via sol-gel technique and deposited onto indium tin oxide via electrophoretic deposition (EPD). Ag-SiO2 NC was investigated using X-ray diffraction, FTIR spectroscopy, Uv-vis and transmission electron microscopy. The XRD and Uv-vis results revealed that Ag-SiO2 NC is stable with a filling fraction of 0.6 in the dielectric medium with excellent absorption peak. Spectroscopy Ellipsometry shows that the effective permittivity and refractive index obtained from this filling fraction are -0.88 and 0.90, respectively. We discovered a ragged of metamaterial properties at negative permittivity.
Metastatic basal cell carcinoma to the bone: A case of bone metastasis in uncommon sites
Authors: Nigro Olga , Chini Claudio , Marcon Ilaria Gioia Angiola , De Giorgi Annamaria , Bascialla Linda , Gallerani Elisa , Giaquinto Alice , De Palma Diego , Lombardo Maurizio
Published: July 2022

Basal cell carcinoma (BCC) is the most common malignant tumor of the skin. Despite the indolent nature, metastatic BCC can occur, albeit rarely. Metastasis to the bone is very rare. From its approval, mBCC patients are treated with vismodegib, a selective hedgehog pathway inhibitor. Unfortunately, in recent period, it was demonstrated an emergence of drug resistance, due to Smoothened (SMO) mutation. To date, several groups are studying the effectiveness of immunotherapy in BCC. Clinical trials with Immune Checkpoint Inhibitors are ongoing. We report the rare case of a man with multiple bony metastasis, with a resistance to vismodegib, and we evaluated all manuscripts in literature reporting bone metastasis. Moreover, we review all the manuscripts in literature reporting bone metastasis, and we summarize the main therapeutic strategies, and the further perspectives.
Post-COVID-19 Infection; Paediatric Multisystemic Inflammatory Syndrome in an 8-Month-Old Infant
Authors: Adamu Halima , Zaidu Aisha Musa , Sabo Umar Abba , Bashir Lawal , Umar Umar Isa
Published: July 2022

The coronavirus disease 2019 (COVID-19) associated with multisystem inflammatory syndrome in children and adolescents is an emerging challenge and has been described as a new dangerous childhood disease that is temporally associated with COVID-19. An 8-month-old infant presented with unrelenting fever of 2 weeks, associated non-purulent conjunctivitis, redness of the lips and tongue, as well as tenderness, swelling and desquamation of the palms and digits and diarrhoea. She also had associated irritability, refusal to feed and poor sleep. She had positive polymerase chain reaction (PCR) COVID-19 test 3 months earlier. However, a repeat PCR test was negative at presentation. She had raised erythrocyte sedimentation rate of 85 mn/h, good systolic function on echocardiogram with normal rhythm electrocardiogram. She was diagnosed with post-COVID-19 paediatric multisystemic inflammatory syndrome and treated with intravenous immunoglobulin, oral prednisolone and aspirin. Patient symptoms improved significantly after 72 h of treatment. Therefore, a high index of suspicion is required in all children presenting with unexplained fever.
Management of Acute Stroke
Authors: Taallapalli Ashok Vardhan Reddy , Mailankody Pooja , Kulkarni Girish Baburao
Published: July 2022

Management of acute stroke has considerably changed over the past 20 years. It has evolved from extreme nihilism to an exciting science where patients can improve to near normal with reperfusion therapies. We have reviewed the recent advances in the management of acute stroke, especially acute ischemic type (AIS). A search was done in pub med with keywords- “Acute Stroke,” “Treatment,” and “Recent advances.” Relevant articles were downloaded, cross-references were reviewed and this article was written. Stroke care requires the organization of the available facilities at the hospital to provide basic to advanced services, with coordination between different centers through the Hub and Spoke model. Recognition of time of onset of stroke, knowledge about options available for AIS patients at 4.5, 6, and 24 h and planning appropriate imaging studies helps in management. Intravenous thrombolysis and endovascular therapies play a key role in the reperfusion in patients with AIS. Patients with transient ischemic attack/minor stroke should be treated with dual anti-platelets, for at least three weeks followed by a single agent. Investigating a stroke patient for modifiable risk factors and classifying them to various subtypes will help in the prevention of recurrence. Management of intracerebral hemorrhage requires evaluation for etiology and supportive care. Cerebral venous thrombosis is a rare but unique type of stroke, which requires knowledge about signs on imaging, risk factor evaluation, and treatment with anticoagulants. Health education plays an important role in prevention and compliance with medications.
COVID-19 and Psychological Distress among the General Population of India
Authors: Sharma Suresh , Joseph Jaison , Dhandapani Manju , Varghese Abin , Radha K. , Mathews Elezebeth , Varkey Biji P.
Published: July 2022

Background:

There is scanty evidence regarding the magnitude of COVID-19-related psychological distress (PD) among the general population of India.

Objectives:

This study aimed to estimate the pooled prevalence of PD among the general public of India during the COVID-19 pandemic.

Material and Methods:

We conducted a meta-analysis of 21 online surveys conducted across the Indian subcontinent and published between 2020 and 2021.

Results:

Overall estimates of PD among the general public during the COVID-19 pandemic by the random-effects model is 33.3% (95% confidence interval: 23.8%-42.8%; n = 21 studies). The level of heterogeneity was high among the included studies (I2 = 99.67%). In subgroup analysis, it was found that the survey tool and the methodological quality had a significant effect on the overall prevalence estimates. Approximately 33% of the general public reported to have PD during the COVID-19 pandemic in India, although the overall prevalence varied based on survey tools and quality of studies.

Conclusion:

As the pandemic crisis seems to be ebbing across the world, the current findings are a wake-up call to devise pragmatic strategies to curtail the burden of similar pandemics and to successfully meet the challenges ahead.
Assessing Waterborne Disease Vulnerabilities in the Blocks of Kalahandi District of Odisha, India
Authors: Mishra Martand Mani , Sahu Netrananda
Published: July 2022

Background:

Outbreaks of waterborne diseases caused by the contamination of water in the rural and tribal regions have become an area of prime concern in the research arena. The impact and intensity of waterborne diseases are expected to increase in these socioeconomic backward regions.

Objective:

The purpose of the study is to calculate the waterborne disease vulnerability index (DVI) for 13 blocks of the Kalahandi district of Odisha. Diarrhea and typhoid are two major diseases prevailing in each block of the district.

Materials and Methods:

Livelihood vulnerability index has been applied with some modifications to calculate the DVI for each block. In the DVI calculation, diseases are taken as an indicator for the exposure section. The sensitivity and adaptive capacity sections are categorized into two subcomponents to study the vulnerability of each block.

Results:

We have observed uneven distribution of diarrhea and typhoid among the blocks of Kalahandi. The result indicates that vulnerable populations and infrastructure play an important role in enhancing vulnerability whereas educational and health-care capacity reduces its impact. We have found that more than 50% of blocks in the district are categorized in moderate to high vulnerable zones.

Conclusion:

This study is done to understand the relationship between disease exposure, related vulnerability, and adaptive capacity. It is unique in the way the indicators have been chosen in the proposed method for the calculation of DVI and will have a higher degree of practical applicability.
Capacity Building of “Accredited Social Health Activist” under Rural Health Training Center Regarding Mental Health
Authors: Patel Mehul , Misra Shobha
Published: July 2022

Background:

Mental health is one of the critical health requirements that society needs to address in the present century. Accredited Social Health Activist (ASHA) can play an important role in identifying mental health problems at the earliest and help in improving community health status.

Objectives:

The objective of this study was to evaluate the effectiveness of a mental health education program on knowledge, attitude, and practices (KAP) of ASHAs.

Materials and Methods:

An intervention study was conducted to empower ASHAs for providing mental health services at a district located in Western India during 2016 and 2017. A semi-structured questionnaire was administered to assess KAP regarding mental health in intervention and control groups before and post intervention. An educational program was imparted in two batches. Hybrid methods for imparting teaching/training were utilized. “Paired t-test” was applied to compare pre- and post-results in intervention group and “unpaired t-test” for baseline comparison.

Results:

There was a statistically significant improvement in KAP of ASHAs after intervention. Majority of ASHAs referred cases of mental health problems to government tertiary care hospitals.

Conclusions:

The study indicates that it is possible to empower ASHAs with a short course related to mental health to achieve effective outcomes in terms of improved knowledge, attitudes, and practices.
Validation of Expanded form of Lubben Social Network Scale among Community-Dwelling Geriatric Population in India
Authors: Bincy K. , Logaraj Muthunarayan , Anatharaman V. V.
Published: July 2022

Background:

For assessing social networks in the elderly and the social support they receive and to predict social isolation, a proper valid and reliable short-scale screening tool is necessary. The present study aims to estimate the internal consistency and structural validity of the Lubben Social Network Scale (LSNS-18) among community-dwelling Indian older adults.

Materials and Methods:

We have administered the LSNS-18 scale to 500 older adults (>60 years) and performed confirmatory factor analysis (CFA) and structural equation modeling for the validation. Cronbach's alpha was done for estimating the internal consistency.

Results:

The LSNS-18 was easily answerable and the only minimum time is required for administration. CFA identified three domains with six items for each domain that demonstrated a good fit for the older adults with the internal consistency of 0.91.

Conclusion:

These findings suggest that LSNS-18 may be a valid tool for assessing the social network of the elderly and help to predict the risk for isolation in this vulnerable group.
Impact of Self-Help Groups among Persons With Disabilities in Rural Karnataka - A Comparative, Cross-Sectional Study
Authors: Regy Minitta Maria , Shanbhag Deepthi N. , Ramesh Naveen , Pasangha Elaina , Fernando Alex , Maria Monisha , Jogi Cyriac
Published: July 2022

Background:

The prime concern for an individual with disability is independence. Self-help groups (SHGs) provide opportunities for those with such needs.

Objectives:

The objectives of the study were (i) to assess the impact of SHGs on the livelihood, social inclusion, and community participation of those with disability and (ii) to evaluate the self-esteem and assess the role of such SHGs among those with disability.

Materials and Methods:

This was a community-based, cross-sectional study. An interview schedule captured responses to standardized questionnaires (community-based rehabilitation assessment tool, Rosenberg's self-esteem score, and Social Inclusion Scale). Responses were scored and compared among the two groups of those with disability (member or nonmember of SHGs).

Results:

The median scores for all our outcome variables were found to be more among those with disabilities enrolled in SHGs than those who were not with a significant association in the component of empowerment, sociocommunity participation, social inclusion, and self-esteem.

Conclusion:

SHGs improve social and community participation of individuals with disability. It empowers them to lead independent lives and also contributes to social inclusion.
Phenotypic variations in ocular features among siblings with oculocutaneous albinism
Authors: Bhate Manjushree , Lalwani Sakshi , Chakrabarti Subhabrata
Published: July 2022

Purpose:

To assess the clinical profiles, presenting ocular features, and variations in the phenotypic features in siblings with oculocutaneous albinism (OCA).

Methods:

Electronic medical records of consecutive siblings diagnosed with albinism from January 2016 to December 2020 were reviewed to identify the affected siblings. The variations in their phenotypic characteristics were studied.

Results:

Significant variations were observed in the clinical features between the siblings (n = 42). A difference of >2 lines in visual acuity was observed in 50% (n = 21) of the sibling pairs. Compound hyperopic astigmatism was the commonest refractive error. The refractive status was different in 80.95% (n = 34) pairs. Although individually strabismus and abnormal head posture were observed in one-third and one-fourth of individual children, respectively, both siblings with similar strabismus were seen in only 16.67% (n = 7) and with a similar abnormal head posture in 13.33% (n = 5). Nystagmus was the most consistent finding across these siblings with a similar nature of horizontal jerk or pendular in 65% of sibling pairs.

Conclusion:

This study observed significant variations in phenotypic presentations among siblings with OCA. Such differences in clinical manifestations and severity would be helpful in appropriate counseling of these families as the need for rehabilitation services is likely to vary across siblings.
A safer alternative approach to penetrating keratoplasty in opaque corneas
Authors: Venugopal Anitha , Chandratreya Madhura P , Ghorpade Aditya S
Published: July 2022

Background:

This video demonstrates a useful technique of keratoplasty which can be routinely undertaken by all surgeons when imaging modalities such as anterior segment optical coherence tomography are not available and prior patient history is not forthcoming.

Purpose:

To demonstrate a technique of lamellar separation and layer by layer removal of host cornea when dealing with keratoplasty in perforated corneal ulcers, adherent leucomas, dense corneal opacities, which obscure visualization of the iris and anterior chamber details.

Synopsis:

In this video, we demonstrate penetrating keratoplasty in a failed opacified graft with iridocorneal adhesions, with no visualization of anterior chamber details. Lamellar dissection of the host cornea is done starting at its periphery and moving centrally, with gentle peeling of the superficial layers, the epithelium and bulk of stroma, following which, the deeper portion of the cornea is dissected and separated from underlying adherent iris tissue. Layer by layer separation allows better visualization through the remaining thin layers of the cornea. This permits fine dissection and layered removal of the cornea, thereby avoiding injury to iris and lens. Debulking of the host cornea decreases the force that is needed to be applied to separate adherent iris tissue from the host cornea, and reduces the chances of sudden entry into the anterior chamber and subsequent damage to the iris or lens. This also reduces the chance of iris tears, iridodialysis and bleeding from the iris and helps maintain iris integrity, which is essential intraoperatively for protection of lens and anterior chamber formation, and to avoid glare and photophobia postoperatively. Preventing iris damage also reduces the chances of formation of peripheral anterior synechiae (PAS), which can predispose to graft rejection, graft failure and secondary glaucoma.

Highlights:

Layer by layer corneal separation beginning inside the graft host junction, careful separation of iridocorneal adhesions and PAS is a helpful technique to optimally preserve the anterior segment anatomy during difficult cases of penetrating keratoplasty.

Online Video Link:

https://youtu.be/ZmQQhuOnAh4
A 28-mm intraocular foreign body removal: The vitreoretinal surgeon’s dilemma
Authors: Gangwe Anil , Barwar Gulshan
Published: July 2022

Background:

Intraocular foreign body (IOFB) removal becomes tricky if its large and impacted in the ocular coats. When confronted with such a combination, the vitreoretinal surgeon will need to modify the surgical plan. This surgical video describes one of such situation encountered during removal of a long wooden IOFB impacted in the ocular coats.

Purpose:

The video describes a scenario when the surgeon becomes aware that injury to ocular structure is inevitable due to inherent length of the IOFB. However, a careful assessment of the situation helps the surgeon to identify how he could minimize the damage to the eye and not put vision at risk.

Synopsis:

A young boy presented with painful loss of vision in left eye since 15 days. Examination showed BCVA of 20/32 and limitation movement in up gaze. Fundus showed hazy media and an IOFB in superior quadrant. It was noted that IOFB was moving with eye movement. The impaction in sclera and extraocular extension was suspected. After pars plana vitrectomy, it was observed that IOFB was longer than what was measured by the scan and it was impacted in the coats. Removal using IOFB forceps further pulled the IOFB into vitreous cavity. A rectangular scleral window was created, IOFB was pushed towards opposite pars plana region to avoid injury to macula, optic nerve, lens and peripheral retina. The IOFB was then removed.The retinal tears were lasered. Three months following the surgery, he developed cataract, which needed surgery. His BCVA at the last follow up visit was 20/25 with attached retina.

Highlights:

1. Limitation of movement in presence of linear IOFB shall raise a suspicion of IOFB being impacted in coats and possibility of its extraocular extension; 2.An oblique IOFB posterior to limbus, can have length more in transverse diameter of the eyeball. Though rarely used, an ab-externo approach can be a viable option in such a case to minimise injury to vital structure of the eye, particularly if the IOFB is severely impacted in sclera.

Online Video Link:

https://youtu.be/2bF3WLd812o
Structural and functional phenotypic features and molecular analysis of Indian patients with Bietti crystalline dystrophy
Authors: Ratra Dhanashree , Chattree Surabhi , Raviselvan Munispriyan , Pradhan Arkaprava , Giridhar Sneha
Published: July 2022

Purpose:

Bietti crystalline dystrophy (BCD) is a rare retinal dystrophy, uncommon in Indians. This study describes the various phenotypic features seen in the Indian population.

Methods:

In this retrospective, descriptive case series, records of patients with either clinical or molecular diagnosis of BCD from 2009 to 2020 were perused. Phenotypic and genotype information was collected and analyzed.

Results:

This study included 58 patients of BCD (31 males) aged 21–79 years (mean: 47 ± 14 years). The age at onset ranged from 7 to 41 years (mean: 28.8 ± 5.1 years). Vision ranged from 20/20 to counting fingers. There were 18 (31%) patients with stage 1 with crystals and mild retinochoroidal atrophy, 22 (38%) with stage 2 with atrophy extending beyond arcades, and 18 (31%) with absent crystals and extensive atrophy of stage 3. Choroidal neovascular membrane was seen in four patients. The optical coherence tomography showed retinochoroidal thinning (84.6%), outer retinal tubulations (71.8%), and paradoxical foveal thickening with interlaminar bridges (7.7%). Electrophysiology and visual fields showed reduced responses in advanced retinochoroidal changes. Molecular confirmation was available in five patients; five mutations were seen in the CYP4V2.

Conclusion:

A wide variation is seen in the phenotypic picture of BCD. A molecular diagnosis is helpful in differentiating from other retinal dystrophies. The OCT shows the peculiar feature of the interlaminar bridge in early cases with photoreceptor loss. Further investigations into this OCT feature may provide insights into the pathogenesis of BCD. A genotype–phenotype correlation could not be done.
Clinical and molecular aspects of congenital aniridia – A review of current concepts
Authors: Tibrewal Shailja , Ratna Ria , Gour Abha , Agarkar Sumita , Dubey Suneeta , Ganesh Suma , Kekunnaya Ramesh , Sangwan Virender , Liu Yutao , Vanita Vanita
Published: July 2022

Congenital aniridia is a pan ocular disorder characterized by partial or total loss of iris tissue as the defining feature. Classic aniridia, however, has a spectrum of ocular findings, including foveal hypoplasia, optic nerve hypoplasia, nystagmus, late-onset cataract, glaucoma, and keratopathy. The latter three are reasons for further visual compromise in such patients. This entity is often due to mutations in the PAX6 (Paired box protein Pax-6) gene. Recently, aniridia-like phenotypes have been reported due to non-PAX6 mutations as in PITX2, FOXC1, FOXD3, TRIM44, and CYP1B1 as well wherein there is an overlap of aniridia, such as iris defects with congenital glaucoma or anterior segment dysgenesis. In this review, we describe the various clinical features of classic aniridia, the comorbidities and their management, the mutation spectrum of the genes involved, genotype-phenotype correlation of PAX6 and non-PAX6 mutations, and the genetic testing plan. The various systemic associations and their implications in screening and genetic testing have been discussed. Finally, the future course of aniridia treatment in the form of drugs (such as ataluren) and targeted gene therapy has been discussed.
North India Childhood Cataract Study - The real scenario and causes of surgical delay of pediatric cataract
Authors: Khokhar Sudarshan , Gupta Yogita , Rani Deeksha , Rathod Aishwarya , Moharana Sikshya
Published: July 2022

Purpose:

The study sought to describe the clinical presentation pattern of pediatric cataracts and factors leading to delay in surgery at a tertiary care center in North India.

Methods:

A cross-sectional, interview-based study was conducted from January 2020 to October 2020, that included pediatric patients <12 years, with unilateral or bilateral congenital or developmental cataract. A pre-validated questionnaire was used to record data. The parameters recorded were age at first symptoms, age at diagnosis of cataract, age at surgery, laterality of cataract, first symptom, first family member noticing the abnormality, the morphology of cataract, association of perinatal complications, family history, systemic diseases, and cause (s) of delay in surgery.

Results:

A total of 89 patients were included. The mean age of subjects was 4.75(±3.51) years. A white pupil was the most common symptom (64.04%) and appeared in infancy in 30.3% of cases. Parents first detected the problem in 60.67%, and the pediatrician was the first medical contact in 11.23% of cases. The median (IQR) delay period between diagnosis of cataract and cataract surgery was 4 (3–6) months, the major causes were long GA waiting (30.33%), and delay due to systemic ill health (14.61%).

Conclusion:

Parental education on cataract detection is recommended to help in the timely detection and hence, improved outcomes of pediatric cataract surgery. Pediatricians, consulted for any systemic illness, have the role of the second most important contact in the detection of pediatric cataract.
A report on a series of nanophthalmos with histopathology and immunohistochemistry analyses using light microscopy
Authors: Rajendrababu Sharmila , Shroff Sujani , More Shilpa , Radhakrishnan Shanthi , Chidambaranathan Gowripriya , Senthilkumar Vijayalakshmi A , Sithiq Uduman M , Kannan Naresh Babu
Published: July 2022

We aimed to study the histopathological and immunohistochemistry features in clinically diagnosed cases of nanophthalmos using light microscopy. This was an observational comparative study. We enrolled four eyes of four consecutive patients with nanophthalmos and visually significant cataract, who underwent cataract surgery with prophylactic posterior sclerostomy. Histological analysis of the excised scleral tissue was done and compared with age-matched cadaver controls between January 2021 and October 2021. Hematoxylin and Eosin (H&E) stains were used for histological analysis, and was further supplemented with immunohistochemistry (IHC) and immunofluorescence (IF) analyses using a simple light microscope. The immunostained sections were analyzed using confocal microscope for the fibronectin expression level. The main outcome measure was demonstration of histological changes of sclera in nanophthalmic eyes undergoing cataract surgery. Light microscopic features of nanophthalmos revealed thick fibers with fraying and lightly stained cores, irregular serrated edges, and randomly interspersed fibroblasts compared to regular arrangement of collagen fibers seen in cadaver controls. Immunohistochemistry analysis with anti-fibronectin antibody showed strong positivity in clustered fibers in nanophthalmos, and less intense diffuse staining in cadaver tissue. Histoclinical correlation was observed in one nanophthalmic scleral tissue with axial length less than 17 mm showing severe disorganization with diffuse collagenization, loss of fibrillary architecture compared to another specimen with axial length more than 17 mm. Simple, cost-effective light microscopy using basic stains was effective in identifying the characteristic histopathological features in nanophthalmic eyes, and this was further highlighted by immunohistochemistry and immunofluorescence analyses.
Choroidal ganglioneuromas in Francois variant neurofibromatosis-1: A rare retinoblastoma mimic
Authors: Gupta Himika , Kandalkar Bhuvaneshwari
Published: July 2022

Neurofibromtosis-1 (NF-1) is the commonest oculo-neuro-cutaneous syndrome with multiple ocular manifestations. Reporting three children who presented with unilateral glaucoma (buphthalmos), ipsilateral facial hemihypertrophy, and eyelid plexiform neurofibroma: completing the triad of François syndrome, a rare NF1 variant. Two presented with leukocoria and were referred to as retinoblastoma suspects. Histopathology showed ganglioneuroma, a benign choroidal tumor, associated with NF-1, which does not need treatment. Knowledge of this rare condition avoids misdiagnosis of retinoblastoma, prevents aggressive management, and the associated psychological impact.
Approach to inherited retinal diseases
Authors: Ratra Dhanashree , Ozdek Sengul , Raviselvan Munispriyan , Elchuri Sailaja , Sharma Tarun
Published: July 2022

Inherited retinal diseases (IRDs) are a group of phenotypically diverse disorders with varied genetic mutations, which result in retinal degeneration leading to visual impairment. When a patient presents to a clinician who is not an IRD expert, establishing a correct diagnosis can be challenging. The patient and the family members are often anxious about further vision loss. They are eager to know the prognosis and chance of further worsening of the vision. It is important for every eye specialist to educate himself/herself about the basics of IRD. It would help to familiarize oneself about how to approach a patient with an IRD. An early and accurate diagnosis can help predict the vision loss and also help the patient plan his/her education and choose appropriate career choices. An updated knowledge about the genetic mutations, mode of inheritance, and possible therapies would empower the eye specialist to help his/her patients. This article gives a broad plan of how to approach a patient with IRD with regards to characterization and diagnosis of the disorder, visual rehabilitation, and possible therapy.
Posterior corneal morphological changes in primary congenital glaucoma
Authors: Gupta Shikha , Mahalingam Karthikeyan , Singh Abhishek , Selvan Harathy , Somarajan Bindu I , Gupta Viney
Published: July 2022

Purpose:

To compare posterior corneal morphology between older treated and younger untreated children with primary congenital glaucoma (PCG) using anterior segment optical coherence tomography (ASOCT) and intraoperative OCT (iOCT), respectively.

Methods:

In this comparative study, ASOCT of older PCG children were compared with iOCT of younger untreated PCG patients. Differences between the two groups with respect to posterior corneal morphology were studied.

Results:

Observed morphological patterns within posterior cornea in older treated (age: 72–300 months) children (87 eyes) included Descemet’s membrane (DM) excrescences (70%), thickened DM (35%), intracameral twin protuberances (92%), and DM detachment (26%). Changes within pre-Descemet’s layer (PDL) (28%) included thickening, breaks, and detachments. Extent of Haab’s striae was associated with thickness of DM/PDL complex (P= 0.008) when analyzed in the treated group. In contrast, in the untreated group (n= 53 eyes, age 1–63 months), posterior corneal changes were limited to diffuse hyper-reflectivity of the DM/PDL complex, with absence of DM tears.

Conclusion:

Posterior cornea thickens and Haab’s striae become more circumscribed in eyes of older treated children compared to untreated PCG eyes, probably reflecting a healing response of posterior cornea over time.
Effectiveness of a modified therapeutic protocol for the management of vernal keratoconjunctivitis based on Bonini’s graded clinical severity
Authors: Pradhan Anuradha , Pattanayak Sabyasachi , Dora Jayashree , Subudhi Praveen
Published: July 2022

Purpose:

To evaluate the effectiveness of a modified therapeutic protocol used for vernal keratoconjunctivitis (VKC) based on severity as per Bonini grading system.

Methods:

This was a prospective observational clinical study conducted with 123 eyes of 63 patients. A meticulous clinical examination was performed, and data was documented in all the cases. Patients on known systemic atopy and antiallergic therapy were excluded from the study. Eyes with a clinical diagnosis of VKC were segregated based on Bonnini’s grading system. A treatment protocol was created depending on the grade of VKC. Therapeutic responses were documented at 3 weeks, 3 months, 6 months, 12 months, and 24 months. Grading of the eyes was performed in each visit.

Results:

The mean age of the patients was 8.85 years with a standard deviation of 4.48 years. Males were predominant, and 95.24% had bilateral manifestation. The palpebral component was the most common form of manifestation. Itching was the most common manifestation, followed by congestion, discharge, and papillae in a decreasing order. Also, 68% of patients were in grade 2, 14% in grade 3, 12% in grade 1, and the rest were in grade 4. Following the treatment protocol, 70% showed signs of significant improvement in grade by the end of 6 weeks, reaching 90% at the end of 6 months (P = 0.074) and 92% at the end of 12 months (P = 0.002). Also, 52.4% versus 77.8% of patients had no recurrence in the pre- versus posttreatment protocol and it was statistically significant (P = 0.001).

Conclusion:

Grading of VKC gives a clear evaluation of the severity and progression of the condition. Besides, significant improvement in the grades was observed with fewer incidences of recurrences following execution of the therapeutic protocol. Hence, it is essential to maintain a treatment protocol in our clinical practice to provide grade-based therapy and monitor accurate changes in the clinical condition.
Relationship between Aedes aegypti indices with perception and practices of dengue in an urban community of Mysore
Authors: Sunil B. C. , Kulkarni Praveen , Renuka N. , Murthy M. R. Narayana
Published: July 2022

Background:

Dengue is one of the major public health problems in the world. Currently, dengue is endemic in more than 100 countries of Asian pacific region. Prevention and control of dengue is largely influenced by the level of awareness and the preventive practices people undertake. In this background, the present study was conducted to find out the relationship between Aedes aegypti indices and perception and practices regarding dengue and its prevention.

Materials and Methods:

This cross-sectional study was conducted in an urban slum for the period of 1 year among 270 households selected by probability proportionate to size technique. Data were collected by structured questionnaire with details on sociodemographic characteristics, perception, and practices adopted by people toward dengue and its prevention. Larva survey was conducted by observing for the A. aegypti larvae in the containers within and outside the households.

Results:

Among 270 households included in the present study, overall, 70 (25.9%) and 96 (35.6%) of the study respondents were having poor and average levels of perception. 22 (8.1%) and 163 (60.4%) of respondents had poor and average levels of dengue prevention practices, respectively. Household index, container index, and Bretau's index (BI) were 5.52%, 6.05%, and 8.51%, respectively. Median perception and practice scores among the respondents of households with larva breeding were significantly lower as compared to the ones without larva breeding.

Conclusion:

Majority of the study participants had poor to average levels of perception and practices regarding dengue and its prevention. These scores were significantly lower among households with active larva breeding.