bluuebunny/crossref_metadata_2025 huggingface dataset:
Ten commandments for biometry in tricky situations
Authors: Israni Neeraj , Kochar Shruti
Published: August 2022

Background:

Recently, the number of litigations on cataract surgeons has increased. Because of the increasing ambitions of surgeons and demands for a spectacle-free life, the incidence of unhappy patients is at an all-time high. To an ophthalmologist, the fruits of a good surgery are dependent largely on their skills. However, more importantly, the roots of good results of a surgery are laid by a perfect IOL (intraocular lens) power calculation. Inaccurate biometry is one of the major reasons for unhappy patients, especially in some challenging scenarios.

Purpose:

To hit the bull’s eye, as far as target refraction is concerned, it is necessary to understand the benefits and limitations of currently available cutting-edge technology and formulae and apply them to the cataract surgery practice. The aim of the video is to familiarize modern-day ophthalmologists to these situations to achieve a perfect IOL power calculation.

Synopsis:

Using a step-by-step approach, we decoded biometry in special scenarios like poor cornea, ocular surface disorders, dry eyes, toric IOL calculation, cases with posterior corneal astigmatism, irregular corneas like keratoconus, pellucid marginal degeneration, post Lasik ectasia and penetrating keratoplasty. In this video we tried to address the solution to these special conditions and how to attain target refraction in such cases. A few more issues are addressed like biometry post retina surgery, very dense cataract where it is difficult to obtain axial length, and cases with extreme axial lengths.

Highlights:

In this case-based approach, with relevant example, we tried to provide solutions for biometry in tricky scenarios like poor cornea, biometry post refractive surgery, dense cataracts, and cataract post retinal surgery. On following these commandments, not only will the litigations stop but our patients will be happier as well.

Online Video Link:

https://youtu.be/dNXP2nDYUZo

Key words: Case based approach, IOL power calculation, tricky situations
Deciphering the enigma of astigmatism in cataract surgery
Authors: NeerajIsrani  , Kochar Shruti , Paryani Mukesh , Shah Shreya , Bhatnagar Sanket
Published: August 2022

Background:

With about 87% of patients with cataracts having astigmatism, management of astigmatism in cataract surgery not only yields an improved unaided visual acuity and image quality but also higher patient satisfaction. The video will give a step-wise guide to cataract surgeons to manage astigmatism with cataracts.

Purpose:

To hit the bull’s eye as far as target refraction is concerned, it is necessary to understand the benefits and limitations of currently available cutting-edge technology and formulae and apply them to the cataract surgery practice. The purpose of the video is to make sure that we have no surprises in our Toric intraocular lens (IOL) planning.

Synopsis:

After a brief introduction to available modalities for the treatment of astigmatism, a step-wise approach to diagnostics is discussed, which will include the role of corneal topography and aberrometers and their application to planning Toric IOLs. Appropriate planning, implementation, and execution in form of preoperative and intraoperative pearls of using Toric IOLs are shown in the video. This will be followed by troubleshooting and case-based discussions and future perspectives including the possible role of corneal biomechanics.

Highlights:

What this video adds new is the importance of topography, interpretation of Belin‒Ambrosio display map and the equivalent keratometry reading (EKR) map, aberrometry, and higher order aberration (HOA) analysis and role of biomechanics in Toric IOL planning. Video also highlights the importance of posterior corneal astigmatism and accurate axis marking. With a case-based approach and relevant examples, we are trying to decipher the enigma of astigmatism by giving a step-wise approach for the same.

Online Video Link:

https://youtu.be/5VuEY_6NdQA

Key words: astigmatism, cataract, aberrometry, toric, intraocular lens
Comparison of two protocols of subthreshold micropulse yellow laser treatment for non-resolving central serous chorioretinopathy
Authors: Beniwal Abhijeet , Shaikh Nawazish , Chawla Rohan , Azad Shorya Vardhan , Kumar Vinod , Vohra Rajpal
Published: August 2022

Purpose:

To study the effect of subthreshold micropulse yellow laser treatment on central serous chorioretinopathy (CSC) and to compare two laser protocols. As per our knowledge, there are no studies comparing the two protocols of subthreshold laser.

Methods:

Twenty-three patients with non-resolving CSC of at least three months duration were treated with subthreshold laser (577 nm). Ten patients were treated with 5% duty cycle (group A) and 13 patients with 10% duty cycle (group B). At one month, best corrected visual acuity (BCVA), central macular thickness (CMT), subretinal fluid (SRF), choroidal thickness (CT) and choroidal vascularity index (CVI) were evaluated.

Results:

In group A, BCVA improved from 0.508 ± 504 to 0.174 ± 0.171 (P = 0.0058), CMT improved from 349.8 ± 168.9 micrometers (µm) to 183.3 ± 70.312 µm (P = 0.0093) and SRF reduced from 202.4 ± 158.024 to 43.8 ± 46.599 µm (P = 0.0069). In group B, BCVA improved from 0.437 ± 0.426 to 0.289 ± 0.470 (P = 0.0026), CMT improved from 280.846 ± 72.668 to 196.769 ± 72.62 µm (P = 0.0002) and SRF reduced from 110.385 ± 57.687 µm to 52.538 ± 52.111 µm (P = 0.0064). No significant difference was found in BCVA and CMT between the groups (P = 0.8716 and P = 0.8523, respectively). CSC completely resolved in 50% of cases in group A and in 69.2% of cases in group B. This difference was not statistically significant (0.423); however, the odds ratio of resolution was 2.25 times more with 10% duty cycle. No change was observed on fundus autofluorescence (FAF) following laser.

Conclusion:

Subthreshold micropulse laser can lead to resolution of SRF in 60.87% of cases (groups A and B combined). Ten per cent duty cycle had higher odds of resolution without causing any RPE damage.
Effect of atropine 0.01% on progression of myopia
Authors: Sen Snigdha , Yadav Himanshu , Jain Anu , Verma Sadhna , Gupta Preeti
Published: August 2022

Purpose:

Myopia is the most common type of refractive error and the leading cause of functional visual loss. Increased risk of myopic maculopathy, retinal detachment, glaucoma and cataract has been seen with a myopia of as low as −1D. This study was done to determine the effect of atropine 0.01% eye drops on the progression of myopia in children >5 years.

Methods:

This was a single-blind, prospective, randomized case–control study which included children of 5–15 years with myopia of >2D and were divided into treatment group (group 1) and placebo group (group 2). Children under treatment group were treated with application of 0.01% atropine at night. Children with history of any ocular surgery, chronic ophthalmic illness, squint and amblyopia were excluded from the study. The follow-up for myopia progression was done for two years.

Results:

This study showed a significant difference in increase of spherical equivalent and axial length among treatment and placebo groups after a duration of two years. Total duration of follow up was twenty-four months. Mean increase in axial length of group 1 and 2 was 0.115 mm and 0.32 mm, respectively. Mean increase in refraction of groups 1 and 2 was −0.30 D and −0.88 D, respectively, showing significant change in axial length and refraction (P < 0.0001).

Conclusion:

This study supports the use of atropine 0.01% eye drops in reducing the progression of myopia.
Descemet membrane endothelial keratoplasty: Update on preoperative considerations, surgical techniques, and outcomes
Authors: Singh Prabhakar , Sinha Akanksha , Nagpal Ritu , Chaurasia Sunita
Published: August 2022

Descemet membrane endothelial keratoplasty (DMEK) is the closest to the physiological replacement of endothelial cells. In the initial years, the technique was surgically challenging. Over the years, with better understanding and modifications in the surgical steps, the technique has evolved as an alternative to more popular procedure Descemet stripping endothelial keratoplasty. The article highlights the various preoperative, intraoperative, and postoperative nuances of DMEK. Additionally, it summarizes the various comparative and noncomparative studies on DMEK outcomes.
The role of Tenonplasty in the management of limbal and scleral ischemia due to acute ocular chemical burns
Authors: Sharma Supriya , Kate Anahita , Donthineni Pragnya Rao , Basu Sayan , Shanbhag Swapna S
Published: August 2022

Of the various manifestations of ocular chemical burns (OCBs), ischemia of the limbus and the peri-limbal sclera indicates poor prognosis and in severe cases threaten the integrity of the globe. Tenonplasty is a surgical procedure which involves advancing the Tenon’s capsule over the ischemic areas to provide a vascular supply and to enable migration of the conjunctival epithelium. This review aims to provide an overview of the diagnosis of limbal ischemia and its management with Tenonplasty. A literature review was conducted using the keywords “Tenonplasty,” “Tenon’s capsule,” “ocular chemical injury,” “ocular thermal injury,” “Tenon advancement,” “scleral ischemia,” and “limbal ischemia,” and outcomes were studied from seven selected articles. In addition to clinical evaluation, in vivo imaging techniques such as anterior segment optical coherence tomography angiography can provide an objective method of measuring and monitoring the ischemia and re-perfusion of the peri-limbal vasculature. Tenonplasty can be performed in eyes with acute OCBs with scleral or limbal ischemia by dissecting the Tenon’s layer from the orbit and securing it to the limbus. The indications, mechanism of action, peri-operative considerations, surgical technique, and post-operative care of Tenonplasty are discussed in detail. The average time for post-operative re-epithelization ranges from 1 to 6 months with the formation of a symblepharon being the most common complication. In conclusion, Tenonplasty is a globe-salvaging procedure in cases with severe limbal and scleral ischemia because of OCBs and has good anatomical outcomes priming the globe for subsequent re-constructive and vision-restoring surgeries.
Independent risk factors of type III acute acquired concomitant esotropia: A matched case–control study
Authors: Zhang Jingjin , Chen Jinguo , Lin Hong , Huang Longxiang , Ma Shaoqing , Zheng Weidong
Published: August 2022

Purpose:

To investigate the risk factors and surgical design for type III acute acquired concomitant esotropia (AACE).

Methods:

In this retrospective, matched, case–control study, 51 patients developed type III AACE between March 2018 and September 2020, and the control group consisted of 60 patients matched by age and refractive power during the same period. A history of the duration of near work per day and the use of glasses were reviewed, and the refractive power of both eyes, deviation angles at both near and far vision, visual function, and treatment options were analyzed. Additionally, the distance from medial rectus insertion to the limbus was measured in surgical patients. The data were analyzed by logistic regression analysis.

Results:

We found that 99.96% of the patients and 91.67% of the controls had myopia. Of these, 60.8% and 20.0%, respectively, did not wear glasses for near work. Twelve patients were treated with a prism and 39 were treated surgically. The average time devoted to near work per day was 7.24 and 3.7 h by the patients and controls, respectively. Univariate logistic regression analysis showed that increased hours of near work per day and near work without the use of spectacles were associated with the incidence of type III AACE. Multiple logistic regression analysis revealed that increased hours of near work per day and near work without the use of glasses were independent risk factors for AACE.

Conclusion:

Increased hours of near work per day and uncorrected myopia in near work are independent risk factors for type III AACE.
Clinical profile and demographic distribution of ophthalmia nodosa: An electronic medical record-driven big data analytics from a multitier eye care network
Authors: Das Anthony V , Venugopal Ragukumar , Reddy Jagadesh C
Published: August 2022

Purpose:

To describe the demographics and clinical profile of ophthalmia nodosa in patients presenting to a multitier ophthalmology hospital network in India.

Methods:

This cross-sectional, hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of ophthalmia nodosa in at least one eye were included as cases. The data were collected using an electronic medical record system.

Results:

Overall, 434 (0.014%) patients were diagnosed with ophthalmia nodosa. Most of the patients were male (71.43%) and had unilateral (97.7%) affliction. The most common age group at presentation was during the third decade of life with 116 (26.73%) patients. The overall prevalence was higher in patients from a higher socioeconomic status (0.015%) presenting from the urban geography (0.019%) and in professionals (0.027%). The setae were identified and removed at presentation in 287 (66.13%) patients. The most common location of the setae was conjunctiva (45.72%) followed by cornea (39.64%). Most of the eyes (355; 79.95%) had mild or no visual impairment (<20/70). The most documented ocular signs were eye lid edema (35.81%), conjunctival congestion (73.87%), and corneal abrasion (29.05%). Less than one-tenth of the eyes required a surgical intervention for removal of the setae, corneal foreign body removal was performed in 10 (2.25%) eyes and conjunctival foreign body removal in four (0.90%) eyes.

Conclusion:

Ophthalmia nodosa more commonly affects males presenting during the third decade of life and is predominantly unilateral. The setae are most commonly lodged in the conjunctiva followed by the cornea, and the majority of the eyes have mild or no visual impairment.
Effectiveness and future implications of COVID-19-related risk stratification for managing retinopathy of prematurity: The Indian twin cities retinopathy of prematurity study report number 10
Authors: Belenje Akash , Agarwal Komal , Naveen Nukkala , Sahoo Niroj K , Parmeswarappa Deepika C , Jayanna Sushma , Padhi Tapas R , Nayak Sameera , Panchal Bhavik , Jalali Subhadra
Published: August 2022

Purpose:

To evaluate the effectiveness and future implications of COVID-related risk stratification for managing retinopathy of prematurity (ROP).

Methods:

A prospective study was conducted at a tertiary eye care center from the beginning of the lockdown in India from 23 March 2020 till the end of the first phase of lockdown on 29 May 2020. We evaluated 200 prematurely born infants (< 34 weeks of gestational age) using the new safety guideline protocols for low-risk babies developed in conjunction with the Indian ROP Society for care during the COVID-19 pandemic. Low risk included babies born at more than 30 weeks of gestational age, post menstrual age 34 weeks or above at presentation, more than 1000 grams of birth weight, and stable systemically with good weight gain.

Results:

New guidelines were implemented in 106 (53%) infants who were low risk while 94 (47%) infants with high risk were followed up as per the old guidelines. Out of the 106 infants (212 eyes) managed by the new guidelines, good outcome (group 1) was seen in 102 (96.2%) infants. Twenty-seven of the 102 infants had some form of ROP and 5 of these infants needed treatment. None of the low-risk babies with no detachment at presentation managed by new guidelines required surgery later (group 2). Two (1.9%) infants came with retinal detachment at presentation and underwent successful surgery (group 3) and two infants (1.9%) were lost to follow up.

Conclusion:

New risk stratification during the COVID-19 pandemic was an efficient and safe strategy in managing low-risk ROP babies.
Mentor–mentee relationship in ophthalmology – Following the footsteps of stalwarts
Authors: Gurnani Bharat , Kaur Kirandeep , Bhandari Sahil , Gireesh Prasanth , Sisodia Priya
Published: August 2022

Mentor- mentee relationship in any discipline is a professional and interpersonal relationship. It associates a mentor with a protégé or a mentee. Mentoring is a serious business in Ophthalmology, both academically and surgically. The mentors act as role models for future generations by acting as a friend, coach, or guide to the mentee. They do so by giving valuable advice, moral support, and inculcating skills in a mentee. It is difficult to pinpoint the precise function of the mentor-mentee relationship, but the final goal is to achieve personal and professional objectives. In the current article, the authors have shed light on the imperative aspect of one’s Ophthalmology career, i.e., the mentor-mentee relationship. This article describes various aspects of mentoring, the traits of a perfect mentor and mentee, the pre-requisites for a good mentee-mentor relationship, the hindrances and obstacles in a good relationship, and the impact of COVID-19 on the same. The potential goal of this article is to ignite the constructive spirit of the mentor-mentee relationship, encourage potential mentors to become ideal mentors, and potential mentees to gain from serious mentors
Fundus findings in patients admitted with post COVID-19 sepsis in an intensive care unit
Authors: Mehta Salil , Jiandani Prakash , Prabhudesai Prahlad
Published: August 2022

Purpose:

COVID-19 infection is being increasingly identified as a risk factor for the development of ocular infections, especially endogenous endophthalmitis. Current studies primarily report cases among survivors, and the overall prevalence, especially amongst patients admitted with active sepsis is unknown. We report on the fundus and systemic findings of inpatients who were being treated for post-COVID-19 systemic secondary infections in a tertiary intensive care unit.

Methods:

Retrospective observational study based on chart review.

Results:

A total of 24 patients were identified. These included 21 (87.5%) males and 3 (12.5%) females with ages ranging from 33 to 72 years (mean 54.1 years). Pre-existing risk factors included type 2 diabetes mellitus, systemic hypertension, chronic kidney disease, multiple myeloma, and patients on long-term corticosteroid/immunosuppressive treatment. Nine patients (37.5%) died and 15 (62.5%) survived. Of a total of 48 eyes, observed fundus lesions included endogenous endophthalmitis (4 eyes of 2 patients, 8.3%), preretinal hemorrhages (4 eyes of 2 patients, 8.3%), optic disc pallor (2 eyes of 1 patient, 4.1%), moderate non-proliferative diabetic retinopathy (4 eyes of 2 patients, 8.3%), Roth spots (2 eyes of 1 patient, 4.1%), and 2 eyes of 1 patient (4.1%) with evidence of previous pan-retinal photocoagulation.

Conclusion:

Two patients had evidence of endogenous endophthalmitis. These findings suggest that the actual incidence of ocular lesions, especially infections is higher than that reported. Fundus examination should form a part of the management protocol for patients being treated for post-COVID-19 systemic infections.
Short-term surgical outcomes of twin-site combined phaco-emulsification and mitomycin-C augmented trabeculectomy in pseudo-exfoliation glaucoma versus primary open-angle glaucoma
Authors: Senthilkumar Vijayalakshmi A , Kumar MRanjith , Wijesinghe Hiruni Kaushalya , Uduman Mohammed Sithiq , Krishna Shiva M , Odayappan Annamalai , Puthuran George Varghese
Published: August 2022

Purpose:

To compare the short-term outcomes of combined phaco-emulsification with posterior chamber intra-ocular lens and mitomycin augmented trabeculectomy in patients with pseudo-exfoliation glaucoma (PXFG) versus primary open-angle glaucoma (POAG).

Methods:

A total of 144 eyes of 144 patients were enrolled in this prospective interventional comparative study, 72 each of which had PXFG and POAG, respectively. All patients underwent twin-site combined phaco-trabeculectomy at a tertiary eye center in India between December 2017 and December 2018 and were followed up for a period of 12 months. The main outcome measures were intra-ocular pressure (IOP), best corrected visual acuity (BCVA), total surgical time, rate of intra-operative and post-operative complications, and the number of ocular hypotensive medications needed. Success rates were determined via Kaplan–Meier survival analysis.

Results:

The mean age was 63.9 ± 7.9 years in the POAG group and 66.4 ± 6.8 years in the PXFG group (P - 0.04). The baseline BCVA, IOP, and cup-disc ratio were comparable between two groups. Intra-operative complications and post-operative outcomes were comparable between the two groups. There was a significant drop in anti-glaucoma medications in both groups. Six patients, three (4.2%) in each group, were lost to follow-up after 6 months. Three patients (4.2%) in PXFG needed additional glaucoma intervention for controlling IOP, one patient needed a non-valved glaucoma drainage device, and two patients required diode cyclo-photocoagulation within the follow-up period.

Conclusion:

Patients with PXFG had a longer surgical time than POAG. Similar success and complication rates were observed following combined twin-site phaco-trabeculectomy in both POAG and PXFG at 1 year. Combined glaucoma surgery resulted in good IOP control, improvement in BCVA, and lower requirement of ocular hypotensives in both the groups.
Bilateral multifocal choroiditis with disc edema in a 15-year-old girl following COVID-19 vaccination
Authors: Kakarla Peeyusha D , Venugopal RYC , Manechala Upendra B , Rijey Joash , Anthwal Deepak
Published: August 2022

A few cases of posterior uveitis following COVID-19 vaccination have been reported but none in the pediatric age group. A 15-year-old girl presented with history of headache and bilateral blurred vision of five days duration. The symptoms developed five days after vaccination with the first dose of Covaxin (inactivated SARS-CoV-2 vaccine). Her anterior segment was normal in both eyes (BE), whereas the posterior segment showed mild vitritis with disc edema and multiple yellowish lesions at the level of choroid clustered at the macula and associated with multiple serous detachments. BE uveitis resolved, and the vision was completely recovered three weeks after treatment with steroids. Hence, ophthalmologists should be aware of uveitis following vaccination—a condition that is usually benign, transient, and results in excellent outcomes with timely diagnosis and early treatment with steroids.
The influence of the Artisan–Verisyse position on the postoperative outcomes: A systematic review and meta-analysis
Authors: Romero Daniel , Escolano Jaime , Fernández Cristian , Martínez-Toldos Jose Juan , Monera Carlos E , Castilla Germán , Moyá Alejandro
Published: August 2022

Iris-fixated intraocular lens (IOL) is considered a safe and effective option for the correction of aphakia in patients with insufficient capsular support. This systematic review aims to summarize the existing evidence about the Artisan/Verisyse IOLs and to assess the influence of the IOL position on the postoperative outcomes. Three different databases were used for this systematic review and metaanalysis (PubMED, Scopus, and Embase). We searched for case series or clinical trials comparing the prepupillary versus retropupillary Artisan/Verisyse implantation. The statistical analysis was performed with the programming language R (version 3.6.1 2019-07-05). The number of articles included in the meta-analysis was six, with 506 eyes included in total. We found no significant differences in postoperative corrected distance visual acuity (CDVA) (0.309 [0.089–0.528] vs. 0.32 [0.2–0.44]), spherical equivalent (SE) (0.0153 D [−0.362 to 0.393] vs. −0.329 D [−0.62 to − 0.038]), and central corneal cell density (CECD) (1669.85 cells [1605.949–2150.937] vs. 1635.99 cells [1413.64–1858.363]) between the prepupillary and the retropupillary implantation, respectively. There were no significant differences in the rates of cystoid macular edema (CME; 7.70% vs. 9.8%), pupil deformation (4.5% vs. 5.4% retropupillary), or IOL luxation (2.3% and 2.2%). We found little influence of the IOL position in the postoperative analyzed outcomes. Thus, the implant position should be based on the surgeon’s technical experience. Double-blind randomized prospective studies would improve the available evidence on the best implant position for the Artisan/Verisyse IOL.
A cross-sectional study on the incidence of retinal changes and its correlation with variables like blood pressure, liver function tests, kidney function tests, proteinuria, and pedal edema in patients of pregnancy-induced hypertension in a rural setting
Authors: Singh Sonali , Chauhan Shantanu S , Ranjan Ravi
Published: August 2022

Purpose:

Pregnancy-induced hypertension is a multisystem disorder that occurs after 20 weeks of pregnancy usually in primigravidas and is characterised by proteinuria, pedal edema, hypertension, and abnormal liver and kidney function tests. Since there exists a close relationship between retinal, cerebral, and renal vessels, fundoscopy gives the opportunity of observing the changes in the vascular tree.

Methods:

We conducted a study on 203 pregnant females over a period of 1.5 years in the rural population of North India. We recorded the baseline data from the patient files, including the biochemical investigations, and conducted a fundoscopic examination of all patients included in the study, and correlation of various variables was established.

Results:

Out of 203 patients (403 eyes), 60% were primigravidas of mean age 25.71 ± 4.46 years with the mean duration of pregnancy being 36 weeks. The mean systolic and diastolic blood pressure were160 and 101 mmHg, respectively. There was no significant correlation was seen of proteinuria with eclampsia and the fundus findings. But there was a significant correlation between proteinuria and pedal edema and between the fundus findings and deranged LFT and KFT values. Relationship between the variables was calculated by using Chi-square and Fisher’s exact test. A P value < 0.05 was taken as significant.

Conclusion:

Hypertension in pregnancy is the major concern of public health issue worldwide. With proper understanding of the correlating factors such as fundus changes which are directly correlated with whole bo dy vascular changes, which might affect the fetal growth, we can easily predict the outcome and can take appropriate actions as early as possible.
Evaluation of Sensitivity and Specificity of High Fluorescence Lymphocyte Count Percentage of Sysmex XN Analyzer in Diagnosis of Dengue
Authors: Ningombam Aparna , Acharya Shreyam , Sarkar Abhirup , Kumar Kundan , Brijwal Megha , Routray Srimantinee , Sachdev Janya , Srigyan Deepankar , Choudhary Aashish , Subramanian Arulselvi , Dar Lalit
Published: August 2022

BACKGROUND:

The Sysmex XN-series hematology analyzers provide newer parameters including high fluorescence lymphocyte cell percentage (HFLC%) which correlates with the presence of atypical lymphocytes in peripheral blood. We aimed to analyze the sensitivity and specificity of HFLC% as a diagnostic tool and its association with serological status in diagnosed dengue patients and thereby establish a cutoff of HFLC% based on serology. Besides, we also wish to correlate HFLC% with thrombocytopenia in these patients.

MATERIALS AND METHODS:

A total of 1500 serum samples were subjected to serological evaluation for dengue. After excluding hematological malignancies and autoimmune disorders, the same day complete blood count parameters including HFLC% and platelet counts were collected retrospectively for 292 serologically positive dengue cases and 76 seronegative controls.

RESULTS:

Our result shows that in nonstructural 1 antigen-positive cases, a cutoff of >5.2% HFLC can have a sensitivity of 79.5% and specificity of 98.6%. We found a different cut off of HFLC% >3.2% (sensitivity 83.4%, specificity 98.6%) for the cases with only immunoglobulin M positivity and a cut off of HFLC% >2.6% (sensitivity 86.1%, specificity 96%) in the dual positive cases (immunoglobulin M with nonstructural 1 antigen). Besides, high HFLC% also shows a strong correlation with platelet count with a Spearman correlation coefficient of −0.6.

CONCLUSIONS:

The result of our study shows that a specific cutoff of HFLC% can not only help us to suspect dengue fever but also predict the risk of thrombocytopenia in already diagnosed dengue patients. The sensitivity and specificity of HFLC% varied with the serological status of the patients which depend on the days of fever on presentation.
The Roles of Aromatase Inhibitors in Treating Hypogonadism and Male Infertility
Authors: Huang William J.
Published: August 2022

Testis is an organ with both endocrine and exocrine functions. The former stands for testosterone release, and the latter represents sperm production. Spermatogenesis is a process highly depending on adequate supply of testosterone by the Leydig cells of the testis. In men at the reproductive age, more than 90% of testosterone produced is used for spermatogenesis. In men with diminished testosterone secretion in testis, or hypogonadism, the spermatogenesis process is impaired. Testosterone can be converted into estradiol through the catalyzation of aromatase, a cytochrome P450 enzyme presented in the peripheral tissue. Blocking the activity of aromatase causes an elevation of serum testosterone and a decrease of serum estradiol levels. These effects result in an increase of testosterone-to-estradiol ratio. Infertile males with dysfunction of spermatogenesis may demonstrate a low testosterone-to-estradiol ratio. Studies have shown that aromatase inhibitors (AIs) are beneficial to treat patients with impaired spermatogenesis, by demonstrating improvement of the semen parameters in men with oligoasthenoteratozoospermia. Besides, AIs can also be applied in other health issues, such as hypogonadism-related erectile dysfunction, short statue, depression, or male breast cancer. There are two different types of AIs: steroidal and nonsteroidal. Steroidal AI (e.g., testolactone) is an irreversible, but weaker inhibitors, while nonsteroidal AIs (e.g., letrozole and anastozole) are potent reversible inhibitors. Both types of AIs demonstrate plausible effects to improve semen parameters. In this review, the physiological action of aromatase and the indications of AIs treatment are discussed in detail, especially focusing on the function of spermatogenesis in infertile men.
Comparison between Tubeless Mini-Percutaneous Nephrolithotomy Versus Retrograde Intrarenal Surgery for the Treatment of 2 to 3Cm Renal Lithiasis
Authors: Lee Ya-Che , Jou Yeong-Chin , Cheng Ming-Chin , Shen Cheng-Huang , Lin Chang-Te
Published: August 2022

Purpose:

To assess the outcome and safety of tubeless mini-percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) to treat patients with renal and upper ureteral stones between 2 and 3 cm.

Materials and Methods:

Between July 2017 and June 2020, 140 patients underwent tubeless mini-PCNL and RIRS for renal stone size between 2 and 3 cm were enrolled in this study. The outcome was determined immediately after operation on plain radiograph kidney, ureter, and bladder and sonography. Various patient and stone characteristics including perioperative outcomes and complications were evaluated. SPSS version 16. Institutional Review Board of Ditmanson Medical Foundation Chia-Yi Christian Hospital, approval number 2021037.

Results:

Stone-free rates after the procedure were achieved in 78.4% of patients for the tubeless mini-PCNL and 36.4% of patients for the RIRS Group (P < 0.001). However, the stone-free rates at 3 months after surgery were 78.4% for the tubeless mini-PCNL and 68.2% of the RIRS Group (P = 0.172). The mean operative time per patient was 88.6 ± 27.4 min in the tubeless mini-PCNL group, and it was 129.1 ± 44.8 min in the RIRS groups (P < 0.001). The average hospital stay is 3.4 ± 2.0 days in the tubeless mini-PCNL group and 1.9 ± 1.8 days in the RIRS group (P < 0.001). The postoperative infection rates for the tubeless mini-PCNL and RIRS groups were 9.5% and 6.1%, respectively (P = 0.456). Blood transfusions were needed in one patient in the tubeless mini-PCNL group.

Conclusion:

Tubeless mini-PCNL and RIRS are safe and effective methods for medium-sized renal calculi. Tubeless mini-PCNL compared to RIRS offers the better outcome of higher stone-free rate and lower operation time, but with longer hospital stay and stone-free rate (3-month postoperative).
О сложности реализации булевых функций в некоторых классах гиперконтактных схем
Authors: Tarazevich Yury Georgievich
Published: August 2022

В классах $\operatorname{РМ}_F^{(n)}$ расширенных матриц над кольцами полиномов с идемпотентными переменными определены подклассы (гиперконтактных схем): $\operatorname{ГС}_F^{(n)}$ (над произвольным полем $F$) и $\operatorname{ГС}_Z^{(n)}$ (над кольцом целых чисел), - алгебраически расширяющие класс матриц инциденций контактных схем ($\operatorname{КС}^{(n)}$) и реализующие произвольные булевы функции $n$ переменных со сложностью менее $3\sqrt{2}\cdot2^{n/2}$ контактов. Такой же порядок нижней оценки получен для соответствующей функции Шеннона в классе $\operatorname{ГС}_{F_q}^{(n)}$ над произвольным конечным полем $F_q$. Для матриц класса $\operatorname{ГС}_Z^{(n)}$ найдена физическая интерпретация в виде матриц инциденций-зацеплений контактно-трансформаторных схем.
Инверсные гомоморфизмы конечных групп
Authors: Shaposhnikov Igor' Gavrilovich
Published: August 2022

Если в выражении условия гомоморфизма многоосновной универсальной алгебры вместо равенства выполняется неравенство, то говорят о существовании инверсного гомоморфизма многоосновной универсальной алгебры. В работе исследуются методы построения нетривиальных инверсных гомоморфизмов конечных групп.
Короткие условные полные диагностические тесты для схем при однотипных константных неисправностях элементов
Authors: Popkov Kirill Andreevich
Published: August 2022

Доказано, что любую (почти любую) булеву функцию от $n$ переменных можно реализовать схемой из функциональных элементов в базисе «конъюнкция, дизъюнкция, импликация, отрицание», допускающей условный полный диагностический тест глубины не более $n$ (соответственно не более $n-1$) относительно константных неисправностей типа $0$ на выходах элементов.
Marked Cognitive and Activities of Daily Living Improvement by Shunt Embolization in a Very Old Man with Portosystemic Encephalopathy Mimicking Alzheimer Disease: A Case Report
Authors: Kondo Soichiro , Takada Kazufumi , Kojima Taro , Tanaka Kosuke , Yakabe Mitsutaka , Shibata Eisuke , Umeda-Kamayama Yumi , Takao Hidemasa , Ogawa Sumito , Akishita Masahiro
Published: August 2022

A 91-year-old man with chronic cognitive impairment underwent shunt embolization for portosystemic encephalopathy (PSE). He experienced intermittent episodes of impaired consciousness and decreased cognitive function and activities of daily living (ADL), for which Alzheimer disease was suspected. On admission, he was in a coma and PSE was diagnosed based on his high ammonia level and the computed tomography findings. After shunt embolization, the patient fully recovered from the impaired consciousness and experienced no recurrence. The patient’s Revised Hasegawa Dementia Scale and Mini-Mental State Examination scores improved significantly from 12 and 17 to 30 and 29 points, respectively. The Barthel Index score also improved from 55/100 to 85/100, suggesting a marked improvement in ADL. PSE progresses slowly in very old patients and may mimic the clinical course of Alzheimer disease but without liver enzyme abnormalities. Therefore, it should be distinguished in every dementia case.
Care Seeking and Treatment of Febrile Children with and without Danger Signs of Severe Disease in Northern Uganda: Results from Three Household Surveys (2018–2020)
Authors: Awor Phyllis , Kimera Joseph , Brunner Nina C. , Athieno Proscovia , Tumukunde Gloria , Angiro Irene , Signorell Aita , Delvento Giulia , Lee Tristan , Amutuhaire Maureen , Opigo Jimmy , Kaggwa Flavia Mpanga , Kagwire Fred , Nakiganda Juliet , Burri Christian , Lengeler Christian , Hetzel Manuel W.
Published: August 2022

Identification, stabilization, and prompt referral of children with signs of severe febrile disease (danger signs) in rural communities are crucial for preventing complications and death from severe malaria, pneumonia, and diarrhea. We set out to determine the treatment-seeking practices and treatment patterns for children < 5 years of age with an acute febrile illness, with or without danger signs of severe disease, in a highly malaria-endemic area of northern Uganda. Three household surveys were conducted from November through December each year in 2018, 2019, and 2020. Overall, 30% of the children in the study were reported to have had a WHO-classified danger sign including convulsions, unconsciousness/unusually sleepy, inability to feed or drink, and vomiting everything. Only half of the children in this study sought care from a health provider. However, significantly more children with danger signs of severe disease sought and received treatment and diagnostics from a health provider, compared with those without danger signs (adjusted odds ratio: 1.6, 95% confidence interval: 1.2–2.0; P < 0.01). In the total population studied, care seeking in the public sector was 26% and similar to care seeking in the private sector (24%). Community health workers were used as the first source of care by 12% of the children. Approximately 38% of the children who were reported to have danger signs of severe disease requiring prompt referral and treatment did not seek care from a health provider. Understanding and addressing barriers to accessing healthcare could contribute to better treatment seeking practices.
Health Service delivery and training at Makerere University College of Health Sciences: The role of the academic health centers’ network
Authors: Nakanjako Damalie , Byamugisha Josaphat
Published: August 2022

Academic Health Centers provide a network of clinical training facilities for high quality service delivery, within clinical training and research settings. At an academic health/medical center, education, research, and clinical care are combined to provide the best possible clinical care, which uses cutting-edge technologies, resources and therapies other community hospitals may not have available.This paper summarizes the network of teaching hospitals for health care training in the last century of Makerere University College of Health Sciences, its local and regional impact, lessons learned and future of actively engaging the network of academic health centers to expand clinical training and research opportunities to meet the needs of the 21st Century populations.Medical schools and training hospitals need to integrate of their roles in research, education, and patient care to provide evidence-based interventions and innovations to both treat illness and improve health.

Keywords: Academic Health Centers; Clinical training; Health care delivery; Health professions education.
Drugs and alcohol Use patterns among those seeking care in urban rehabilitation centres before and during early months of COVID-19 in Uganda
Authors: Mbona Tumwesigye Nazarius , Ocama Ponsiano , Basangwa David , Matovu Flavia , Abbo Catherine , Wamala Twaibu , Biribawa Claire , Namanda Cissie , Blessing Joshua , Twesigomwe Ronald
Published: August 2022

Introduction: There is a rise in alcohol and other drug (AOD) abuse in the country but details of the practice are scanty. This paper provides characteristics of clients in the rehabilitation centres, their AOD related practices before and early months of COVID-19, and correlates of repeat treatment.

Methods: The study was conducted in 10 rehabilitation centres in Kampala Metropolitan area. Characterization of AOD clients involved descriptive analysis while comparison of AOD related practices pre-and during COVID-19 lockdown was carried out using interrupted time series analysis. Modified Poisson regression model was used to analyse the repeat treatment.

Results: The clients were mostly male (85%), single (57%) and had attained secondary education (84%). Nearly a third of them (29%) were unemployed while 68% were aged between 15-34 years. The commonest substances used were alcohol (52%), cannabis (19%), cocaine (13%) and opioids (8%). The commonest sources of substances were street dealers (52%) and friends (37%). COVID-19 did not change the pattern of AOD use except for Opioids. Repeat treatment was associated with being male, seeking care in private facilities, being casual labourer/self-employed.Conclusion: Intervention programs should target the educated, the unemployed, young men, their friends, street drug dealers and AOD hotspots.

Keywords: Covid 19; substance use; rehabilitation centres; drugs; alcohol; interrupted time series; modified Poisson regression.
Editorial: A century of health professions’ education, training, academic research and service at Makerere University, Kampala, Uganda
Authors: Nakanjako Damalie , Omaswa Francis
Published: August 2022

NIL.
Clinical observership as an aid to learning and understanding of human embryology
Authors: Tijani Ahmed Adekilekun , Alese Margaret Olutayo , Adetunji Adedeji Enitan , Oluwadiya Kehinde Sunday
Published: August 2022

Hands-on learning approach such as ‘Clinical observership’ is globally applicable in learning. This study evaluated clinical observership as an aid to  pre-clinical medical students’ understanding of human embryology. Students were grouped into A and B; group B took calls as studentobservers in  the labour ward of Ekiti State University Teaching Hospital in addition to taking regular classes in embryology while group A was the control group.  Previously validated selfadministered questionnaires were used to test students’ intelligence quotient and knowledge of embryology before and  after lectures and clinical observership. The short-term effect of clinical observership was tested by comparing the pre-field and post-field responses  of the studentvolunteers while the long-term effect was tested by evaluating their performance in the first professional exams after the  completion of pre-clinical program. The perception of group B participants on the observership program was assessed with a pre-tested  questionnaire. There was no significant difference (p=0.4162) in the IQ between the control (77±1.2) and the experimental group (79±1.4). There was  no significant difference (p= 0.0795) in the mean preobservation test score between the control (33±1.7) and the experimental group (38±1.7).  However, a significant increase (p=0.0282) was observed in the mean post-observation test score in the experimental (29±2.4) when compared with  the control (22±1.9). Although there was an increase in the mean score in the MBBS exam in the experimental group (59±2.7) when compared with  the control (57±2.0), it was not statistically significant. On the perception of the method in improving learning, majority of the students were  affirmative. Clinical observership enhances the learning of embryology hence we recommend its incorporation into the teaching methods of  embryology in medical schools.
Anatomical investigation on the craniofacial and ocular morphometrics of the male Western Cattle egret (Bubulcus ibis)
Authors: Ayodeji Azeez Idris , Kazeem Ekeolu Oyetunde , Levi Usende Ifukibot , Abiola Adejumobi Olumuyiwa , Adefunke Adetogun
Published: August 2022

The heron species, Cattle egret (Bubulcus ibis) can be found all over the world. In the South-Western region of Nigeria, they are colonial, white in  colour, and are seen in open lands and around water bodies. Morphometric data are important parameter in the assessment of functional  morphology, hence we here present for the first time, data on the craniofacial indices of cattle egret. The cranium, nasal, orbital and beak  morphometric indices and correlation data of the cattle egret were investigated on the fresh specimen and macerated skull of the male cattle  egrets, using the GraphPad Prism. The height of the cranium was 33.92±0.970 cm, while the cranium length and breadth were 52.92±1.800 and  34.48±1.714, respectively. The right eye socket length, 36.17±5.636 and breadth, 31.67±2.160 were slightly greater than the left eye socket length,  35.92±4.128 and breadth, 31.00±2.757. There was a strong positive correlation between the right eye socket breadth and the left eye socket breadth  (r=0.940), and also, a very strong positive correlation was found between the right and the left eye socket length (r=0.981). Results showed the  foramen magnum length and breadth to be 19.17±0.753 and 18.83±0.753, respectively, however, a low positive correlation was recorded between  the foramen magnum length and breadth (r=0.059). A strong positive correlation was observed between the upper beak length and the lower beak  length (r=0.901), while similar values were recorded for the nasal breadth and length, respectively. Data generated from this study will prove useful  in comparative, regional and clinical anatomy and could also help in identifying archaeological remains of the cattle egrets.
A perineal branch of the sciatic nerve: A case report
Authors: Otieno Elisha Harry , Ong’idi Ibsen , Misiani Musa , Munguti Jeremiah , Ongeti Kevin
Published: August 2022

No Abstract.
Variations in Ocular Biometrics Related to Refractive Errors Among Adult Patients Attending the University Teaching Hospitals-Eye Hospital in Lusaka, Zambia
Authors: Ng’andu Albertina , Krikor Erzingatsian , Mutati Grace Chipalo
Published: August 2022

Coordination among anatomical components (Ocular biometrics) of the eye [corneal and lens power (CP/LP), anterior chamber depth (ACD), lens  thickness (LT), and axial length (AL)] determine the refractive state of the eye. Ocular biometric measurements are crucial for the selection of the  correct IOL and prescription of power to achieve the desired refractive outcome after cataract surgery and refractive errors respectively. This was a  cross-sectional study conducted at University Teaching Hospitals Eye Hospital in Lusaka– Zambia; from April to June 2021, to assess the relationship  between ocular biometrics and refractive errors. The study involved the measurement of refractive errors and ocular biometrics (Axial length, Lens  power, Lens thickness, anterior chamber depth, corneal dioptric power, corneal radius, and Pupil size) in 205 study participants aged between 16  and 60 years of which 64 (31.2%) were males and 141 (68.8%) were females. Refractive errors were measured with a KR-9600  auto keratore fractometer whilst Ocular biometric parameters were done using an Optilex 780 marvels 11 A/B Scan Dell ultrasonography machine  and autokeratometry. Out of 205 recruited study participants, 135 (65.9%) had refractive errors. The proportion of types of refractive errors were 66  (48.9%), 39 (28.9%), 19 (14.1%), and 11 (8.1%) for myopia, presbyopia, astigmatism, and hyperopia respectively. Variations of ocular biometrics  among participants showed that mean values of anterior chamber depth, axial length and pupil size were greater in myopic study participants (2.7 mm, 23. 9 mm, and 4.39 mm respectively). Mean Lens thickness was much thicker in Presbyopia (3.95+/-0.65) while Lens power varied across all  types of REs. Ocular biometrics related to refractive errors were axial length, anterior chamber depth, and lens thickness. Axial length and anterior  chamber depth associated strongly with Myopia while lens thickness was more linked to Presbyopia. Age (16 and 47) years, inheritance, and  childhood-onset associated strongly with Myopia while Presbyopia increased with increase in age.