bluuebunny/crossref_metadata_2025 huggingface dataset:
A aliança indígena com as novas tecnologias da informação: as investidas dos povos originários amazônicos diante um cenário multifacetado
Authors: Pereira Paulo César Barros , Suruí Gasodá Wawaeitxapôh , Silva Maria Liziane Souza , Silva Adnilson de Almeida
Published: March 2023

Este trabalho é fruto das pesquisas realizadas durante fase da Dissertação de Mestrado em Geografia defendida em 2020. O objetivo foi analisar a inserção das novas tecnologias da informação e comunicação como meio de defesa territorial dentro dos Territórios Indígenas dos Ashaninka situados no estado do Acre e dos Paiter Suruí, do estado de Rondônia. Nos últimos anos alguns povos indígenas da Amazônia brasileira têm buscado novos métodos de melhorar seu bem viver, defendendo seu território e preservando sua herança cultural. As pressões territoriais e culturais depois do contato com o não indígena têm se tornado cada vez mais fortes. Diante disso, alguns destes povos tem se posicionado no enfrentamento diante tais ameaças ao utilizar modernos aparatos como oportunidade não somente de ressignificação ancestral e histórica, mas, de autonomia indígena, em um cenário multifacetado e complexo. Para refletirmos sobre tais questões adotamos o método fenomenológico que consiste na ciência dos fenômenos e propõe olhar para as nossas experiências com uma postura científica. Adotamos duas técnicas, a bibliográfica e a fonte oral, esta última considerada a mais antiga na difusão e propagação do saber. Como resultado apresentamos a utilização de equipamentos tecnológicos adotados pelas duas etnias (Ashaninka e Paiter Suruí), as quais são tidas como fundamentais para a defesa de seus territórios, bem como para o estabelecimento de parcerias estratégias para seus projetos e fortalecimento de suas identidades étnicas.
Uso e cobertura da terra e efetividade das normativas legais em unidades de conservação no estado de Goiás - Brasil
Authors: Nunes Fabrizia Gioppo , Santos Alex Mota dos
Published: March 2023

Reconhecendo a inequívoca importância das Unidades de Conservação (UCs) para a manutenção dos ecossistemas naturais, o objetivo deste trabalho foi o de avaliar a eficiência, ou não, da preservação da vegetação nativa dentro dos limites do Parque Estadual de Terra Ronca (PETeR) e da Área de Proteção Ambiental (APA) da Serra Geral de Goiás (APASG), após decretos de criação. Para tanto, foram utilizados dados do Projeto de Mapeamento Anual do Uso e Cobertura da Terra no Brasil (MapBiomas), em diferentes datas de aquisição e processados via ferramentas de análises espaciais em um Sistema de Informação Geográfica. Para a avaliação do teor da biomassa e da conservação da vegetação original foi aplicado o Índice de Vegetação por Diferença Normalizada (NDVI). Os resultados revelaram que existe uma melhor conservação da vegetação nativa no interior do PETeR do que na APASG. Dessa forma, pode-se constatar, que diferentemente da APASG, o PETeR está cumprindo com seu objetivo de preservar a natureza. O NDVI permitiu avaliar a dinâmica espaço-temporal do uso e cobertura da terra, havendo variação entre os seus valores, a depender do tipo fitofisionômico da vegetação de cerrado e das características do ambiente, mostrando-se como um bom complemento de análise do procedimento adotado.
Probabilidade de ocorrência de temperaturas mínimas e máximas mensais do ar prejudiciais e favoráveis aos cultivos agrícolas no Rio Grande do Sul
Authors: Borges Rodrigo de Morais , Cargnelutti Filho Alberto , Loro Murilo Vieira
Published: March 2023

Os objetivos deste trabalho foram verificar o ajuste de séries temporais de temperaturas mínima mensal (Tmín) e máxima mensal (Tmáx) do ar, do Estado do Rio Grande do Sul, às distribuições de probabilidade normal, log-normal, gama e weibull, determinar probabilidades de ocorrência e elaborar mapas com a interpolação de isolinhas. Aplicou-se o teste de aderência de Kolmogorov-Smirnov em 216 séries temporais de Tmín e 216 séries temporais de Tmáx (18 municípios × 12 meses). Com base na distribuição normal, determinaram-se valores de Tmín, cuja probabilidade de ocorrência de Tmín menor ou igual a esse valor é de 90%, e valores de Tmáx, cuja probabilidade de ocorrência de Tmáx maior ou igual a esse valor é de 90%. A partir desses valores foram elaborados mapas com interpolação de isolinhas com diferença de 0,5ºC. Os dados de Tmín e Tmáx se ajustam às distribuições normal, log-normal, gama e weibull, apresentando melhor aderência à distribuição normal. Os mapas com as isolinhas são úteis para verificar a probabilidade de ocorrência de Tmín e Tmáx prejudicial ou favorável para culturas agrícolas no Estado do Rio Grande do Sul, durante os meses do ano.
Relações entre os espaços rurais e urbanos e as taxas de incidência de malformações congênitas no Brasil
Authors: Rudy Julia Taveira , Matos Karina Flávia Ribeiro , Silva Gabriel Rodrigues Rocha e , Miranda Marina Jorge de , Lara Flávio Alves , Gurgel Helen
Published: March 2023

Estima-se que cerca de 2% a 5% dos nascidos vivos no mundo apresentam algum tipo de malformação detectada no nascimento. As maiores prevalências de malformação congênita no Brasil estão na Bahia, Distrito Federal, Alagoas, Pernambuco, Ceará, Tocantins e Sergipe. Malformações congênitas podem ser decorrentes de diversos fatores, inclusive ambientais. Para uma compreensão mais adequada da distribuição deste evento no país, deve-se considerar a complexidade e a heterogeneidade de manifestações socioeconômicas observadas na extensão do território. Neste contexto, este estudo tem como objetivo caracterizar a distribuição das taxas de malformações congênitas segundo as tipologias de espaços rurais e urbanos no Brasil, definidas pelo Instituto Brasileiro de Geografia e Estatística (IBGE). Para tanto, utilizou-se dados secundários de malformações congênitas e o número de nascidos vivos por município de residência da mãe de 2012 a 2017 disponibilizados pelo Ministério da Saúde (MS). Verificou-se a concentração de altas prevalências de malformações congênitas em municípios rurais sugere a necessidade de estudos que identifiquem fatores que tenham de alguma forma contribuído para as malformações congênitas, bem como que caracterizem o acesso dessas populações aos serviços de saúde, para melhor adequar as políticas públicas vigentes às necessidades de saúde dessas populações.
Immunogen-Specific Strengths and Limitations of the Activation-Induced Marker Assay for Assessing Murine Antigen-Specific CD4+ T Cell Responses
Authors: Nguyen Nguyen X , Richens Andrew W , Sircy Linda M , Allard Denise E , Kolawole Elizabeth M , Evavold Brian D , Bettini Maria , Hale J Scott
Published: March 2023

The activation-induced marker (AIM) assay is a cytokine-independent technique to identify Ag-specific T cells based on the upregulated expression of activation markers after Ag restimulation. The method offers an alternative to intracellular cytokine staining in immunological studies, in which limited cytokine production makes the cell subsets of interest difficult to detect. Studies of lymphocytes in human and nonhuman primates have used the AIM assay to detect Ag-specific CD4+ and CD8+ T cells. However, there is a lack of validation of the strengths and limitations of the assay in murine (Mus musculus) models of infection and vaccination. In this study, we analyzed immune responses of TCR-transgenic CD4+ T cells, including lymphocytic choriomeningitis virus–specific SMARTA, OVA-specific OT-II, and diabetogenic BDC2.5-transgenic T cells, and measured the ability of the AIM assay to effectively identify these cells to upregulate AIM markers OX40 and CD25 following culture with cognate Ag. Our findings indicate that the AIM assay is effective for identifying the relative frequency of protein immunization–induced effector and memory CD4+ T cells, whereas the AIM assay had reduced ability to identify specific cells induced by viral infection, particularly during chronic lymphocytic choriomeningitis virus infection. Evaluation of polyclonal CD4+ T cell responses to acute viral infection demonstrated that the AIM assay can detect a proportion of both high- and low-affinity cells. Together, our findings indicate that the AIM assay can be an effective tool for relative quantification of murine Ag-specific CD4+ T cells to protein vaccination, while demonstrating its limitations during conditions of acute and chronic infection.
A Quality Index Method-based evaluation of sensory quality of red mullet (Mullus barbatus) and its shelf-life determination
Authors: Lauteri Carlotta , Ferri Gianluigi , Pennisi Luca
Published: March 2023

Every day the consumer must choose a food product rather than others based on its quality; for fishery products the main quality parameter is freshness. Implementation of the Quality Index Method (QIM) in the fish industry provides information on fish quality; therefore, it is important for effective quality and process management in the production of high-quality fish products. The present study aims to validate the shelf- life study of fresh red mullet (Mullus barbatus) stored in ice previously presented by Özyurt in 2009 through Torry scheme in cooked filet and microbiological evaluation. Next, this revised scheme was applied to determine the shelf-life. It included seven descriptors and varies from 0 to 15 points. The use of a modified QIM scheme showed a good correlation between the quality index and days of storage time, with a R2 value of 0.9698. In fact, all the subjects examined reached the end of their commercial life, or the day of sensory rejection, in 9-10 days with a Quality Index of 13.83.
Research and characterization of fibrous microplastics and natural microfibers in pelagic and benthic fish species of commercial interest
Authors: Santonicola Serena , Volgare Michela , Di Pace Emilia , Mercogliano Raffaelina , Cocca Mariacristina , Raimo Gennaro , Colavita Giampaolo
Published: March 2023

The ingestion of synthetic microfibers, the most prevalent type of microplastics in marine environments, and natural fibers was assessed in Engraulis engrasicolus and Mullus barbatus, two commercially important fish species in the Mediterranean Sea. Microfibers were isolated from the fish gastrointestinal tract using a 10% potassium hydroxide solution. For the microfiber characterization, the evaluation of specific morphological features using a light microscope, coupled with the Fourier-transform infrared (FTIR) analysis of a subsample of isolated particles, was applied. The preliminary results showed the occurrence of microfibers in 53 and 60% of European anchovy and Red mullet, respectively. A mean of 6.9 microfibers/individual was detected in anchovies, while on average Red mullet samples contained 9.2 microfibers/individual. The most common colors of fibers in both species were black, blue, and transparent. Visual characterization of fibers allowed the classification of 40% of the items as synthetic microfibers. FTIR spectroscopy confirmed the visual classification by fiber morphology. Microfibers were made of different typologies of polymers, represented by cellulose, cotton, and polyester. These findings confirm as the wide distribution of fibrous microplastics, and natural microfibers may impact both pelagic and deep-sea trophic webs. Despite the presence of microfibers in fish species poses a potential risk to human health, the literature is scarce regarding studies on the uptake by commercial marine fish mostly due to methodological issues. The visual characterization, corroborated by spectroscopic techniques, may be useful to differentiate synthetic and natural fibers, representing a fast and easy method to assess fibrous microplastic pollution in commercially important fish species.
Relation between Cardiometabolic Risk Factors and Obesity Differs in Children and Adults
Authors: Haq Tahniyah , Tohfa-E-Ayub  , Fariduddin Md. , Sutradhar Palash Chandra , Aurpa Nishat Nayla , Hasanat Md. Abul
Published: March 2023

Background:

Obesity is a harbinger of cardiovascular disease. It is affecting individuals from an early age.

Aim:

The aim of the study was to compare cardiometabolic risk factors (CRFs) in obese children and adults; and to see their relationship with obesity.

Materials and Methods:

Two hundred and thirty-nine overweight and obese individuals (189 ≤20 and 50 >20 years) without secondary causes of obesity were included and data on their CRFs (blood pressure, plasma glucose, glycated hemoglobin, and lipid profile) were obtained from clinic records.

Results:

Mean age and body mass index (BMI) of ≤20 years of group were 13.77 ± 2.32 years and 33.29 ± 8.45 kg/m2, respectively. The mean age and BMI of >20-year group were 39 ± 1.41 years and 36.81 ± 2.40 kg/m2, respectively. Participants in the ≤20-year group had a lower rate of abnormal glucose tolerance (28.9% vs. 61.9%, P < 0.001) and hypertension (3.6% vs. 15.4%, P < 0.001), but a higher rate of dyslipidemia (98.8% vs. 97.5%, P < 0.001) than the ≤20 years of group. After adjusting for all cardiovascular risk factors, diastolic blood pressure was significantly related to obesity (BMI β = 0.380, P = 0.001; waist circumference β = 0.499, P < 0.001; fat mass index β = 0.407, P = 0.001; waist height ratio β = 0.356, P = 0.004) in the ≤20-year group, while fasting plasma glucose was related to BMI (β = 1.086, P = 0.001) in the >20-year group.

Conclusion:

There is a high rate of dyslipidemia in young obese individuals. Blood pressure is associated with obesity at a younger age, while dysglycemia is associated with increasing BMI in adults.
Determination of hematological response to iron and folic acid supplementation among the expectant mothers attending Kakamega County Referral Hospital, Kenya
Authors: Dennis Kirui , Marera Dominic , Were Tom
Published: March 2023

Background

Despite iron and folic acid supplementation program among expectant mothers while attending antenatal care clinic at Kakamega County, the rates of maternal and fetal morbidity and mortality due to anemia complications are still high.

Aim

First, we determined changes in hematological profiles following iron and folic acid supplementation. Second, we determined association between hematological changes with demographic and clinical characteristics in response to iron and folic acid supplementation.

Patients and methods

Full hemogram and reticulocyte profiles of 127 expectant mothers were determined at baseline and endpoint after 1 month of iron and folic acid supplementation. Full hemogram profiles were measured using a Maxim 3010 fully automated hematology analyzer, whereas reticulocyte profiles were examined microscopically at ×100 magnification. Demographic data were collected using pretested structured questionnaires.

Results

The end point measures of red blood cells, hemoglobin (Hb), hematocrit, mean cell volume, reticulocyte count, reticulocyte production index, and absolute reticulocyte number among the anemic mothers were significantly higher relative to baseline levels. Among nonanemic mothers, Hb and mean cell volume levels differed significantly between baseline and end point of the study. The change in erythropoietic response and adequate Hb response was significantly associated with adherence to iron and folic acid supplement.

Conclusion

Hematological profiles significantly changed especially among anemic mothers following iron and folic acid supplementation. Adherence to supplement is associated with positive erythropoietic response and adequate Hb response.
Tyrosine kinase inhibitors reduce myeloid-derived suppressor cells in patients with chronic myeloid leukemia with better outcome
Authors: Refaat Youmna , Rahman Youseria A. , Mohammed Saleh Mostafa F. , Sayed Douaa M. , Elzohri Mona H.
Published: March 2023

Background and objectives

Myeloid-derived suppressor cells (MDSCs) are increased in several hematologic malignancies. We looked at the effect of imatinib and nilotinib (tyrosine kinase inhibitors) on MDSCs in patients with chronic myeloid leukemia (CML) and how those cells could affect prognosis in CML.

Patients and methods

A randomized controlled trial was conducted that enrolled 103 patients with newly diagnosed chronic phase CML who were randomly subgrouped into group I, which included patients treated with oral imatinib (n=58) 400 mg/day, and group II, which included patients treated with oral nilotinib (n=45) 600 mg/day. Follow-up of BCR/ABL transcript was measured by quantitative PCR every 3 months. Moreover, detection of the percentages of granulocytic-MDSCs and monocytic (M-MDSCs) in the peripheral blood (HLA-DR/CD11b//CD33/CD14) by flow cytometry was done at baseline and during follow-up.

Results

Both groups had insignificant difference regarding baseline laboratory and clinical data. Both groups showed significant reduction in MDSCs but with insignificant differences between both of them. Patients did not achieve major molecular response (MMR) and had significantly higher M-MDSCs at baseline. Moreover, baseline M-MDSCs were a predictor for MMR (odds ratio=0.78, 95% confidence interval=0.66–0.93) and for loss of MRR (odds ratio=2.17, 95% confidence interval=1.22–3.87). For prediction of MMR, baseline M-MDSCs had 89.2% accuracy at cutoff point less than 8.9% and had 89.5% accuracy for prediction of loss of MMR at a cutoff point more than 8.5%.

Conclusion

Both imatinib and nilotinib are effective in reducing MDSCs in patients with CML. Baseline M-MDSCs are predictors of MMR and loss of response in patients with CML. The study was registered on clinicaltrials.gov with NCT03214718.
A narrative review of what the neuropathologist needs to tell the clinician in neuro-oncology practice concerning WHO CNS5
Authors: Hou Yanghao , Sahm Felix
Published: March 2023

The fifth edition of the World Health Organization Classification of Tumors of the Central Nervous System (WHO CNS5) was released in late 2021. The adoption of new tumor nomenclature, grading criteria, terminology, tumor types, and novel diagnostic approaches, including methylation profiling, will benefit the precise diagnosis of CNS tumors, facilitate optimal patient care and improve diagnostic reproducibility with higher clinical relevance. However, the gap between rapid updates in tumor classification and the clinical management of patients requires frequent and up-to-date communications between neuropathologists and clinicians. This review aims to provide an overview of WHO CNS5, focused on the changes that are most pertinent to the clinical care of patients. Forming concrete ideas for neuropathologists that are necessary to express to clinicians, for a better understanding of how the patient may benefit from the new classification.
Outcomes of Descemet’s membrane endothelial keratoplasty performed in combination with, before, or after cataract surgery in Fuchs’ endothelial dystrophy: A review of the literature and meta-analysis
Authors: Mukhija Ritika , Henein Christin , Lee Hanbin , Phee Jaewon , Nanavaty Mayank A
Published: March 2023

This review aimed to compare the outcomes of Descemet’s membrane endothelial keratoplasty (DMEK) in combination with (category 1), before (category 2), or after cataract surgery (category 3) in patients with Fuchs’ endothelial dystrophy (FED). Primary outcome was gain in best-corrected log of minimum angle of resolution (logMAR) visual acuity (BCVA). Secondary outcomes were graft detachment, rebubbling rates, rejection, failure, and endothelial cell loss (ECL). In category 1, 2, and 3, 12 studies (N = 1932) were included (five in category 1 [n = 696], one in category 2 [n = 286], and two in category 3 [n = 950], and the remaining four compared between two of the three categories). At 6 months, the gain in BCVA was 0.34 ± 0.04, 0.25 ± 0.03, and 0.38 ± 0.03 logMAR in category 1, 2, and 3, respectively. The difference was significant between categories 1 and 2 (Chi2 = 11.47, P < 0.01) and categories 2 and 3 (Chi2 = 35.53, P < 0.01). At 12 months, the gain in BCVA was 0.52 ± 0.05 and 0.38 ± 0.06 logMAR in categories 1 & 3 (Chi2 = 14.04, P < 0.01). The rebubbling rates were 15%, 4%, and 10% (P < 0.01) and the graft detachment rates were 31%, 8%, and 13% (P < 0.01) in categories 1, 2, and 3, respectively. However, graft rejection, survival rates, and ECL at 12 months were not different between categories 1 and 3. There is low certainty evidence that gain in BCVA in category 1 was comparable to category 3 at 6 months; however, it was significantly better with category 3 at 12 months. Although rebubbling and graft detachment rates were highest in category 1, there was no significant difference in graft rejection, survival rates, and ECL. Further high-quality studies are likely to change the effect estimate and have an impact on the confidence of the estimate.
Orthokeratology compliance, digital device use, and myopia control among children with myopia during COVID-19 home confinement in Taiwan
Authors: Chang Li-Chun , Sun Chi-Chin , Liao Li-Ling
Published: March 2023

Purpose:

The coronavirus disease 2019 (COVID-19) pandemic profoundly impacts lifestyle habits and myopia control in children worldwide. This study investigated the changes in eyecare habits, orthokeratology compliance, axial length, and time interval of follow-up visits during home confinement in the COVID-19 pandemic in Taiwan.

Methods:

This investigation was part of a prospective study undertaken to evaluate the effectiveness of a mobile application. A semi-structured telephone interview was conducted with parents retrospectively to document eyecare habits and myopia control during the COVID-19 home confinement.

Results:

Thirty-three children with myopia participated in the follow-up of orthokeratology lenses for 2 years. The children’s time viewing digital devices such as tablets and televisions significantly increased during the COVID-19 pandemic (P < 0.05). An analysis using McNemar’s test found that the proportional growth of axial length <0.2 mm in 2021 was significantly higher than that in 2020 (77.42% vs. 58.06%, P < 0.05). In the multivariate logistic regression analysis, onset <10 years of age (P = 0.001) and parents with high myopia (P < 0.001) were independent risk factors for the growth of axial length ≥0.2 mm in 2021.

Conclusion:

The suspension of face-to-face classes and after-school tutorials benefited myopic axial elongation in children during COVID-19 home confinement. The use of digital devices and staying indoors may not be the exclusive reasons for myopia progression. Educating parents about the influence of extra learning classes after school on myopia progression would be prudent.
Observation of the curative effect of scleral suture fixation technique with four-loop foldable intraocular lens
Authors: Liu Caijuan , Chen Zhimin , Zhang Baoyue
Published: March 2023

The objective of the study was to evaluate the curative effect of a modified technique of scleral suture fixation with a four-loop foldable intraocular lens (IOL) for eye with inadequate capsule support. This was a retrospective study of 22 eyes with inadequate capsule support of 20 patients who underwent the scleral suture fixation technique with 9-0 polypropylene suture and foldable four-loop IOL implant. Preoperative and follow-up data were collected for all patients. The mean follow-up was 5.08 ± 0.48 months (range: 3–12 months). The mean pre- and postoperative log of minimum angle of resolution (logMAR) uncorrected distance visual acuity was 1.11 ± 0.32 versus 0.09 ± 0.09 (P < 0.001). The mean pre- and postoperative logMAR best corrected visual acuity was 0.37 ± 0.19 versus 0.08 ± 0.07 (P < 0.001). The intraocular pressure (IOP) increased briefly (range: 21–30 mmHg) in eight eyes on the first day postoperatively and returned to normal within 1 week. No IOP drops were used postoperatively. The IOP was 12–19.3 (13.72 ± 1.28) in this follow-up, which had no significant difference compared to the preoperative IOP (t = 0.34, P = 0.74). At this follow-up, there was no hyperemia, local hyperplasia, obvious scar, suture knots, or segment ends observed under the conjunctiva, as well as no pupil deformation or vitreous hemorrhage. The mean postoperative IOL decentration degree was 0.22 ± 0.08 mm. At the 7-day follow-up postoperatively, one side of the IOL was dislocated to the vitreous cavity in one case, which was resolved by reimplantation of a new IOL in time with the same technique. Scleral suture fixation technique of a four-loop foldable IOL was a feasible operation method for an eye with inadequate capsular support.
Clinical outcome of diffractive multifocal lens versus monofocal lens in post-laser in situ keratomileusis patients: A retrospective, comparative study
Authors: Cheng Anny M S , Yin Han Y , Davenport Connor , Walter Keith
Published: March 2023

Purpose:

To compare the clinical outcomes of diffractive multifocal and monofocal lenses in post-laser in situ keratomileusis (LASIK) patients who underwent cataract surgery.

Methods:

This was a retrospective, comparative study of clinical outcomes that was conducted at a referral medical center. Post-LASIK patients who underwent uncomplicated cataract surgery and received either diffractive multifocal or monofocal lens were studied. Visual acuities were compared at baseline and postoperatively. The intraocular lens (IOL) power was calculated with Barrett True-K Formula only.

Results:

At baseline, both groups had comparable age, gender, and an equal distribution hyperopic and myopic LASIK. A significantly higher percentage of patients receiving diffractive lenses achieved uncorrected distance visual acuity (UCDVA) of 20/25 or better (80 of 93 eyes, 86% vs. 36 of 82 eyes, 43.9%, P = 1.0 x 105) and uncorrected near vision of J1 or better (63% vs. 0) compared to the monofocal group. The residual refractive error had no significant difference (0.37 ± 0.39 vs. 0.44 ± 0.39, respectively, P = 0.16) in these two groups. However, more eyes in the diffractive group achieved UCDVA of 20/25 or better with residual refractive error of 0.25–0.5 D (36 of 42 eyes, 86% vs. 15 of 24 eyes, 63%, P = 0.032) or 0.75–1.5 D (15 of 21 eyes, 23% vs. 0 of 22 eyes, P = 1.0 x 10−5) compared to the monofocal group.

Conclusion:

This pilot study shows that patients with a history of LASIK who undergo cataract surgery with a diffractive multifocal lens are not inferior to those who receive monofocal lens. Post-LASIK patients with diffractive lens are more likely to achieve not only excellent near vision, but also potentially better UCDVA, regardless of the residual refractive error.
Distribution of corneal densitometry in different grades of keratoconus
Authors: Mounir Amr , Awny Islam , Yousef Hassan S , Mostafa Engy M
Published: March 2023

Purpose:

To evaluate the use of Scheimpflug tomography in corneal densitometry (CD) in comparing the stages of keratoconic eyes.

Methods:

Keratoconic (KC) corneas (stages 1–3 classified according to the topographic parameters) were examined using the Scheimpflug tomographer (Pentacam, Oculus) using the CD software. CD was measured over three different depths (anterior stromal layer [120 μm], posterior stromal layer [60 μm], and middle stromal layer between these two layers), and concentric annular zones (0.0 to 2.0, 2.0 to 6.0, 6.0 to 10.0, and 10.0 to 12.0 mm diameter area).

Results:

The study participants were divided into three groups: keratoconus (KC) stage 1 (KC1) with 64 participants, keratoconus stage 2 (KC2) with 29 participants, and keratoconus stage 3 (KC3) with 36 participants. Comparing CD of all three layers (anterior, central, and posterior) of the cornea over different circular annuli (0–2, 2–6, 6–10, and 10–12 mm) revealed a significant difference in the 6–10 mm annulus between all groups and in all layers (P = 0.3, 0.2, and 0.2, respectively). Area under curve (AUC) was done. It revealed that the central layer showed the highest specificity (93.8%) in comparing KC1 and KC2, whereas CD in the anterior layer between KC2 and KC3 had the highest specificity (86.2%).

Conclusion:

CD showed increased values in the anterior corneal layer and in the annulus 6–10 mm more than other locations in all stages of KC.
Comparison of conjunctiva-related complications between scleral and corneal patch grafts in Ahmed glaucoma valve implantation
Authors: Panda Smita , Khurana Mona , Vijaya Lingam , George Ronnie , Balekudaru Shantha
Published: March 2023

Purpose:

Comparison of the conjunctiva related complication rates and success rates among eyes with Ahmed glaucoma valve (AGV) implantation in which eye bank derived scleral and corneal patch grafts had been used to cover the tube.

Methods:

Retrospective comparative study. Patients who underwent AGV implantation between January 2000 to December 2016 were included. Demographic, clinical data, intra and post operative data was obtained from electronic medical records. Conjunctiva related complications were divided into two groups: with and without implant exposure. Conjunctiva related complication rates, success rate, risk factors among eyes with corneal and scleral patch graft were compared.

Results:

Three hundred and twenty three eyes of 316 patients underwent AGV implantation. Scleral patch graft was used in 214 eyes of 210 patients (65.9%) and corneal patch graft was used in 109 eyes of 107 patients (34%). Median follow up was 14 months. There was no significant difference in the conjunctiva related complication rate (7.3 % in corneal patch graft versus 7.0% in scleral patch graft;p=0.5) and conjunctival dehiscence rate (3.7% versus 4.6%, P = 0.7) among the two groups. Success rate was significantly higher in the corneal patch graft group versus the scleral patch graft group (98% versus 72%; p=0.001). Eyes with corneal patch graft had a higher survival rate (P = 0.01).

Conclusion:

There was no significant difference in the rate of conjunctiva related complications following corneal and scleral patch grafts used to cover the AGV tube. Eyes with corneal patch graft had a higher success rate and survival rate.
Strabismus in pediatric orbital wall fractures
Authors: Bhate Manjushree , Adewara Bolajoko , Bothra Nandini
Published: March 2023

Purpose:

To assess the clinical profiles and outcomes of strabismus in pediatric patients with orbital wall fractures.

Methods:

A retrospective interventional study of all consecutive children of age ≤16 years who presented with traumatic orbital wall fractures with and without resultant strabismus was conducted. The details of patient demographics, clinical features, interventions, and outcomes were obtained.

Results:

Forty-three children presented with traumatic orbital fractures to a tertiary care center. The mean age at presentation was 11 years and there was a male predominance (72.09%). Isolated floor fracture involvement was the most common (n = 24, 55.81%), and almost half of the children had a white-eyed or trapdoor fracture (n = 21, 48.83%). Twenty-six (60.46%) children had surgical repair of fracture(s). Manifest strabismus following orbital fracture was documented in 12 children (27.90%). Of these, an exotropia was noted in seven (58.33%), hypotropia in two (16.67%), hypertropia in one (8.33%), and esotropia in one patient (8.33%), while an exotropia with hypotropia was noted in one patient (8.33%). Restrictive nature of strabismus due to either muscle entrapment or local trauma was more commonly observed in 11/12 patients (91.66%). Primary position diplopia before orbital wall fracture repair was observed in four children and after repair was observed in two children with manifest strabismus. Four children underwent strabismus surgery post-fracture repair.

Conclusion:

An improvement in strabismus and ocular motility was noted in majority of the patients after fracture repair. The few that underwent strabismus surgery had a restrictive nature of strabismus. Trapdoor fractures and the nature of trauma in children vary compared to adults. Persistence of strabismus may be due to an excessive time interval between trauma and fracture repair or the extensive nature of trauma.
Cataract surgical training among residents in India: Results from a survey
Authors: Nair Akshay Gopinathan , Mishra Deepak , Prabu A
Published: March 2023

Purpose:

To assess the quantum of cataract surgical training opportunities for trainees enrolled in ophthalmology residency programs in India.

Methods:

An anonymous online survey was sent across to resident ophthalmologists across India through various social media platforms. The results were tabulated and analyzed.

Results:

A total of 740 resident ophthalmologists participated in the survey. In all, 40.1% (297/740) were independently performing cataract surgeries. Of those who were not performing independent cataract surgeries, 62.5% (277/443) were in the third year of residency. A significantly higher proportion of trainees who were not operating independent cataract surgeries were enrolled in MD/MS programs as compared with DNB courses (65.6% vs. 43.7%; P < 0.0001). Of those who were operating independent cases; 97.1% had exposure to manual small incision cataract surgery (MSICS), whereas only 14.1% performed phacoemulsification. It was noted that 31.3% of residents reported that on an average a trainee in their training program performed less than 100 independent cataract surgeries throughout the residency. Apart from cataract surgery, the most performed surgeries by residents were pterygium excision (85.3%), followed by enucleation/evisceration (68.1%). When it came to training aids, 47.2% (349/740) of the respondents reported no access to wet lab, animal/cadaver eyes, or surgical simulators for training.

Conclusion:

The amount of surgical exposure in terms of cataract surgery across residency programs in India is low with most of the ophthalmology residents who participated in this survey not operating cataracts independently; even in their final year of residency. Exposure to phacoemulsification in residency programs is very limited across the country. Although some programs do provide well-rounded surgical exposure to trainees, such centers are scarce; the stark variations in infrastructure, training opportunities, and surgical numbers warrant an overhaul in the structure and curriculum of residency programs in India.
Graft rejection in component keratoplasty
Authors: Deshmukh Rashmi , Murthy Somasheila I , Rapuano Christopher J , Vajpayee Rasik B
Published: March 2023

Among the various indications for keratoplasty, failed graft is one of the commonest indications in many published series. It is well known that the major cause of graft failure is endothelial rejection. In the last two decades, there has been a major paradigm shift in the surgical management of corneal diseases, and component keratoplasty has emerged from the concept of replacing the layer that is actually diseased, rather than replacing the full-thickness cornea with the traditional penetrating keratoplasty. This has resulted in improved outcomes and the risk of endothelial rejection has reduced drastically, thus expanding the survival time of the graft. In recent years, reports of graft rejection in component keratoplasty have emerged, with each having a different presentation and responding to a different line of treatment. This review aims to summarize the presentation, diagnosis, and management of graft rejections in component keratoplasty.
Predictive factors and visual outcomes after immediate pars plana vitrectomy for posteriorly dislocated lens fragments during complicated phacoemulsification surgery
Authors: Kelkar Aditya S , Kelkar Jai A , Mondal Sukanya , Bolisetty Mounika , Amrute Trupti , Jain Harsh H
Published: March 2023

Purpose:

To investigate the prognostic factors for visual outcome in patients undergoing immediate pars plana vitrectomy (PPV) for posteriorly dislocated lens fragments during phacoemulsification surgery.

Methods:

This was a single-center, retrospective, cross-sectional study of 37 eyes of 37 patients undergoing immediate PPV for posteriorly dislocated lens fragments from 2015 to 2021. The primary outcome measure was changes in the best-corrected visual acuity (BCVA). Additionally, we analyzed the predictive factors for poor visual outcomes (BCVA <20/40) and perioperative complications.

Results:

The mean (±standard deviation [SD]) age of the patients was 66.57 (±10.86) years, with an almost identical gender profile (M: F = 18/19 [48.64%:51.36%]). The median (interquartile range [IQR]) log of minimum angle of resolution (logMAR) BCVA improved significantly from the baseline (1 [0.6–1.48], ~20/200) to the final visit (0.3 [0.2–0.6], ~20/40) (P < 0.0001) after a mean (±SD) follow-up of 6.35 (±6.32) months. The final BCVA was 20/40 or better in 59.5% of the eyes. Poor final BCVA (<20/40) was associated with small preoperative pupillary size (P = 0.02), presence of preoperative ocular pathology (P = 0.02) including uveitis, glaucoma, and clinically significant macular edema (CSME), intraoperative displacement of >50% of lens matter into the vitreous (P < 0.001), use of iris-claw lens (P < 0.001), and postoperative cystoid macular edema (CME; P = 0.007). The postoperative complications included CME (13.51%), retinal detachment (10.81%), chronic uveitis (8.11%), glaucoma (8.11%), iritis (2.7%), posterior chamber IOL (PCIOL) dislocation (2.7%), and vitreous hemorrhage (2.7%).

Conclusion:

For retained lens fragments in complicated phacoemulsification surgery, immediate PPV is a viable approach with the potential for a good visual outcome. The important predictors for poor visual outcomes include a small preoperative pupil size, preexisting ocular pathology, displacement of significant volume of lens matter (>50%), use of an iris-claw lens, and CME.
A clinical trial on phakic intraocular lens for the treatment of refractive amblyopia in children and adolescents
Authors: Morya Arvind Kumar , Kaur Kirandeep , Gurnani Bharat , Janti Siddharam S , Shrivastava Ankur Kumar , Tejaswini Antarvedi , Sinha Aprajita , Venkatesh Dharavath
Published: March 2023

Purpose:

To analyze the demographics and clinical outcomes of posterior chamber phakic intraocular (IOL) implantation for refractive amblyopia in children and adolescents.

Methods:

A prospective interventional study was performed on children and adolescents with amblyopia at a tertiary eye care center from January 2021 to August 2022. Twenty-three eyes of 21 anisomyopic and isomyopic amblyopia patients operated for posterior chamber phakic IOL (Eyecryl phakic IOL) as a treatment for amblyopia were included in the study. Patient demographics, pre- and postoperative visual acuity, cycloplegic refraction, anterior and posterior segment examination, intraocular pressure, pachymetry, contrast sensitivity, endothelial count, and patient satisfaction scores were evaluated. Patients were followed up at day 1, 6 weeks, 3 months, and 1 year after surgery, and visual outcomes and complications were documented.

Results:

The mean age of patients was 14.16 ± 3.49 years (range: 10–19 years). The mean intraocular lens power was − 12.20 diopter spherical (DS) in 23 eyes and − 2.25 diopter cylindrical (DC) in four patients. The mean unaided distant visual acuity (UDVA) and best-corrected visual acuity (BCVA) were 1.39 ± 0.25 and 0.40 ± 0.21 preoperatively on the log of minimum angle of resolution (logMAR) chart. Postoperatively, the visual acuity improved by 2.6 lines in 3 months period and maintained till 1 year. Postsurgery, contrast sensitivity in the amblyopic eyes significantly improved, and the average endothelial loss recorded was 5.78% at 1 year, which was statistically insignificant. Patient satisfaction score was statistically significant, with 4.736/5 recorded on the Likert scale.

Conclusion:

Posterior chamber phakic IOL is a safe, effective, and alternative method for treating amblyopia patients who are noncompliant with glasses, contact lenses, and keratorefractive procedures.
Single haptic iris fixation of posterior chamber intraocular lens
Authors: Vivekanandan Vellam R , Dhanaseelan Thamizhselvi , Benzy Merlin , Venkatesh Rengaraj , Odayar Varshini
Published: March 2023

Single haptic iris fixation technique is used where there is a loss of 6 clock hours anterior capsular support. It helps the anterior segment surgeon to fix the intraocular lens to the iris on the side of absent capsular support and place the other haptic over the capsular support. A 10-0 polypropylene suture on a long-curved needle is only used to take a suture bite on the side of capsule loss. Meticulous automated anterior vitrectomy is done. Then, the suture loop below the iris is taken out and the loops are twirled multiple times around the haptic. The leading haptic is then gently glided behind the iris, and the trailing haptic is gently placed on the other side using forceps. The suture ends are trimmed and internalized into the anterior chamber and then externalized through the paracentesis using a Kuglen hook, and the knot is tied and secured.
Role of artificial intelligence in determining factors impacting patients’ refractive surgery decisions
Authors: Kundu Gairik , Virani Imranali , Shetty Rohit , Khamar Pooja , Nuijts Rudy M M A
Published: March 2023

Purpose:

To create a predictive model using artificial intelligence (AI) and assess if available data from patients’ registration records can help in predicting definitive endpoints such as the probability of patients signing up for refractive surgery.

Methods:

This was a retrospective analysis. Electronic health records data of 423 patients presenting to the refractive surgery department were incorporated into models using multivariable logistic regression, decision trees classifier, and random forest (RF). Mean area under the receiver operating characteristic curve (ROC-AUC), sensitivity (Se), specificity (Sp), classification accuracy, precision, recall, and F1-score were calculated for each model to evaluate performance.

Results:

The RF classifier provided the best output among the various models, and the top variables identified in this study by the RF classifier excluding income were insurance, time spent in the clinic, age, occupation, residence, source of referral, and so on. About 93% of the cases that did undergo refractive surgery were correctly predicted as having undergone refractive surgery. The AI model achieved an ROC-AUC of 0.945 with an Se of 88% and Sp of 92.5%.

Conclusion:

This study demonstrated the importance of stratification and identifying various factors using an AI model which could impact patients’ decisions while selecting a refractive surgery. Eye centers can build specialized prediction profiles across disease categories and may allow for the identification of prospective obstacles in the patient’s decision-making process, as well as strategies for dealing with them.
The epidemiology and disease pattern of pediatric ocular morbidities in Western India: The National Institute of OphthalMology AmBlyopia StUdy in Indian Paediatric EyeS (NIMBUS) study report 1
Authors: Kelkar Jai , Kelkar Aditya , Thakur Prajakta , Jain Harsh H. , Kelkar Shreekant
Published: March 2023

Purpose:

To determine the pattern of pediatric ocular morbidities in western India.

Methods:

This was a retrospective longitudinal study that included all consecutive children aged £15 years who presented to the outpatient department of a tertiary eye center for the first time. Patient demographics, best-corrected visual acuity (BCVA), and ocular examination data were compiled. Subgroup analysis was also performed based on age group (years): £5, 5–10, and >10–15.

Results:

A total of 11,126 eyes of 5563 children were included in the study. The mean age of the study population was 5.15 (±3.32) years with males (57.07%) being predominant. Approximately half of the patients (50.19%) were under the age of 5 years, followed by those aged 5–10 years (45.1%) and >10–15 years (4.71%). Among the study eyes, the BCVA was ³20/60 in 58.57%, indeterminable in 35.16%, and <20/60 in 6.71%. The commonest ocular morbidity noted was refractive error (28.97%) followed by allergic conjunctivitis (7.64%) and strabismus (4.95%) in the total study cohort and also after age stratification.

Conclusion:

Refractive error, allergic conjunctivitis, and strabismus are the major causes of ocular morbidity in pediatric eyes at a tertiary care center. Planning screening programs at the regional and national levels is crucial to decreasing the burden of eye disorders. These programs also need to have a suitable referral mechanism established and be smoothly connected to primary and secondary health-care centers. This will help to assure quality eye care delivery, while also reducing the strain of overworked tertiary centers.
Slit-lamp assisted TORic Marker (STORM): A novel corneal axis marker
Authors: Israni Neeraj , Kochar Shruti , Kadu Amol , Shah Shreya
Published: March 2023

Background:

Toric Intraocular lenses (IOLs) are supposed to be aligned at a particular axis for spectacle-free vision for distance. The evolution of topographers and optical biometers has made it quite achievable for us to aim the target. However, the result sometimes remains unpredictable. A big aspect of this depends on the preop axis marking for toric IOL alignment. Errors in axis marking have been reduced recently with the array of different toric markers in the market, but still we see postoperative refractive surprises due to faulty marking.

Purpose:

In this video, we present a novel slit lamp–based toric marker innovation, STORM, which gives us a hands-free approach to a reliable and accurate axis marking on the cornea. The axis marker is a simple modification to our age-old marker, with the advantage of no touch and slit-lamp assistance, which will make it error free and easy to use.

Synopsis:

The present innovation answers the problem statement of stable, economical, and accurate marking solution. Many a times, hand-holding devices create inaccurate and stressed condition while marking the cornea before corneal surgery.

Highlights:

The invention can be used for marking of accurate and easy astigmatic axis of a toric IOL preoperatively, that is, before the surgery. If the appropriate device is used to mark the cornea, it would impact the outcome of surgery. This device also makes the patient and the surgeon comfortable to mark the cornea with accuracy and without hesitation.

Video link:
https://youtu.be/4MVM7HRwz70

Key words: Slit lamp based toric marker, Corneal axis marker, Toric marker innovation- STORM
Hidden blind spot and pseudofixation loss
Authors: Mansoori Tarannum
Published: March 2023

Background:

Correct mapping of the blind spot is important, as it serves as an estimate of fixation reliability. When the blind spot is not seen in the expected location in Humphrey visual field (HVF) printout, the clinician should give a thought to why this might be the case.

Purpose:

This video describes a series of cases, in which due to different reasons the blind spot could not be seen in the presumed expected location in the grayscale and numeric data of the HVF printout and the possible explanation behind this.

Synopsis:

When interpreting perimetry results, it is important to know whether the field test is reliable or not. A stimulus presented at the location of physiologic blind spot should not be seen by a patient with a steady fixation in Heijl–Krakau method. Responses will also occur, however, if the patient has a tendency for false-positive responses, or when the blind spot of the properly fixing eye is not in the location where the test stimulus is presented, because of anatomic variation, or if the patient’s head is tilted while performing the test.

Highlights:

Perimetrist should recognize these potential artifact, during the test and relocate the blind spot. In case, such results are seen after finishing the test, it is recommended for the clinician to repeat the test.

Video link:
https://youtu.be/I1gxmMWqDQA

Key words: Humphrey visual field, Blind spot mapping, False positive response