bluuebunny/crossref_metadata_2025 huggingface dataset:
Advanced Mechanical Analysis Workflow for Chiplets Integration Predictive Design
Authors: Cao Lihong , Kou Chinli , Wang Chen-Chao , Lo Chieh
Published: January 2025

Chiplet-based designs offer a compelling value proposition compared to traditional monolithic System on Chip (SoC) architectures with advantages in IP reuse, performance, cost, and time to market. Mechanical modeling and analysis (M&A) play a critical role in enabling the integration of chiplets, spanning the chip-package-board-system domains to support product development. The integration of chiplets from various suppliers and deverse technologies introduces differences in material properties, thermal coefficients, and mechanical behaviors that presents a significant challenge in ensuring a good mechanical reliability across the chiplet-based integration system. Consequently, chiplet-based designs encounter more challenges to address the elevated mechanical stress and reliability concerns.

Traditional mechanical analysis and simulation workflows are primarily tailored for monolithic SoC-based designs and are not readily applicable to chiplet-based designs. The latter can no longer afford to overlook issues related to mechanical and thermal stress induced by multiple chiplets, especially with the use of advanced 2.5D and high-density fanout packages.

In this paper, an advanced mechanical analysis workflow for chiplet-based designs is proposed. The representative examples that demonstrate the efficacy of this workflow are also presented. The advanced mechanical analysis workflow involves modeling of chiplets interactions at the early design stage spanning from the Si level to package level and encompassing scales from micrometers to millimeters that includes the components such as Through-Silicon Vias (TSVs), HIgh Density Fanout Cu RDL (Redistribution Layer) and microbumps. Furthermore, the predictive mechanical analysis workflow extends to analyses at the millimeter to meter scale, considering entire systems and incorporating elements like heat sinks and printed circuit boards (PCBs). It represents a multifaceted process spanning chip-to-package co-design, stress analysis, thermal analysis, failure analysis, and chiplet-based design optimization.
Discrete Carbon Nanotubes vs. Carbon Fiber: Nano-Uniform Surface Resistance for Next Gen ESD-Safe Fixtures
Authors: Sweeney Brandon
Published: January 2025

Elect Nano has successfully developed next-generation ESD-safe injection molding compounds leveraging discrete carbon nanotube (dCNT) technology for use in semiconductor media handling trays. Traditional molding compounds are not suitable for the next generation of chip and fab processes where cleanliness, ESD uniformity, dimensional tolerances and sustainability are being pushed to the incumbent material tolerance and performance limits. The dCNT injection molding compounds were compared directly with carbon fiber filled molding compounds and showed outstanding benefits for surface resistance uniformity, surface finish quality, laser marking contrast and isotropic mold shrinkage.
Process Considerations for Defluxing Ultra-Fine Pitch Die on CoWs
Authors: Parthasarathy Ravi
Published: January 2025

Heterogeneous integration stands as a pivotal strategy in the semiconductor technology realm. As process nodes relentlessly scale down from 16nm to 5nm and beyond, CMOS component speeds soar. This dynamic corresponds to incorporating twice the component count within the same space every 18-24 months.

The evolution from CoS (Chip on Substrate) to CoW (Chip on Wafer) marks a significant advancement. CoW integrates chips onto an interposer, applies wafer-level molding, and culminates with a flip chip (FC) substrate connection. This technology offers a superior physical structure to accommodate extensive die and larger interposer dimensions.

The technical paper titled ‘Defluxing of Copper Pillar Bumped Flip Chips,’ initially presented at IPC Apex 2022 and subsequently at IMAPS Device Packaging Conference 2023, discussed a comparative study. The study confirmed that the De-ionized water inline cleaning system faces consistent and effective cleaning challenges beneath low standoff components under copper pillar packages featuring 150μm pitch and a 30μm Cu pillar height when compared to low concentration alkaline cleaning agents.

This follow-up study is a continuation of the initial effort, focusing on cleaning under next tier of ultra-fine pitch CoW devices with bump pitches under 25μm and bump counts surpassing 150K. The author adhered to the same low-concentration alkaline cleaning agent for testing, exploring the impact of wash temperatures and conveyor belt speed.

The assessment employed analytical/functional tests, including Visual Inspection, FTIR with color mapping, and SEM/EDX analysis.
P-WLCSP Advanced Packaging Enabling Next Generation Medical Device Applications
Authors: Hackler Doug , Prack Ed
Published: January 2025

Flexible hybrid microelectronics systems are being introduced for wearables, implants, drug delivery, human-machine interfaces, rapid diagnostics and more. These novel medical devices rely on leading-edge thin and flexible microelectronics. Semiconductor-on-Polymer (SoP) 300mm SoP-TM, is a new protected wafer level chip scale advanced packaging process (P-WLCSP) producing six-side (6S) die protection without use of reconstitution. The process produces the thinnest and only physically flexible packaged ICs in the world. SoP packaged devices are currently being adopted in a variety of new medical device products. The new advanced packaging process enhances die strength for CMOS ICs bending to a 5 mm radius of curvature to meet requirements for next generation medical device form factors. This presentation will include examples of new medical devices being enabled by ultra-thin SoP-TM packaged ICs. New applications include ocular, embedded, implants, and labeling. Reliability data such as accelerated stress tests, die strength, operating lifetime and thermal testing are key areas of investigation for the new P-WLCSP technology that will be presented. The presentation will also include an update for ultra-thin device reliability test methods under consideration for new SEMI standards.
Custom, High Density Power Modules Enabled by Thermal Integration Technologies
Authors: Porter Errol
Published: January 2025

Researchers at the University of Arkansas are achieving significant strides in power electronic packaging, focusing on the critical needs for high power density and integrated thermal management. They have introduced an innovative non-metallic jet impingement cooler, produced via advanced additive manufacturing techniques, which has proven to be effective in lowering thermal loads. Specifically, it reduces junction temperatures by as much as 30°C and attenuates electromagnetic interference, a crucial factor for the efficiency of high-power silicon carbide MOSFET-based inverters. In response to the 2021 PowerAmerica Institute challenge, the team engineered a high-voltage power module, achieving the specifications of 1.7-kV/1600-A within a confined volume of 100 cm³. This module exemplifies the successful integration of thermal and electrical systems in a space-efficient package, highlighting the practical resolution of high-density packaging challenges. The process has provided insights into the behavior of thermal resistance in such compact modules and the associated operational constraints. Further extending their research, the team has examined advanced cooling techniques employing dielectric fluids, targeting applications surpassing 1.2 kV. They have balanced the turbulence within fluid movement and the fluid’s voltage blocking capacity, essential for the stability of thermal management systems in high-voltage electronics. Moreover, the group has developed an empirical model for direct jet impingement cooling using dielectric fluids, optimizing for enhanced cooling performance with minimal flow rates. They are also researching in the area of two-phase immersion cooling, with a focus on maintaining electrical isolation, especially during phase changes, and conducting assessments of breakdown voltages in boiling dielectric fluids. These efforts are pivotal in guiding the next generation of efficient, compact power electronic packaging solutions, contributing significantly to the field’s future advancements.
Editorial independence needs to be protected and preserved at all cost
Authors: Seedat Soraya
Published: January 2025

N/A
Changes of retinal ganglion cell–inner plexiform layer thickness and visual acuity in patients with diabetic macular edema treated with Aflibercept
Authors: Alsaad Mouna M. , Shehadeh Amin B. , Alsaad Iyman M. , Alubous Khalid A. , Meqbil Jehad S. , Qablawi Mohammed Z. , AIRyalat Saif Aldeen S. , Elubous Rawan A.
Published: January 2025

Background

Anti-vascular endothelial growth factor agents have now become the first line of treatment for diabetic macular edema (DME). Changes in the thickness of the individual retinal layers including the ganglion cell–inner plexiform layer (GC–IPL) might serve as a biomarker for the response to treatment.

Aim

The aim of this study was to evaluate the effect of intravitreal injections of Aflibercept on the average thicknesses of the GC–IPL in naïve eyes and on the visual acuity in patients with DME.

Patients and methods

This is a retrospective observational study that included 224 naïve eyes of 224 patients having DME. It compared the changes in the GC–IPL thickness at baseline and after receiving three loading doses of Aflibercept followed by as needed protocol for 12 months. All patients had optical coherence tomography imaging at baseline (with GC–IPL thickness measurement) and at the 12-month visit. The change in GC–IPL thickness was measured and was correlated with best-corrected visual acuity.

Results

During the study duration, a median of five injections of Aflibercept were given. There was a statistically significant decrease in the posttreatment values of the GC–IPL thickness from 89±13 to 84±14.7 µm (P=0.029). Moreover, a statistically significant association was found between the thickness reduction of the GC–IPL in the central macular area and the best-corrected visual acuity (r=0.9, P=0.005, Pearson coefficient=0.26).

Conclusion

The results of this study suggest that the reduction in the GC–IPL thickness can be used as a prognostic tool for the response to Aflibercept as it was associated with improved visual acuity.
Combined preoperative and intraoperative aflibercept injection versus preoperative intravitreal aflibercept injection only in optimizing the anatomical and functional outcomes in diabetic vitrectomy
Authors: Al-Naimy Mohammed A. , Khedr Marwa A.M. , Deiaeldin Yasmine A.
Published: January 2025

Purpose

The aim of this study was to evaluate the effect of adding intraoperative aflibercept injection to preoperative injection in optimizing the anatomical and functional outcomes of diabetic vitrectomy compared to preoperative injection only.

Patients and methods

This retrospective interventional comparative study included 30 eyes of 30 patients scheduled for pars plana vitrectomy for complications of proliferative diabetic retinopathy. The patients were allocated into two groups: group I that received combined preoperative and intraoperative aflibercept (Eylea) injection and group II that received preoperative injection only. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were compared preoperatively and 3 months postoperatively in both groups. The patients were also followed up to detect any postoperative persistent vitreous hemorrhage (VH) or sub-silicone hemorrhage. The patients who developed persistent nonclearing VH for more than 1 month or persistent nonclearing sub-silicone premacular hemorrhage were scheduled for surgical reintervention.

Results

The mean preoperative BCVA was 1.53±0.28 LogMAR in group I and 1.50±0.26 LogMAR in group II. At the end of the third postoperative month, there was a continuous significant improvement in BCVA in both groups with a mean of 0.31±0.10 in group I and 0.62±0.26 in group II, with a statistically significant difference between the two groups (P<0.0001). The baseline CMT was measured within 1–3 weeks postoperatively with a mean of 393±31.54 μm in group I and 379.3±40.42 μm in group II. Three months postoperatively, the CMT significantly decreased to 206±12.94 μm in group I and 301.67±48.6 μm in group II with a statistically significant difference between the two groups (P<0.0001). Postoperative persistent VH occurred in three eyes out of the six (50%) air-filled eyes in each group, while three eyes out of the eight (37.5%) silicone-filled eyes in group I and six (60%) eyes out of the 10 silicone-filled eyes in group II developed postoperative sub-silicone hemorrhage. Only one (12.5%) case in group I and five cases in group II required surgical reintervention due to persistent sub-silicone hemorrhage.

Conclusion

Combined preoperative and intraoperative aflibercept injection compared to preoperative injection alone was more effective in optimizing the anatomical and functional outcomes and in reducing the possible postoperative complications after pars plana vitrectomy.
Countries with Fewer Procedures for Cardiovascular Disease Management Face Greater Premature Mortality from Noncommunicable Diseases
Authors: Prasad Manya , Gupta Sunanda
Published: January 2025

Background:

The rate at which low- and middle-income countries (LMICs) are transitioning into high-burden states for noncommunicable diseases (NCDs) is currently posing a global health security threat. Not only cardiovascular disease (CVD) occurs earlier in these countries but also it is likely that individuals do not have access to adequate management procedures. The present study was undertaken to find the effect of availability of procedures for CVD management on premature mortality in NCDs and to juxtapose this with the prevalence of two main risk factors, hypertension and diabetes.

Methods:

The World Health Organization’s Global Health Observatory data were used, which include health-related data on its 194 member states. The correlation matrix was constructed for risk factors, income classification, availability of CVD management procedures, and premature NCD mortality. Multiple linear regression was done to find the association between availability of management procedures, income classification, and premature NCD mortality.

Results:

A negative correlation was observed between premature NCD mortality and income group and between premature NCD mortality and availability of CVD management procedures. Countries possessing fewer procedures for CVD management suffered a greater burden of premature NCD mortality, and this was in the form of a strong linear association. Income class and availability of CVD management procedures both independently affected premature NCD mortality. Each unit increase in income class and number of CVD management procedures reduced the premature NCD mortality by 7.9 and 2.8 units, respectively. The impact of both these factors on premature NCD mortality was statistically significant. Countries with higher prevalence of hypertension were seen to be possessing fewer CVD management procedures. Income groups also demonstrated disparities, with high-income countries bearing less burden of hypertension and having more ubiquitous CVD management resources.

Conclusion:

The present study found that availability of CVD management procedures, such as thrombolysis, coronary bypass/stenting, and acute stroke care and rehabilitation, significantly reduce premature NCD mortality across the world. Countries that face higher burden of premature NCD mortality are not only the ones that are least prepared to manage them but also the ones that bear the greatest prevalence of risk factors like hypertension and diabetes. Making procedures for NCD management available in LMICs must be put on high priority on the global health agenda.
Prevalence and Associated Factors with Sugar-sweetened Beverages Consumption among Kurdish High-school Children
Authors: Abdulah Deldar Morad , Sulaiman Saad Jbraeil , Abdulmajeed Ayoub Abid
Published: January 2025

Adolescents’ excessive consumption of sugar-sweetened beverages (SSBs) has become a global concern due to its detrimental effects on health. We explored the prevalence and associated factors of the consumption of SSB in high-school children in the Kurdistan Region. In this study, we included 560 students randomly from the 152 available high schools in Duhok City in the Kurdistan Region. Both genders of high school children who registered for the academic years 2021–2022 in 32 high schools were eligible. The study found that a considerable number of students did not eat breakfast (32.68%). Mostly, the students had lunch (83.21%) and dinner (53.57%), with 53.57% having extra eating portions. A significant percentage of the students consumed junk food (fast food) more than three times per week (39.82%) and consumed SSB 1–3 times/day (61.07%) at varying frequencies. The study found that 14.64% and 12.86% were overweight and obese, respectively. The prevalence of SSB consumption 4–5 times/week was 47.68% (soda), 21.61% (tea), 34.64% (coffee), 22.50% (energy drink), and 36.25% (juice). A similar prevalence of SSB consumption was found among parents (23.39%) and friends/classmates (20.36%). The male students were more likely to consume tea (P = 0.0104). However, female students were more likely to consume juice and energy drinks (P = 0.004 and P < 0.0001, respectively). Students with lower levels of education were also more likely to consume SSB. The intake of SSB was high among high school children in the Kurdistan Region and was related to gender and parents’ consumption.
Re-thinking the trabecular meshwork anatomy-A histopathological analysis
Authors: Rao Aparna
Published: January 2025

The trabecular meshwork serves as the primary site for regulating the outflow of aqueous humor from the eye. In glaucoma, dysfunction or structural abnormalities within the trabecular meshwork can impede the normal flow of aqueous humor, leading to elevated intraocular pressure and, if untreated, blindness. This study reveals the histopathological morphological alterations observed in various regions of the trabecular meshwork (TM) in two patients with primary glaucoma who underwent microincisional trabeculectomy. The distinct involvement of different regions of the TM in these patients introduces a novel perspective on the damage and pathogenesis of glaucoma within the TM.
Bilateral peripapillary choroidopathy and serous retinal detachment in a case of severe preeclampsia-associated HELLP syndrome. A case report
Authors: Kaur Rajwinder , Kaur Harleen , Khan Balbir , Bedi Mini
Published: January 2025

HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is a rare, serious, and potentially life-threatening complication that can occur in pregnancy associated with preeclampsia and is associated with high risk to the life of the mother and fetus. A 37-year-old patient, gravida IV, para II, living 2 and abortus 1 (G4P2L2A1), with a period of gestation of 27 weeks and 6 days, presented to the emergency. On fundus examination, the left eye showed serous retinal detachment involving the macula along with peripapillary hypertensive choroidopathy in both eyes. Bilateral serous retinal detachment might be the earliest sign observed by the ophthalmologist in severe preeclampsia-associated pregnancy to suspect HELLP syndrome, which is a potentially threatening cause of either maternal or fetal death, where ophthalmologists can play a significant role in early detection of this entity.
Ocular leech infestation – A case report and literature review
Authors: Ziv-On Elad , Assayag Elishai , Weill Yishay
Published: January 2025

We report a rare case of ocular infestation by a leech in a six-year-old male and provide an overview of the literature on similar cases. The patient presented with ocular pain, foreign body sensation, and redness after swimming in a natural spring. A leech was discovered above the cornea and removed using forceps under topical anesthesia, followed by a short course of topical antibiotics and corticosteroids. Symptoms resolved within days, except for subconjunctival hemorrhage, which took 2–3 weeks. The leech was characterized by an entomologist as Limnatis nilotica. A literature review of 12 comparable cases revealed that the Middle East had the highest number of reported cases, primarily linked to contact with spring water. Common symptoms included ocular pain, foreign body sensation, and redness. The primary treatment involved forceps removal of the leech and topical medications, with no reported complications. This report contributes to the limited documentation on ocular leech infestation and presents the first comprehensive review of such cases.
Annular choroidal detachment mimicking aqueous misdirection following XEN-63 implantation
Authors: Riccardo Manocchio , Forte Paolo , di Cello Luca , Macocco Francesco , Traverso Carlo Enrico
Published: January 2025

Aqueous misdirection syndrome, also known as malignant glaucoma, is a severe form of secondary angle-closure glaucoma, often occurring postoperatively after glaucoma filtration or cataract surgery. We report a case of choroidal detachment initially misdiagnosed as aqueous misdirection syndrome following combined XEN®63 implantation and cataract surgery in a patient with advanced glaucoma. The patient presented with a postoperative flat anterior chamber and elevated intraocular pressure. Initially diagnosed with aqueous misdirection syndrome, subsequent evaluations using ultrasound biomicroscopy (UBM), echography, and wide-field fundus imaging revealed choroidal detachment, which was initially visible only via UBM.
A rare case of post-operative bleeding in cataract surgery – An eye opener
Authors: Rahim Meera B , Reddy Charishma P , Lahkar Gariyashee , Prasad Senthil , Nagu Kamatchi , Shekhar Madhu
Published: January 2025

Ocular surgery in patients with bleeding disorders is challenging due to the high risk of hemorrhagic complications. This case report of a patient with chronic decompensated liver disease, who presented with incessant postoperative bleeding, served as a forerunner for devising definitive preoperative, intraoperative, and postoperative protocols for managing patients with bleeding disorders at our institute.
Bilateral anterior uveitis associated with Fanconi syndrome and tubulointerstitial nephritis: A case report and review of literature
Authors: Kumarasamy Chellarani , Agarwal Aniruddha , Valjalo Ricardo
Published: January 2025

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare inflammatory disease affecting the renal tubules and uveal tract. Although the etiology of TINU remains uncertain, it has been associated with multiple immunologic conditions and human leucocyte antigen (HLA) association. We report a case of 55-year-old healthy female who was diagnosed with Fanconi syndrome and later developed bilateral uveitis. While the initial renal biopsy-pathology report misled the nephrologist to an end-stage renal disease and initiation of hemodialysis, later development of bilateral anterior uveitis made a strong clinical suspicion for TINU. Elevated urinary Beta-2 microglobulin (B2M) level, a revisit into the clinical and laboratory details by the nephrologist and pathologist and led to revised diagnosis of Fanconi syndrome associated with TINU. This is the first case of TINU with Fanconi syndrome from Latin America which highlights that high index of suspicion and multispecialty approach is needed in the management of these cases.
Targeted focal laser photocoagulation of retinal capillary macroaneurysm in retinal vein occlusion related macular edema
Authors: Prabhakaran Parvathy , Sagar Pradeep , Biswal Suchitra , Pradeep B. C. , Ravishankar H. N. , Sweta Shubhra
Published: January 2025

We report a case of a 65-year-old male who presented with best-corrected visual acuity (BCVA) of 20/125 in the right eye. Fundus examination and multimodal imaging demonstrated superotemporal retinal vein occlusion (RVO), macular edema, and a retinal capillary macroaneurysm (RCM). The patient was treated with targeted focal laser photocoagulation of the RCM. At 4-month follow up, BCVA improved to 6/6 with complete resolution of macular edema. RCM can develop in the chronic stage of RVO. Targeted laser photocoagulation is an effective therapeutic modality in the management of macular edema secondary to RCM in retinal vein occlusion.
Expanding the ophthalmic spectrum of marfanoid progeroid lipodystrophy syndrome? A case report
Authors: Appaji Anuradha , Mahadevappa Vidyadevi , Sudev Drishya , Dheera Mulasthanam Sai
Published: January 2025

Marfanoid progeroid lipodystrophy (MPLD) syndrome is a rare genetic disorder with less than ten reported cases as of the last decade. It occurs due to heterozygous mutations of the FBN1 gene, leading to alteration in fibrillin production. The reported ocular manifestations include entropion, ectopia lentis, and high axial myopia. We report a unique case of a 14-year-old boy who was detected to have MPLD with unilateral advanced open-angle glaucoma as his predominant ocular manifestation.
Tuberculoma causing isolated pseudoabducens palsy
Authors: Bijlani Madhavi Subhash , Tabani Salma , Potdar Nayana A , Kale Ruchita
Published: January 2025

Tuberculomas are the most common cerebrovascular complications in extrapulmonary tuberculosis. Pseudoabducens palsy is a neurological limitation of abduction when the abducens nerve is intact. We describe a case of isolated left pseudoabducens palsy in a young male patient with tubercular meningitis and thalamic tuberculoma revealed by magnetic resonance imaging. The patient presented with horizontal binocular diplopia and reduced levoversion which was abolished on demonstrating vestibulo-ocular reflex. This case supports the hypothesis that damage to direct inhibitory projections from the thalamus or impairments of inputs to midbrain neurons involved in vergence control may lead to tonic activation of medial rectus muscle causing thalamic esotropia.
Macular neovascularization type 3 in a case of coexisting proliferative diabetic retinopathy and macular telangiectasia type 2
Authors: Kumar Prateek , Radhakrishnan Natasha , Velagala Aditya Reddy , Pillai Gopal S
Published: January 2025

We report a case of coexisting proliferative diabetic retinopathy (PDR) and macular telangiectasia (MacTel) with macular neovascularization type 3. A 50-year-old diabetic patient presented with a decrease in the RE vision. Her presenting vision was 20/80 and LE was 20/30. She was diagnosed with both eye PDR and features of MacTel in both eyes such as right-angled vein and pigment migration. On fundus examination, there was the presence of atypical features such as large PEDs in the RE, which warranted multimodal imaging. SDOCT revealed a large trapezoid serous PED in the RE along with erosion sign and subretinal hyperreflective material. Indocyanine green angiography (ICGA) revealed a hotspot along with hairpin loops. OCT angiography (OCTA) revealed an intraretinal abnormal vascular complex descending from the deep plexus to the choriocapillaris slab. After two doses of aflibercept, the collapse of large PEDs and shrinkage of the neovascular network were noted. This supported the diagnosis of type 3 MVN in the setting of coexisting PDR and MacTel.
Bilateral posterior scleritis in a patient with palmoplantar psoriasis
Authors: Panigrahi Pradeep K , Patro Manaswini , Patro Pradeepta S , Kar Bikash R , Pattnaik Srimant
Published: January 2025

A 46-year-old female patient presented with sudden onset bilateral painful vision loss. She was misdiagnosed as optic neuritis elsewhere. Comprehensive ophthalmic evaluation helped in reaching a diagnosis of bilateral posterior scleritis. She was also diagnosed with psoriasis. The patient responded well to medical treatment with improvement of vision and resolution of clinical signs. Bilateral posterior scleritis is a very rare disease with the potential to cause permanent vision loss. Psoriasis can be a rare systemic association in a patient with posterior scleritis.
Traumatic dacryocystitis operated by powered endoscopic dacryocystorhinostomy after orbital fracture reconstruction with an implant: A case report
Authors: Wang Kerui , Yu Xinyue , Mao Jun , Li Zuohong , Liang Xuanwei
Published: January 2025

Traumatic dacryocystitis is a rare complication of nasolacrimal duct obstruction (NLDO) resulting from naso-orbito-ethmoid (NOE) fractures. NLDO following orbital fracture reconstruction using an implant is even less prevalent. Few cases have reported the best treatment strategy for traumatic dacryocystitis caused by NLDO due to compression from displaced bony fragments in patients who have undergone orbital fracture reconstruction with an implant. This study presents a case of a recurring lacrimal sac abscess resulting from post-traumatic obstruction of the nasolacrimal duct following a naso-orbito-ethmoid fracture in a patient who had previously undergone orbital fracture reconstruction with an implant. The patient had no evidence of compression or damage to the lacrimal drainage system caused by the implant. Consequently, a powered endoscopic dacryocystorhinostomy was performed without requiring implant removal. Following the postoperative period, the patient demonstrated significant improvement and has remained asymptomatic for the past 6 months.
Eye as an index of cholesterol levels – A case of recurrent lipemia retinalis
Authors: Rajasekar Goutham , Temkar Shreyas , Deb Amit K , Nair Shruti
Published: January 2025

Lipemia retinalis is a condition in which the retinal blood vessels appear cream-colored due to extreme levels of triglycerides in the blood. We report a case of familial hypercholesterolemia with lipemia retinalis. There was resolution of fundus findings in her after 4 months of lipid-lowering therapy. However, there was a recurrence of lipemia retinalis when she stopped medications. This case shows that lipemia retinalis can recur when the patient is not compliant with medications, and repeated fundus examination will be helpful to ascertain the compliance of such patients to medications. This is especially important because familial hypercholesterolemia is usually asymptomatic, and many laboratories usually do not give an exact value of serum triglyceride and report it as just >1000 mg/dL. Retinal findings are observed when the serum triglyceride level is >2500 mg/dL. So, we can get an approximate idea of the triglyceride levels based on fundus examination.
Drug-induced myopia mimicking angle closure glaucoma – A diagnostic dilemma
Authors: Sugumar Hema , Renugadevi K , Nallamuthu P
Published: January 2025

A 17-year-old female patient presented with complaints of acute onset of headache with bilateral eye pain since 1 day, associated with H/O blurring of vision in both eyes. No H/O redness or watering of eyes, ocular trauma. Patient has H/O migraine for which she was on Sumatriptan. No H/O of any chronic illness or chronic medication. No H/O of any previous spectacle use or ocular treatment. The visual acuity in both eyes was recorded 5/60 with improvement with pinhole to 6/18. Subjective correction showed myopia of -4 D in right eye and -3D in left eye. The IOP measurement was 58 mm Hg in both eyes. Gonioscopy showed closed angles in both eyes. Ocular alignments were orthophoric and extraocular movements were free and full in all directions of gaze. Anterior segment examination of both eyes showed shallow anterior chamber. Undilated examination of fundus of both eyes was normal. Sumatriptan was stopped and patient was started on topical anti glaucoma drug and aqueous suppressant. Within a week of commencement of treatment, patient improved symptomatically with complete resolution of myopia with vision in both eye 6/6 and IOP becoming normal with deepening of anterior chamber.
Preseptal cellulitis in an advanced case of Ludwig’s angina
Authors: Winly  , Pramita Ida Ayu Ary , Juliari I Gusti Ayu Made , Handayani Ariesanti Tri , Surasmiati Ni Made Ayu , Susila Ni Ketut Niti , Putri Putu Dian Aryanti , Sudarma I Wayan
Published: January 2025

Ludwig’s angina is known to be diffuse, life-threatening cellulitis that usually involves the submandibular, sublingual, and submental spaces. Prompt diagnosis and management can be a life-saving procedure. Nowadays, Ludwig’s angina is a fairly rare disease, as well as its ocular manifestations. We reported an advanced case of Ludwig’s angina due to a widespread from odontogenic bacterial infection, with one example of its clinical manifestations is periorbital cellulitis, which also known as preseptal cellulitis. A multidisciplinary approach to diagnosis and treatment was carried out in conjunction with the otolaryngology-head and neck surgery department as well as the thoracic cardiac and vascular surgery department. Unfortunately, this disease progresses so rapidly and eventually caused a mortality.
Vision loss as an initial clinical manifestation in a case of adolescent-onset MTHFR enzyme deficiency with a rare genetic mutation
Authors: Jha Rakesh Kumar , Ranjan Rajeev , Kaushik Jaya , Prasad Arun , Bhatkoti Bhupesh
Published: January 2025

Methylenetetrahydrofolate reductase (MTHFR) enzyme deficiency is a rare autosomal recessive disorder characterized by a wide range of mutations and highly variable clinical manifestations. Herein, we report a rare c.547C > T (p.Arg183Ter) mutation in a compound heterozygous state, presenting as adolescence-onset bilateral painless visual diminution, along with subtle gait abnormalities. An 11-year-old girl, previously diagnosed with bilateral ametropic amblyopia elsewhere, was found on initial evaluation to have normal ocular findings, normal retinal imaging, generalized reduced sensitivity of visual fields, and no evidence of any nerve conduction delay in either eye. Neuroimaging revealed multiple leucodystrophic lesions in the periventricular white matter in a symmetrical pattern. A hematological investigation revealed low vitamin B12, low folate, and moderate hyperhomocysteinemia. Genetic evaluation identified a rare pathogenic variant, c.547C > T (p.Arg183Ter), in a compound heterozygous state, along with a c. 973C > T (p.Arg325Cys) variant of uncertain significance in exons 4 and 6 of the MTHFR gene, respectively. She was treated with high doses of folic acid, vitamin B6, and vitamin B12 supplementation. A follow-up evaluation after 3 months revealed complete visual recovery, substantial improvement in the gait abnormalities, and regression of the leucodystrophic lesions. Late-onset MTHFR enzyme deficiency should be considered a possible cause in cases of bilateral, painless, progressive diminution of vision in the absence of a clinically detectable ocular cause, especially when accompanied by subtle or evident neurological manifestations, such as gait abnormalities. Additionally, this case report broadens the spectrum of MTHFR pathogenic mutant variants.
Oncocytoma of the lacrimal gland: A rare case report
Authors: Kiyat Pelin , Ceylan Naim , Akalin Taner , Palamar Melis
Published: January 2025

Oncocytomas are considered as benign, slowly growing tumors. Orbital oncocytomas are quite rare and are usually located in the caruncle and accessory lacrimal glands. A 43-year-old female presented with a 2 year history of swelling over the right lacrimal gland region. Besides detailed ophthalmologic examination, magnetic resonance imaging (MRI) of the orbit was evaluated and excisional biopsy under general anesthesia through lateral orbitotomy was performed. Histopathologic examination of the surgical specimen and immunohistochemical evaluation revealed that the tumor was oncocytoma. Although lacrimal gland oncocytoma is very rare, ophthalmologists should be familiar with this diagnosis. In addition to clinical suspicion, MRI is helpful to evaluate the lesion. However, total excision with histopathologic evaluation is a must for this tumor.
Establishing a baseline titer for reporting immunoglobulin M seropositivity of diagnosis of scrub typhus in our region
Authors: Rout Diptimayee , Praharaj Ira , Rath Sonalika , Otta Sarita
Published: January 2025

Background:

Clinical diagnosis of scrub typhus an agent of undifferentiated fever caused by Orientia tsutsugamushi often rests on serological (immunoglobulin [Ig] M enzyme-linked immunosorbent assay [ELISA]) test. This assay needs a baseline titer in the region to serve to be used as a reference value. Owing to the lack of studies in our area, the present study aims to bridge the gap of data of a baseline titer value for reporting IgM ELISA for O. tsutsugamushi.

Materials and Methods:

The study was conducted in a prospective manner in Bhubaneswar, Odisha, wherein a period of 1 year, 150 serum samples of patients who were hospitalized with a suspicion of scrub typhus and 200 serum samples from healthy blood donors were included. The IgM ELISA was performed by Scrub Typhus Detect™ IgM ELISA system, InBios International Inc. kit. IgG ELISA was performed on 100 healthy blood donor samples by Scrub Typhus Detect™ IgM ELISA system, InBios International Inc. kit.

Statistical Analysis:

The optical density (OD) obtained as the result of ELISA study was entered into MS Excel and cutoff was determined by SPSS software.

Results:

The cutoff value for IgM was 0.6 by receiver operating characteristic curve analysis with a sensitivity and specificity of 92.16% and 98.01%, respectively. Similarly, cutoff OD of 2.1 for IgG ELISA was determined in our area.

Conclusion:

Considering the need for a cost-effective serological method and unavailability of paired sera, these cutoffs can be used in our area and surrounding nearby areas of Eastern part of India as a reference value for reporting of scrub typhus.
Divine visions and vermillion blood: Cultural sanctioning of adolescent distress
Authors: Mishra Ashish , Kumar Suparna , Pattnaik Jigyansa Ipsita , Panda Udit Kumar , Das Sudipta Kumar
Published: January 2025

This case report describes a 16-year-old Indian male who presented with factitious disorder manifesting through culturally influenced symptoms, including simulated hematemesis using vermillion powder and religious experiences. The presentation coincided with his transition to higher secondary education and first-time hostel admission. The patient reported divine visions featuring Hindu deities and supernatural encounters, which were reinforced by family beliefs and cultural interpretations. Initial diagnostic challenges arose from the complex interplay between cultural beliefs and psychopathology. A multimodal treatment approach, including supportive psychotherapy, family interventions, and environmental modifications, led to the successful resolution of symptoms over 6 months. This case highlights the importance of cultural competency in psychiatric assessment, the role of developmental stressors in symptom formation, and the need for culturally sensitive therapeutic approaches. It contributes to the limited literature on factitious disorder in Indian adolescents and emphasizes the significance of understanding cultural contexts in psychiatric practice, particularly in educational settings where academic stress intersects with developmental challenges.
Systemic lupus erythematosus in an adolescent male: A rare case presentation
Authors: Singh Anupama , Saha Ishani , Siva Sadhvik Karri , Rup Amit Ranjan , Das Swarnalata , Mohakud Nirmal Kumar
Published: January 2025

Pediatric systemic lupus erythematosus (pSLE) is a rare but severe autoimmune condition with multisystem involvement, disproportionately affecting females. Here, we report the case of a 15-year-old male presenting with polyarthralgia, fatigue, and intermittent fever, accompanied by photosensitive skin rash, oral ulcers, and nonproductive cough. Examination revealed a malar rash sparing the nasolabial fold, hard palate ulcers, and a palpable purpuric rash. Initial investigations demonstrated bicytopenia, elevated inflammatory markers, and liver enzyme derangements. Autoimmune workup confirmed pSLE per Systemic Lupus International Collaborating Clinics criteria, with positive anti-double-stranded DNA, anti-Smith antibodies, low complement levels, and direct Coombs test positivity. Radiological findings included minimal pleural effusion and mild ileitis. The patient was managed with pulse methylprednisolone, oral prednisolone, hydroxychloroquine, and cyclophosphamide, resulting in clinical improvement. This case underscores the diagnostic challenges of pSLE in male adolescents and highlights atypical manifestations such as scalp lesions mimicking tinea capitis. Early recognition and timely intervention are crucial for the favorable outcomes.
Optimizing Quality Assurance in Naval Hospitals: A Qualitative Study by Comprehensive Strength, Weakness, Opportunity, and Threat Analysis
Authors: Roy Kaushik , Maramraj Kiran K. , Kumar Sanjeev , Sarin Arti , Honwad Manish S.
Published: January 2025

Introduction:

Quality assurance (QA) in healthcare is the degree to which healthcare services increase the likelihood of desired outcomes and are consistent with the current professional knowledge. It is a panacea to achieve higher levels of patient safety and satisfaction. This study aims to do a situational analysis of the current QA mechanism in naval hospitals through a Strength, Weakness, Opportunity, and Threat (SWOT) analysis.

Methods:

The study is a qualitative study where data were collected by in-depth interviews and focused group discussions as well as by review of reports. The data were processed using transcription and anonymized to maintain the data security and integrity. Further, it was iterated and triangulated to establish credibility and reliability. Number and relevant events were analyzed to arrive at inferences. Based on these themes and inferences, a situational analysis of QA mechanisms in naval hospitals by SWOT method was done by the authors. Ethical consent was obtained from the institutional ethical committee.

Results:

National QA Standards (NQAS) developed by the National Health Systems Resource Centre, and the Ministry of Health and Family Welfare is a comprehensive and objective QA tool. QA by modified NQAS tool has also been rolled out systematically in the naval hospitals over the past 1 year. The strengths identified with respect to the adoption of NQAS are improved patient safety and satisfaction, objective assessment to ensure accuracy, consistency, and compliance, ensure benchmarking against international standards, aid in comparison of hospitals, build accountability, and ensure trust among stakeholders. The weakness in the implementation of NQAS is the lengthy assessment process, implementation cost for training and infrastructure upgradation, biased internal audits, lack of felt need among users, and resistance to change. The strengths far outweigh the weaknesses.

Conclusion:

By leveraging the strengths, addressing existing weaknesses, capitalizing on opportunities, and mitigating threats, naval hospitals can significantly enhance their QA mechanisms. Thus, the adoption of a continuous improvement process by NQAS implementation is crucial in advancing healthcare quality. Spreading awareness to generate the felt need, emphasizing proactive training, focusing on patient satisfaction surveys, and incentivizing the process will ensure robust implementation. Through these measures, naval hospitals can maintain excellence in healthcare delivery and readiness to meet future challenges.
Tamil Insights: Enhancing Oral Health Education (OHE) Through Questionnaire Validation
Authors: Anita M , Bhuminathan S , Priya V , Kumar R Pradeep , Suganya P , Dhanushkodi Charumathi
Published: January 2025

ABSTRACT

Aim:

This study aims to validate an OHE questionnaire in Tamil to ensure linguistic and cultural accuracy for Tamil-speaking populations.

Methodology:

The study involved English-Tamil fluent adults, using a 15-item OHE questionnaire translated through expert forward and backward translations. An expert panel ensured conceptual equivalence, and a pilot study with 30 participants refined the translation. The final Tamil version was tested for internal consistency with 1500 participants and test-retest reliability with 500 persons.

Results:

The Tamil OHE questionnaire demonstrated excellent internal consistency, with Cronbach’s alpha values >0.99, and high test-retest reliability, with Pearson correlation coefficients >0.90 for most items.

Conclusion:

The validated Tamil OHE questionnaire is a reliable tool for evaluating oral health-related quality of life, supporting effective, and culturally appropriate oral health interventions in Tamil-speaking regions.
Correlation of Anthropometric Measurements with Insulin Resistance Assessed by HOMA-IR in Obese Normotensive Individuals: A Cross-Sectional Study in South India
Authors: Sudha Meriam S Swarupa Gnana , Susethira Karunya Varsha Ragavendran , Saravanan B.S. , Rajendran Susethira Aruppukottai , Periasamy Panneerselvam , Gunasekaran Sasikala
Published: January 2025

ABSTRACT

Background:

The study aims to evaluate insulin resistance in obese individuals with normotensive diabetes using Homeostasis Model Assessment and correlate it with anthropometric measurements, highlighting the link between poor lifestyles and metabolic syndrome.

Methods:

The research assessed the anthropometric, lipid, fasting blood glucose, hemoglobin A1C, serum insulin, and lipidosis profiles of 100 people using both traditional procedures and the Homeostatic model assessment (HOMA)-IR.

Results:

A study of 100 participants, including 43 males and 57 females, found a significant waist–hip ratio (HOMA-IR >2.5) among the group, indicating a high level of health.

Conclusions:

The research discovered notable connections between anthropometric measurements and clinical and biochemical factors associated with insulin resistance, with subscapular skinfold thickness demonstrating more robust linkages.
Evaluating Ergonomic Awareness in Dentistry: A Survey of Dental Students’ Knowledge During Operative Procedures
Authors: Kalaiarasi Maniarasu , Shobhana Ramu , Prakash Venkatachalam , Mitthra Suresh , Shalini H , Venkatesh Alagarsamy
Published: January 2025

ABSTRACT

Aim:

The research aimed to explore students’ self-perceptions of their clinical work and identify challenges affecting their performance in restorative and endodontic treatments.

Materials and Methods:

The research was conducted among 157 dental students utilizing a self-designed, validated, closed-ended questionnaire.

Results:

The questionnaire received responses from 157 participants, including 88 undergraduates (UGs) and 69 postgraduates (PGs). Of these, 64% reported experiencing pain during clinical procedures, while 36% (n = 72) did not report any pain. Although 71.5% of students were aware of ergonomic posture, 28.5% of students were not. Despite this awareness, 64.5% of students found it challenging to maintain proper ergonomic postures while performing clinical tasks.

Conclusion:

Although most students know ergonomic postures, many struggle to maintain them during clinical procedures. Incorporating dental ergonomics into the curriculum is crucial to improving students’ well-being and efficiency.