bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute postoperative complications increase the risk of recurrence and chronic pain after inguinal hernia surgery: A single-center retrospective analysis
Authors: Ndong Abdourahmane , Diallo Adja C , Diao Mohamed L , Tendeng Jacques N , Nyemb Philippe M M , Cissé Mamadou , Konaté Ibrahima
Published: May 2024

AIMS:

To investigate the factors associated with recurrence and chronic pain after inguinal hernia surgery.

SETTINGS AND DESIGN:

A retrospective study was conducted over a period of 3 years and 5 months.

MATERIALS AND METHODS:

All patients over the age of 15 who underwent surgery for an inguinal hernia were included.

STATISTICAL ANALYSIS USED:

Factors associated with recurrence and chronic pain were evaluated using the Kaplan–Meier method and multivariate Cox proportional hazard model.

RESULTS:

During the study period, 195 patient records were collected. According to the European Hernia Society classification, 75.9% (n = 148) of hernias were lateral, and 24.1% (n = 47) were medial. The hernia was primary in 92.3% (n = 180) of cases and recurrent in 7.7% (n = 15). The hernia was strangulated in 29.7% (n = 58) of cases. The surgical techniques used were: Bassini in 64.6% (n = 126) of cases, Desarda in 23.6% (n = 46), Lichtenstein in 9.7%, Mc Vay in two cases (1%) and trans-abdominal pre-peritoneal (TAPP) in two cases (1%). Acute postoperative complications were observed in 18 cases (9.2%). The average follow-up period was 25.4 months, with a range of 3–62.8 months. Chronic pain was observed in 18 cases (9.2%) and recurrence in 11 cases (5.6%). Multivariate analysis identified several prognostic factors, including recurrence (the existence of acute postoperative complications, P = 0.041); for chronic pain (a work with physical effort, P = 0.04; the existence of acute postoperative complications, P = 0.001, and mesh repair, P = 0.04).

CONCLUSIONS:

Our findings suggest that the management of acute complications, such as seroma, hematoma, and infection, is crucial to minimize the risk of long-term complications.
Ventral hernia repair with concomitant soft tissue excision improves satisfaction without increased costs
Authors: Hubbuch Jacob Christopher , Plymale Margaret A. , Davenport Daniel L. , Farmer Trevor N. , Walsh-Blackmore Seth D. , Hess Jordan , Totten Crystal , Roth John Scott
Published: May 2024

PURPOSE:

Soft tissue management following ventral hernia repair (VHR) may impact wound complications and hernia recurrence. Rationales for soft tissue excision (STE) include ischemia, redundancy, potential space reduction, and cosmesis. This study evaluates outcomes among patients undergoing VHR with and without STE.

MATERIALS AND METHODS:

Institutional Review Board-approved review of VHR patients at a single institution from 2014 to 2018 was performed for 90-day wound complications, reoperations, and readmissions. Hernia recurrence, chronic pain, functional status, and satisfaction were assessed through telephone survey. Outcomes and costs between groups were analyzed.

RESULTS:

One hundred and forty-four patients underwent VHR alone; 52 patients underwent VHR/STE. Obesity, larger defects, severe chronic obstructive pulmonary disease, and higher wound classes were more prevalent among VHR/STE. Deep surgical site infection [SSI (1% vs. 8%, P = 0.018)], wound dehiscence (13% vs. 33%, P = 0.003), and return to operating room (1% vs. 12%, P = 0.005) occurred more commonly in VHR/STE. Total costs were more than 50% greater ($18,900 vs. $29,300, P = 0.001) in VHR/STE, but after multivariable analysis adjusting for risk factors, total costs of VHR/STE no longer remained significantly higher ($18,694 vs. $21,370, P = 0.095). Incidence of superficial SSI (6% vs. 6%), seroma formation (14% vs. 12%), non-wound complications (7% vs. 17%), median length of stay (4 vs. 5 days), readmissions (13% vs. 21%), hernia recurrence (38% vs. 13%), and functional status scores (71 vs. 80) did not differ significantly between groups. Overall patient satisfaction (8 vs. 10, P = 0.034) and cosmetic satisfaction (6 vs. 9, P = 0.012) among VHR/STE were greater than VHR alone.

CONCLUSION:

Soft tissue resection during VHR results in greater patient satisfaction without increased costs.
The open anterior component separation technique for large ventral and incisional abdominal wall reconstruction
Authors: Berrevoet Frederik , Allaeys Mathias
Published: May 2024

Large defects in the abdominal wall have been a challenge for traditional surgical techniques. Over several decades, the development of what is now known as the anterior component separation technique (CST) has evolved to reduce tension through release of the lateral abdominal wall muscles. Initially, Albanese and later Ramirez described and popularized this technique. In this procedure, the space between the external oblique muscle and the internal oblique muscle is dissected immediately lateral to the rectus compartment, that is, at the level of the linea semilunaris. To reach this area, an extensive dissection of the subcutaneous tissue and bilateral dissection of the aponeurosis of the external oblique muscle is mandatory in an open standard approach. Unfortunately, this extensive dissection comes at the cost of higher wound morbidity rates. Herein, the surgical technique, the indications as well as the complications will be discussed and a short overview of the results of the latest systematic reviews will be presented, comparing the anterior CST with other surgical options to achieve fascial closure in large abdominal wall defects.
A case report and a contemporary review of incarcerated and strangulated obturator hernia repair
Authors: de Figueiredo Sergio Mazzola Poli , Tastaldi Luciano , Mao Rui-Min Diana , Lu Richard , Tyler Douglas , Perez Alexander
Published: May 2024

BACKGROUND:

Obturator hernia (OH) usually presents as a surgical emergency, with open primary repair most commonly performed. Given the morbidity and high recurrence of this approach, we present a case and review the literature to evaluate the influence of the operative approach on OH repair.

METHODS:

A literature search via PubMed was performed. Inclusion criteria were studies that: (1) were written in English and published within 10 years; (2) included as keywords “obturator hernia” and/or “incarcerated” and/or “strangulated”; (3) reported the operative approach; and (4) reported postoperative outcomes.

RESULTS:

Overall, 225 studies were identified, and 53 met the inclusion criteria. Data from 425 patients were pooled. Open repair without mesh was performed in 239 (56.2%) patients, 121 (28.5%) had open repair with mesh, 44 (10.4%) had laparoscopic repair with mesh, and 21 (4.9%) had laparoscopic repair without mesh. Open repair had a mean hospital length of stay (LOS) of 13.4 days, 40.3% postoperative complications, and 9.7% 30-day mortality rate whereas laparoscopic repair had a mean LOS of 7.9 days, 3.1% postoperative complications, and no deaths. Small bowel resection (SBR) was performed in 44.7% of open and 15.4% of laparoscopic repairs. Patients with SBR demonstrated higher morbidity and mortality compared with patients without SBR. In patients without SBR, laparoscopy had advantages over open surgery in LOS, complications, and mortality rate. The overall recurrence rate was 7.7%, with a mean follow-up of 20.4 months. One (0.7%) recurrence was reported in mesh repair, whereas 28 (12.1%) recurrences were reported with tissue repair.

CONCLUSION:

OHs are the most common open repair without mesh. Our literature review showed that laparoscopic OH repair is associated with enhanced postoperative recovery and the use of mesh was associated with less recurrence. Further studies are still necessary to determine the optimal approach for OH repair, but laparoscopic repair with mesh should be performed when possible.
Evaluation of the satisfaction and effectiveness of the learning in abdominal wall surgery in residents of the digestive system surgery at a tertiary public hospital in Brazil
Authors: Roll Sergio , Pivetta Luca Giovanni Antonio , Konichi Renata Yumi Lima , Fujikawa Victor Kenzo , Antunes Pedro de Souza Lucarelli , de Carvalho João Paulo Venancio , Macret Jessica Zilberman , Dia Eduardo Rullo Maranhão , Francis Maurice Youssef , Ribeiro Hamilton Brasil , de Freitas Amaral Pedro Henrique , Silva Rodrigo Altenfelder
Published: May 2024

AIM:

To report the outcomes of questionnaire assessment about the teaching of the abdominal wall surgery and the incorporation of the techniques taught during the general surgery and digestive tract surgery residency into the individual practice.

METHODS:

The graduated surgeons and resident doctors from 2014 to 2019 were invited to answer a standardized questionnaire about the abdominal wall surgery teaching program, mastery of specific techniques, and medical practice of each. We performed a chi-square test to evaluate whether the degree of satisfaction correlates to the degree of personal confidence and whether it correlates to performing the procedure in this practice.

RESULTS:

When assessing the degree of self-confidence to perform specific procedures, all students were confident in performing the Lichtenstein procedure; 22% were confident in transabdominal pre-peritoneal hernioplasty (TAPP); 77% were confident in Rives-Stoppa and anterior separation technique; and 18% were confident in Transversus Abdominis Muscle Release (TAR) technique. The statistical analysis showed a correlation between teaching program satisfaction and the degree of self-confidence only for the TAR procedure (P = 0,06). The analysis also showed a correlation between the degree of self-confidence to perform a specific procedure and its usage on daily practice only for the Rives-Stoppa procedure (P = 0,00).

CONCLUSION:

These results show the importance of a structured Abdominal Wall Surgery Program, as well as the continuing education evaluation and quality improvement, as the instrument exposed, which to our knowledge, is the first questionnaire to assess the teaching of the abdominal wall and it may be considered a helpful tool.
Critical body mass index associated with increased ventral hernia recurrence rate
Authors: Rihan Maged , Mostafa Mostafa Mahmoud Salama
Published: May 2024

BACKGROUND:

Body mass index (BMI) is a settled risk factor for ventral hernia repair complications. There is no agreement for a specific perfect BMI maximum value for elective hernia surgical repair. The goal of this study is to determine a BMI threshold that represents a risk for ventral hernia recurrence after repair.

MATERIALS AND METHODS:

This is a retrospective single-center study of electronic medical records for patients with repair of ventral hernia from June 2017 to May 2023. The primary outcome of the study is to measure the hernia recurrence. The decision regression trees method was utilized to set the BMI threshold that is associated with a significant increase in the hernia recurrence risk. Bivariate and multivariate analysis was applied to prove the BMI threshold and to assess other factors related to recurrence.

RESULTS:

In total, 110 patients were included, 8.2% of them suffered from ventral hernia recurrence. The analysis defined BMI 38.7 kg/m2 as the critical value for the recurrence of hernia. Patients with liver disease were more likely to have hernia recurrence (11.1% vs. 0%, P = 0.006), irreducible hernias (66.7% vs. 32.6%, P = 0.002), emergency surgery (66.6% vs. 21.7%, P < 0.001), and BMI >38.7 kg/m2 (77.8% vs. 26.7%, P < 0.001).

CONCLUSION:

We found that a BMI of more than 38.7 kg/m2 had a significant increase in the risk of recurrence in ventral hernia patients. This shows the importance of defining a BMI threshold in ventral hernia patients for repair.
Twenty-year retrospective audit of inguinal herniorrhaphy at the Victoria Hospital in Prince Albert, Northern Saskatchewan
Authors: Vetter Cheyenne , Pillay Yagan , Fast Hope
Published: May 2024

AIM:

To perform a retrospective clinical audit of the long-term effects of inguinal herniorrhaphy at the Victoria hospital in Prince Albert, Saskatchewan. Our hope is that this will form a template for a possible hernia registry in Saskatchewan, Canada.

PATIENTS AND METHODS:

A telephonic audit was carried out for all hernia surgeries performed in the year 2000 at the hospital. Demographics such as age and sex as well as the type of surgery and the mesh used were recorded. Chronic complications were also recorded. The surgical questionnaire was adapted from an established short quality-of-life questionnaire (Qol), the EuroQol questionnaire. We then performed a chart audit to identify basic information including the surgical approach and any intraoperative complications.

RESULTS:

Overall, 119 herniorrhaphies were performed at the Victoria hospital in 2000; 18% of patients (21/119) responded to the telephonic survey. There was a 24% complication rate. All cases of hernial recurrence arose from an original open herniorrhaphy technique. Overall, 22% of patients (27/119) had demised since the surgery; five patients remained incarcerated; and six had dementia and could not respond to the survey. The chronic inguinodynia in four patients was managed with analgesia and non-steroidal anti-inflammatories (NSAIDs). There was no need for chemical or surgical nerve ablation procedures.

CONCLUSION:

Long-term clinical audits in surgery remain sparse. There remains a paucity of data for studies that are more than a decade long. This 20-year audit of inguinal herniorrhaphy is the first of its kind in Saskatchewan, Canada. We propose its use to establish a hernia database that will record chronic complications as well as surgical outcomes. This will hopefully facilitate an improved surgical technique and a universally established method of defining and documenting complications such as chronic inguinodynia and hernia recurrence. Hernia databases help to remove patient subjectivity as well as observer bias and to provide an objective scientific overview of outcomes.
An observational study of short- and long-term complications including pain after onlay mesh umbilical hernia repair
Authors: McCombie Andrew Mark , Osborn Debbie , Roberts Ross
Published: May 2024

BACKGROUND:

Information about outcomes for patients who undergo onlay mesh placement for umbilical hernia repair is scarce and the factors that influence adverse outcomes, such as long-term pain, are not well understood. A study of patients undergoing open umbilical hernia repair was undertaken.

MATERIALS AND METHODS:

Patients who underwent open umbilical hernia repair through a private surgical practice over a 13-year period using either an onlay mesh or suture alone repair were given a questionnaire following surgery to document the incidence of long-term pain or other complications. Data were then analyzed to understand any potential contributors to a poor outcome.

RESULTS:

The information on 346 patients was available for study. Mesh was used for repair in 327 (94.5%) patients, whereas 19 (5.5%) had suture alone repair. Early (≤30 days) complications were experienced by 73 patients (21.1%). The most common complications were seroma formation (27 patients), wound infection (13 patients), and hematoma (11 patients). Four patients developed a combination of hematoma, infection, and seroma formation. Late (>30 days) complications (other than persistent pain) were recorded for nine patients and were all wound-related problems. Long-term pain was significantly more common in those patients reporting wound complications (odds ratio: 7.01, 95% confidence interval 1.82–26.99). Recurrent umbilical herniation developed in three patients (0.9%).

CONCLUSION:

Onlay mesh repair for umbilical hernia repair can be performed with low rates of chronic pain and low recurrence rates; however, surgical site occurrences remain common albeit easily treatable.
Rapid survey for assessing effective cataract surgical coverage (eCSC) and effective refractive error coverage (eREC)—Novel indicators of universal eye health
Authors: Vashist Praveen , Grover Sumit , Manna Souvik , Senjam Suraj S , Gupta Vivek , Gupta Noopur , Bhardwaj Amit
Published: May 2024

Purpose:

As per the recent World Health Organization estimates, approximately 2.2 billion people have near and distance vision impairment (VI) globally, and out of this almost 50% is avoidable.

Methods:

The Rapid Assessment of Avoidable Visual Impairment survey was a cross-sectional study conducted in September 2021, using cluster random sampling in 42 clusters with a cluster size of 140, giving a total of 6000 participants. Two teams comprising of trained optometrists and social workers conducted the ocular examination which included unaided, pinhole, and aided visual acuity assessments followed by examination of the anterior segment and lens. Distance visual acuity was measured using simplified tumbling “E” charts of different sizes for VA of 6/12, 6/18, and 6/60. The lens assessment was done in an un-dilated pupil with torch light by the optometrist.

Results:

Overall, 6520 individuals aged 6 years and above were enumerated, of whom 5440 (83.4%) were examined. The response rate for examination was better among females (93.1%) than males (73.9%), and it decreased from 93.8% in the age group 6–15 years to 77.1% in the 45+ age group. The prevalence of blindness and VI were 0.18% (95% CI: 0.06–0.29) and 4.19% (95%CI: 3.65–4.72), respectively. The major causes of VI in all age groups were uncorrected refractive error (65.4%), cataract (23.7%), cataract surgical complications (2.6%), corneal opacity (0.4%), and other posterior segment diseases (7.5%). The effective cataract surgical coverage (eCSC) was 61.8%, effective refractive error coverage (eREC) for distance vision was 59.8%, and eREC for near vision was 47.0%.

Conclusion:

The RAAVI methodology is suitable to measure effective coverage in the general population, both for baseline measurement and periodic monitoring. The 2030 targets for the surveyed district are 90% eCSC and 100% eREC. Such exercises need to be conducted in each district of the country to determine the baseline and target values of effective coverage.
Clinical characteristics and treatment outcomes of patients with IgG4-positive ocular adnexal marginal zone B-cell lymphoma
Authors: Yang Yu , Jin Xuelian , Xu Manhua , He Weimin
Published: May 2024

Purpose:

To explore the clinicopathological characteristics of immunoglobulin G4 (IgG4)-positive ocular adnexal marginal zone B-cell lymphoma (OAML) and associated patient treatment outcomes.

Methods:

Medical records from patients diagnosed with IgG4-positive OAML treated at the West China Hospital between January 2016 and August 2023 were retrospectively analyzed.

Results:

This study included data from 22 patients (11 males, 11 females), aged between 36 and 83 years, with disease durations from 1 month to 30 years. Sixteen cases exhibited unilateral ocular involvement (ten left eyes, six right eyes), while six exhibited bilateral involvement. Common clinical symptoms included ocular masses, eyelid swelling, and proptosis, with the orbit and lacrimal gland being the most commonly impacted sites. Among the 22 patients, 13 who were clinically suspected of having IgG4-related ophthalmic disease (IgG4-ROD) underwent serum IgG4 testing pre-operatively, revealing elevated IgG4 levels in 11 of these patients. The use of computed tomography and magnetic resonance imaging facilitated the evaluation of the location and size of lesions. All 22 patients received surgical treatment. Subsequently, 14 of these patients underwent local radiotherapy, five received post-operative chemotherapy, and three were closely observed. The follow-up period of patients in this study was 3–77 months, with an average follow-up time of 36 months. Except for one patient who died of disease progression, all others showed favorable prognoses with significant improvements.

Conclusions:

These results support the classification of IgG4-positive OAML as a distinct OAML sub-type with clinical features that partially overlap with IgG4-ROD. Therefore, accurate differentiation between OAML and IgG4-ROD is imperative, necessitating timely surgical intervention and precise pathological diagnosis to prevent diagnostic errors and inappropriate treatment. Currently, no standardized treatments for IgG4-positive OAML exist, but our results suggest that standard OAML therapies are generally efficacious.
Transzonular moxifloxacin and dexamethasone delivery in phacoemulsification: A novel dropless regimen
Authors: Gounder M Srinivasan , Rizvi Syed W A , Asharaf Humayoun , Khan Adeeb A , Ashraf Sameer , Akhtar Afeefa
Published: May 2024

Purpose:

To assess the safety and efficacy of transzonular moxifloxacin and dexamethasone versus standard postoperative topical drug regimen in phacoemulsification.

Design:

Nonrandomized prospective study.

Methods:

The study included 100 eyes of 100 age and gender-matched individuals with senile cataract undergoing routine phacoemulsification. The patients were consecutively divided into transzonular (TZ = 50) and topical (TP = 50) groups. Both the groups were followed up for 4 weeks and assessed for intraocular inflammation, visual acuity, changes in intraocular pressure (IOP), and any adverse events.

Results:

The grades of inflammation were significantly lower in TZ as compared to the TP group (P < 0.001). The IOP remained normal and comparable in both the groups. Most of the patients in the two groups attained a visual acuity of 0.2 or better at the end of the follow-up. No adverse effects and increased rate of endophthalmitis were noted in TZ group.

Conclusion:

A one-time peroperative TZ moxifloxacin and dexamethasone combination is a safe and effective method to control postoperative inflammation after cataract surgery. A word of caution though, due precautions to be exercised to prevent the risk of inflammation and endophthalmitis.
Assessment of choroidal perfusion indices in thyroid eye disease by using optical coherence tomography
Authors: Goel Ruchi , Shah Shalin , Yadav Uddeshya
Published: May 2024

Purpose:

To study choroidal vascularity changes in active and inactive TED orbits by using high-definition optical coherence tomography (HD-OCT) and correlate the changes with the duration and severity of TED and Barrets’ index.

Methods:

A cross-sectional study wherein 37 TED orbits and 30 healthy control (HC) orbits were enrolled. Choroid was imaged using HD-OCT scans centered at the fovea, and subfoveal choroidal thickness (SFCT) was measured. The OCT images were analyzed using ImageJ software to calculate choroidal vascularity index (CVI) and associated choroidal perfusion indices.

Results:

The study included eight active, 13 non-inflammatory active (NIA), and 16 inactive TED orbits. The mean age was 39.73 ± 12.91 years, and the male: female ratio was 1.18:1. Intraocular pressure and CVI were higher, while SFCT was similar in TED on comparison to healthy orbits. CVI and SFCT were raised in active as compared to inactive TED. CVI and SFCT correlated positively with Barrets’ index and negatively with the duration of thyroid disease. The area under curve of CVI (95% CI: 0.651–0.864, P < 0.001) helped in differentiating TED orbits from HC, while CVI (95% CI: 0.780–0.983, P < 0.001) had the maximum discriminatory power in predicting the activity of disease.

Conclusions:

CVI has greater sensitivity than SFCT in differentiating healthy from TED orbits. The blood flow stagnation in active orbits, which improves during the course of TED and tends to worsen with increase in Barret’s index, can lead to choroidal vascularity changes. CVI and SFCT can act as adjunct to existing modalities for monitoring the disease activity.
Combined topography-guided photorefractive keratectomy and corneal collagen crosslinking
Authors: Kumar K Kiran , Nataraj Spurti , Maganty Vandana , Porwal Kinjal H , Gangasagara Suresh B
Published: May 2024

Purpose:

This study aimed to report the long-term results of combined topography-guided photorefractive keratectomy (PRK) and accelerated corneal collagen cross-linking (CXL) for keratoconus using the Zeiss refractive coordinated system.

Methods:

A prospective interventional study was conducted in a tertiary eye care hospital in South India. Patients with mild-to-moderate progressive keratoconus and corneal pachymetry greater than 450 µm were included. They underwent customized topography-guided PRK followed by CXL. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and keratometry readings and complications were evaluated at 1, 3, 6, 12, and 24 months postoperatively.

Results:

Thirty patients (30 eyes) were included in the study. All study parameters showed a statistically significant improvement postoperatively over baseline values. At 24 months, the mean UDVA improved from 0.8 ± 0.180 logarithm of the minimum angle of resolution (logMAR) to 0.38 ± 0.118 logMAR (P-value <0.001) and CDVA improved from 0.467 ± 0.142 logMAR to 0.227 ± 0.078 logMAR (P-value <0.001). The mean flat, steep, and maximum keratometry values were significantly reduced by 2.133, 3, and 4.54 diopters, respectively, at the last follow-up examination (P-value <0.001).

Conclusion:

The combined topography-guided PRK and accelerated CXL procedure seem to be a promising treatment alternative for early keratoconus. This is the first such study on the Zeiss refractive coordinated system. However, further studies with a larger study population and longer follow-up periods are required to draw final conclusions about the benefits of this procedure in keratoconus.
Primary outcomes, secondary outcomes, and their relevance to how many papers are published from a study: A primer for authors, reviewers, and editors
Authors: Menon Vikas , Praharaj Samir Kumar , Andrade Chittaranjan
Published: May 2024

In research, outcomes are often categorized as primary and secondary. The primary outcome is the most important one; it determines whether the study is considered ‘successful’ or not. Secondary outcomes are chosen because they provide supporting evidence for the results of the primary outcome or additional information about the subject being studied. For reasons that are explained in this paper, secondary outcomes should be cautiously interpreted. There are varying practices regarding publishing secondary outcomes. Some authors publish these separately, while others include them in the main publication. In some contexts, the former can lead to concerns about the quality and relevance of the data being published. In this article, we discuss primary and secondary outcomes, the importance and interpretation of secondary outcomes, and considerations for publishing multiple outcomes in separate papers. We also discuss the special case of secondary analyses and post hoc analyses and provide guidance on good publishing practices. Throughout the article, we use relevant examples to make these concepts easier to understand. While the article is primarily aimed at early career researchers, it offers insights that may be helpful to researchers, reviewers, and editors across all levels of expertise.
Development and validation of home-based psychosocial self-management interventions in schizophrenia and related disorders in low-resource settings: A mixed methods approach
Authors: Chadda Rakesh K. , Sood Mamta , Chawla Nishtha , Mahapatra Ananya , Patel Rekha , Mohan MohaPradeep , Iyer Srividya N. , Ramachandran Padmavati , Rangaswamy Thara , Shah Jai , Madan Jason , Birchwood Max , Meyer Caroline , Lilford Richard , Furtado Vivek , Graeme Currie , Singh Swaran P.
Published: May 2024

Background:

Psychosocial interventions, crucial for recovery in patients with schizophrenia, have often been developed and tested in high income countries. We aimed at developing and validating home-based a booklet based psycho-social intervention with inputs from stakeholders: patients, families, and mental health professionals (MHP) for patients with schizophrenia and related disorders in low resource settings.

Methods:

We developed a preliminary version of psychosocial intervention booklets based on six themes derived from focus group discussions conducted with patients, families, and MHP. Initially, quantitative assessment of content validity was done by MHP on overall and Content Validity Index of individual items of the specific booklets, followed by in-depth interviews about their views. The booklets were modified based on their inputs. Further, pilot testing of manuals was done on the users - nine pairs of patients and caregivers followed by development of a final version of psycho-social intervention.

Results:

The percentage content validity of individual modules and overall booklets was ≥78.5% indicating good validity. Most MHP reported that the manuals were relevant and easy to use but were text-heavy, and lengthy. On pilot testing of modified manuals with patients and their family caregivers, majority (77.8%) of them found booklets useful and suggested that there should be separate booklets for both patients and caregivers for providing information and entering separate response for the activities, integrating helpful tips. Language should be simple. Finally, two sets of booklets (“info book” and “workbook”) named ‘Saksham’ (meaning empowered) were created with specific modules (viz., ‘Medicine adherence’, ‘Daily routine’, ‘Eating right’, ‘Physical activity’, ‘Physical health monitoring’, ‘Self-reliance’, and ‘Psychoeducation’) for patients and caregivers each, in two languages (Hindi and English).

Conclusion:

Booklets with modules for psychosocial interventions for patients with schizophrenia and their caregivers were developed after establishing content validity and pilot testing.
Associations between neurological soft signs, executive functions, and brain-derived neurotrophic factor in boys with attention-deficit hyperactivity disorder
Authors: Tunagur Mustafa Tolga , Aksu Hatice , Kurt Tunagur Elif Merve , Yilmaz Mustafa
Published: May 2024

Background:

To determine the association between neurological soft signs, executive functions, and serum brain-derived neurotrophic factor (BDNF) levels in children with attention-deficit hyperactivity disorder (ADHD).

Methods:

Serum BDNF levels were measured in 87 drug-naive boys with ADHD, aged 7–12 years. The Revised Physical and Neurological Examination for Subtle Signs for neurological soft signs, Stroop Color-Word Test for attention functions, and Judgment of Line Orientation Test (JLOT) for visuospatial abilities were performed.

Results:

Age correlated negatively with dysrhythmia, total time, and total overflow in timed movements, Stroop Color-Word Time (SCWT), and serum BDNF levels. The JLOT significantly negatively correlated with Total Gaits and Stations (P1) and Total Time in Timed Movements (adjusted R
2
= 0.247). In addition, SCWT maintained a significant correlation with Total Overflow in Timed Movements (adjusted R
2
= 0.206). There was no correlation between serum BDNF levels and NSS.

Conclusion:

The association between NSS, visuospatial abilities, and selective attention may express a maturational delay in ADHD pathophysiology. Moreover, BDNF may play a role in this maturational delay. Future studies should investigate the contribution of BDNF to neuronal maturation in ADHD.
Prevalence and factors associated with cyberbullying among adolescents (15–19 years) in Gurugram District – A community based cross-sectional study
Authors: Pathak Vineet Kumar , Tripathi Saparya , Kumar Mohan , Panigrahi Sunil Kumar , Sohkey Rohit , Kadian Apila , Bhattacharya Madhulekha , Jha Namrta
Published: May 2024

Background:

Digitalization in the form of increased Internet use through screen media has also shown its ramification like cyberbullying. They are aggressive acts with the intention or motivation to harm another person through technology. The aim is to study the prevalence of cyberbullying and its association with mental illness in the adolescent age group (15–19 years).

Methods:

This community-based cross-sectional study was rolled out among adolescents aged 15–19 years. A total of 387 were given a semistructured interviewer-administered questionnaire consisting of general details, cyberbullying victimization, and offending questions, PHQ-9 and GAD-7.

Results:

The mean (SD) age was 16.8 (1.3) years. More than half (53.2%) were males, and nearly three-fourths (74.4%) were school-going. Around 28.2% reported being cyberbullied at least once in their lifetime. About 7.0% of adolescents were cyberbullied more than once, and 0.8% more than five times in the past 30 days. The most common ways were posting a mean or hurtful picture (31.9%) and the concerned person’s comments (24.2%) online. Multivariable logistic regression analysis found that adolescents attending colleges (AOR 1.9, 95% CI 1.1 to 3.4), using tobacco (AOR 2.5, 95% CI 1.4 to 4.5), and depressed (of any severity, AOR 2.0, 95% CI 1.1 to 4.3) were at significantly increased risk of being cyberbullied (P < 0.05).

Conclusion:

The prevalence of cyberbullying among adolescents aged 15–19 is notable, with significant associations found between cyberbullying and attending college, tobacco use, and depression. Understanding the correlates of cyberbullying can inform targeted interventions to support mental health and well-being among adolescents.
Role of oral melatonin in prevention of postoperative delirium in patients undergoing elective surgery under general anesthesia: A Randomized controlled trial
Authors: Thakur Tanuja , Saini Vikas , Grover Sandeep , Samra Tanvir
Published: May 2024

Background:

Postoperative delirium is a common complication in patients undergoing elective surgery under general anesthesia. We aimed to minimize the incidence with an oral dose of 3 mg of melatonin administered the night before surgery.

Methods:

Hundred and sixty-two patients aged 40–80 years posted for various urological and gastrointestinal surgeries under general anesthesia with no preoperative cognitive deficits were randomly distributed equally to melatonin or control groups. In the control group, routine premedication was done with tablet alprazolam (0.25 mg) and ranitidine (150 mg), but in the melatonin group, the patients were given 3 mg melatonin orally the night before surgery along with routine premedication. The CAM scale was used for diagnosis of postoperative delirium.

Results:

Incidence of delirium was significantly lower in the melatonin group, 23.5%, 8.6%, and 2.5% at 6, 24, and 48 hours, respectively, and the corresponding mean (SD) values of CAM scores were 1.37 (1.30), 1.07 (1.03), and 0.69 (0.80). In contrast, the incidence of delirium was 46.9%, 30.9%, and 16% at 6, 24, and 48 hours, respectively, in the control group. There was a significant reduction in anxiety, a lower incidence of cognitive dysfunction (i.e., MoCA score <26), and improvement in sleep quality in the melatonin group at 6, 24, 48, and 72 hours after the surgical intervention. The generalized estimating equations model (GEE) model was used to study change in MoCA and CAM scores over time between the two groups, and it showed a significant interaction between time and treatment groups (P < 0.001).

Conclusions:

Melatonin premedication reduced incidence of postoperative delirium and cognitive dysfunction and was associated with better sleep quality and anxiolysis.
Delayed vitreous prolapse causing corneal decompensation with normal Intraocular pressure: A case report
Authors: Sharma Prachi , Katiyar Vishal
Published: May 2024

Vitreous prolapse is a postcataract surgery complication that can further cause corneal decompensation, glaucoma, macular edema, and retinal detachment. We present a rare case report of delayed vitreous prolapse in a 55-year-old man 20 years after cataract surgery with posterior capsular rupture causing diminution of vision and central corneal decompensation. To our surprise, the intraocular pressure was 18.6 mmHg (within the normal limits). The patient underwent pars plana vitrectomy for the same and had excellent postoperative visual recovery.
Ocular disorders in Parkinson’s disease: A review
Authors: Bansal Yashi , Grover Renu
Published: May 2024

Parkinson’s disease (PD) is a common degenerative disorder characterized by decreased dopamine levels from damage to the substantia nigra causing classic motor deficits. Several ocular deficits have been recognized in association with PD such as oculomotor disturbances and diplopia, glaucoma and visual field loss, dry eye disease, color and contrast impairment, visual hallucinations, and visuospatial and visuoperceptual impairments. These disorders remain underreported, underrecognized, and poorly understood. Patients with PD are largely dependent on visual cues for compensating the motor deficits. Hence, early recognition and timely management of the above ocular disorders can lead to greater patient safety, independence, and a better quality of life.
Modulation transfer function and higher order aberrations with and without corneo scleral lens in an eye with keratoconus
Authors: Shah Sonal , Pirdankar Onkar H. , Patil Lomesh D. , Sheth Siddharth , Jain Pooja , Saradge Rahul , Shah Smitesh
Published: May 2024

The purpose is to describe image quality metrics such as modulation transfer function (MTF) and Strehl ratio and higher order aberration (HOA) with corneo scleral lens (CSL) in keratoconus. A 25-year-old male visited the outpatient department with a complaint of diminution of distance vision in the right eye. His best-corrected visual acuity was 6/60 and 6/6 partial in the right and left eyes, respectively. Slit-lamp examination revealed right eye keratoconus and left eye was Forme fruste keratoconus. There was a history of corneal collagen cross-linking with riboflavin in the right eye. The patient was dispensed with corneo-scleral contact lens and the left eye was managed with spectacle. Corneal HOA, MTF, and Strehl ratio were measured without and with CSL using iTrace aberrometer. A significant reduction in corneal HOA and improvement in image quality metrics were noted with CSL.
Deep anterior lamellar keratoplasty in advanced keratoconus in children: A 4-year study
Authors: Preethi B. , Kumar K. Kiran , Malepati Nikhila
Published: May 2024

Purpose:

The purpose of the study was to evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) in children and adolescents with advanced keratoconus (KC) at a tertiary eye care center in India.

Design:

This was a retrospective cross-sectional study.

Methods:

All cases of KC under the age group of 18 years, operated for DALK at a tertiary eye care center in South India, were evaluated from January 2018 to January 2022; outcome measures were best-corrected visual acuity (BCVA), graft clarity at final follow-up, and complications.

Results:

Of 27 eyes of 25 cases, 16 were male and 9 were female, with a mean age of presentation at 14.9 years. In stromal dissection technique, big bubble was attempted in 23 eyes and achieved in 20 eyes; manual dissection was done for the rest of the cases. Final BCVA varied from 0.1 to 0.6 logMAR units. Twenty-three eyes had excellent graft clarity at final follow-up. Complications noted in the study were intraoperative microperforation in four cases, postoperatively suture-related complications in three cases, and corneal graft rejection in one case.

Conclusion:

DALK in pediatric age group for advanced KC is an effective treatment option.
Orbital myiasis
Authors: Kumari Suchitra , Bandyopadhyay Antabha , Mahato Anup Kumar , Kumari Anjali
Published: May 2024

Myiasis is a parasitic disease caused by fly larvae of the Diptera order that infest humans and other vertebrates. Orbital myiasis is a potentially destructive infestation of the orbital tissues. We present a case of orbital myiasis in a 34-year-old male with a 4-day history of foreign body sensation, pain, and bloody discharge from his right eye. On examination, a necrosed, gaping wound of approximately 7 cm × 2 cm was present under the right eye. The wound was infested with larvae, eyelids were swollen, and conjunctival congestion and discharge were present. The larvae were removed using turpentine oil, and the wound was debrided and treated with hydroheal AM gel regularly for 1 week. A systemic antibiotic and topical antibiotic-steroid combination was given. After 1 week of treatment, the best-corrected visual acuity in both his eyes was 6/6, and anterior and posterior segment findings were normal; a computed tomography scan was also normal. The wound healed with secondary intention.
Psychological distress among low-vision patients
Authors: Khurana Ashi , Singh Mahendra , Malik Anuprakshi , Agarwal Pradeep , Chauhan Lokesh
Published: May 2024

Purpose:

The purpose of the study was to measure the mental well-being of patients suffering from low vision using the Depression, Anxiety, and Stress Scale (DASS).

Methods:

Low-vision patients who visited the low-vision clinic of CL Gupta Eye Institute were studied using the DASS. Patients were excluded if they were <18 years old or could not understand the questionnaire due to an intellectual disability. Sociodemographic characters (such as age, gender, marital status, and education) were recorded before the administration of the study questionnaire.

Results:

In this study of 60 low-vision patients, high rates of psychological distress were observed, with 85% experiencing depression, 81.7% anxiety, and 75% stress. Demographic variables such as age, gender, marital status, and education did not significantly affect these rates. However, individuals with severe visual impairment (VI) or blindness had significantly higher prevalence rates for depression (P = 0.003), anxiety (P = 0.001), and stress (P = 0.013).

Conclusion:

This study reveals a high prevalence of depression, anxiety, and stress among low-vision patients, with the most pronounced impact seen in individuals with severe VI or blindness. These findings underscore the urgent need for targeted mental health interventions to improve the well-being of low-vision patients, especially those with severe VI. Tailored support can significantly enhance their overall quality of life and psychological health.
Assessing knowledge, attitude, and practice regarding conjunctivitis among patients
Authors: Silva Maxwell , Bhailume Prajakta Vijay , Pargaonkar Nachiket , Silva Malcolm
Published: May 2024

Aims and Objectives:

(1) To assess the knowledge, attitude, and practice about conjunctivitis among patients. (2) To educate society regarding preventive and therapeutic measures.

Methodology:

A cross-sectional study, in which 500 patients were selected as participants, knowledge, attitude, and practice were assessed regarding conjunctivitis using prevalidate questionnaire, which contains 20 questions. Descriptive statistics were used to elaborate patients’ demographic characteristics. Categorical variable was percentage while the continuous variable was conveyed as mean ± standard deviation. A significance P < 0.05 was used for comparison. All analyses were performed using the Statistical Package for the Social Science Version 20.

Results:

Out of 500 distributed questionnaires, 328 were male, 172 were female, majority having age range between 25-60 years. It was seen that 370 participants (74%) have adequate knowledge regarding conjunctivitis.

Conclusion:

Patients have sufficient knowledge and awareness about conjunctivitis, yet effort should be made to bring change about conjunctivitis. Proper eye health facilities and teaching should be involved in institute health services, and early presentation to eye care centers for its treatment should be encouraged.
Keratoconus presentation with respect to age, gender, and severity in Western India
Authors: Shah Zalak A. , Purohit Dipali M. , Danayak Parul M. , Patel Jayadatt D. , Purohit Sena M.
Published: May 2024

Purpose:

To study the demographic profile of keratoconus (KC) patients visiting a tertiary eye care hospital in Western India.

Materials and Methods:

This cross-sectional, observational study included newly diagnosed KC patients visiting our hospital between January 2018 and October 2022. Patient’s demographic details (self-reported age at first presentation, age at diagnosis, and sex) and mean maximum curvature (K Max) were collected. The patients were divided into age band of 5-year groups. A subanalysis of gender and severity was performed among groups. Spearman’s correlation coefficient was used to evaluate the relationship between KC severity and age.

Results:

A total of 536 patients with clinical KC were included. A self-reported age at first presentation was 19.4 ± 6.2 years. The mean age of diagnosis was 20.5 ± 6.0 years (range: 4–43 years). There were 61.6% (330) of males and 38.4% (206) of females (P < 0.01). The mean K Max value was 59.2 ± 13.3 diopter (D). The mean K Max was not significantly different between the sexes, with the exception of the age range of 24–28 years, where females had more severe KC than males (P = 0.02). Among the included patients, 38.6% (207) of patients were pediatrics (≤18 years), while 61.4% (329) were adults (>18 years). The mean K Max in pediatric KC (62.3 ± 15.1 D) was significantly higher than adult KC (57.3 ± 11.5), P < 0.01. Severity of KC did not correlate with the age of the patients (r = −0.20, P = 0.04).

Conclusion:

KC presented at a younger age with moderate-to-severe stage of the disease, indicating the need for early KC detection in our population.
Corneal morphology following use of Malyugin versus B-hex pupil expansion rings in small pupil phacoemulsification
Authors: Gupta Simple , Agrawal Mohini , Pushkar Kumar , Tripathi Abhishek , Bhanot Rohit , Singh Manish
Published: May 2024

Aim:

The aim of the study is to evaluate changes in corneal parameters following the use of the Malyugin ring (MR) and B-Hex ring (BhR) in small pupil phacoemulsification.

Methods:

A prospective cross-sectional study. 51 eyes with small pupil underwent phacoemulsification with the use of MR and BhR as pupil expansion techniques. Best-corrected visual acuity (BCVA), endothelial cell counts density (ECD), coefficient-of-variation (CV), hexagonality, central corneal thickness (CCT), and intraocular pressure (IOP) were recorded on preoperative day and postoperative day 1 and day 30.

Results:

Mean age at presentation was 70.9 ± 4.1 years. The most common cause for small pupils was alpha-blockers used in benign prostate hypertrophy, followed by diabetes mellitus and pseudo-exfoliation syndrome. Mean preoperative BCVA (3/60–6/12), IOP (17.12 ± 2.81 mmHg), CCT (530.96 ± 44.47 μ), ECD (2347.96 ± 298.09 cells/mm2), 6A (48.92% ± 6.34%) and CV (39.50 ± 3.49) changed to BCVA (6/9–6/6), IOP (18.69 ± 1.91 mm of Hg), CCT (536.04 ± 37.61 μ), endothelial cell count (2201.15 ± 276.75 cells/mm2), 6A (45.12% ±4.99%), and CV (37.57 ± 3.37) at day 30 postoperatively after use of MR. Similarly, mean preoperative BCVA (3/60–6/12), IOP (16.40 ± 2.42 mmHg), CCT (532.40 ± 36.14 μ), ECD (2433.68 ± 162.01 cells/mm2), 6A (48.84% ± 3.73%), and CV (39.36 ± 3.915) changed to BCVA (6/9–6/6), IOP (17.68 ± 2.75 mmHg), CCT (546.88 ± 31.25 μ), ECD (2322.08 ± 167.97 cells/mm2), 6A (46.36% ± 3.25%) and CV (38.96 ± 4.43) at day 30 post-operatively after use of BhR. The average change was clinically insignificant at day 30.

Conclusion:

MR and BhRs are safe pupil expansion devices and the corneal parameters are in the acceptable range of any routine phacoemulsification for senile cataracts. Nevertheless, B-hR shows relatively less alteration in corneal parameters, when compared to MR.
Endogenous Aspergillus endophthalmitis in a chronic kidney disease
Authors: Quraishi Mohd Azaz , Nene Amit S. , Pirdankar Onkar H. , Shenoy Pratik , Badole Pushpanjali , Rewatkar Kaustubh , Shah Smitesh
Published: May 2024

Fungal endogenous endophthalmitis (FEE) is an intraocular infection secondary to the fungemia, spreading through the hematogenous route. We here report a case of a 60-year-old female diagnosed with FEE and culture-proven Aspergillus fumigatus in a chronic kidney disease (CKD) patient, which is a rare and challenging condition to manage. Early diagnosis and prompt treatment are the only keys to achieve suitable outcomes. It can be achieved by a multidisciplinary approach involving nephrologists and ophthalmologists. Routine ophthalmology review in CKD patients under hemodialysis may prove to be effective in early diagnosis of the fungal endophthalmitis or even help in ruling out systemic infections.