bluuebunny/crossref_metadata_2025 huggingface dataset:
Integration of traditional medicine into the mental healthcare system in Tshwane, South Africa
Authors: Masemola Vusi F.J. , Thobakgale Ellen M. , Govender Indiran
Published: April 2023

Background: Mental healthcare providers have a negative attitude towards the integration of traditional health medicine (THM) into the mental health system. The attitude is based on their lack of trust in traditional practices, which are not supported by substantial evidence-based medical research. The study was conducted to determine mental healthcare providers views on the integration of traditional health medicine into the mental healthcare system.Methods: The study was conducted at a psychiatric hospital in the Tshwane district, Gauteng province, South Africa. A cross-sectional, descriptive research design was conducted on 85 respondents who consented to participate. Data were collected using a survey questionnaire from 23 psychiatrists and 62 psychiatric nurses. Data were analysed using descriptive statistics and presented in the form of graphs, frequencies and percentages.Results: Mental healthcare providers displayed a negative attitude towards integrating THM in psychiatric hospitals. The results showed no significant difference between psychiatrists and psychiatric nurses in their preference for modern mental healthcare practices (p = 0.25).Conclusion: There is still doubt among the mental healthcare providers on whether to support integration of the THM into mental health system or not. The doubt is based on the two-health system isolated from each other especially in South Africa.Contribution: This study contributed by showing the need and importance of understanding a patients’ cultural background, which supports the integration of a traditional health system into the mental healthcare system, which in turn will lead to the appropriate management of mental illnesses.
Greasing the wheel through bribes: interaction of national culture and local business conditions
Authors: Ohu Eugene A. , Spitzmueller Christiane A.
Published: April 2023

Purpose: Corruption, which includes payments of bribes to government officials, poses a serious impediment to the advancement of developing countries. In this study, a model is developed based on anomie theory and research on ethical behaviour, culture and decision making to predict whether and to what extent small business owners bribe government officials.Design/methodology/approach: Using hierarchical linear modelling on a large World Bank data set, the study hypothesises that the business environmental conditions of crime prevalence, theft and disorder, transportation difficulties, and time-resource requirements for dealing with the government, function as obstacles that enhance small business owners’ informal payments to government officials. The study further proposes that the national culture constructs of masculinity and power distance moderate the relationship between business environment conditions and small business owners’ bribes.Findings/results: The study found support for the role of the proposed business environment conditions, as well as partial support for the role of masculinity and power distance as factors that strengthen the positive relationship between challenging business environments for small business owners and corrupt behaviour.Practical implications: The study proposes ways governments can address structural uncertainties which are impediments to small business survival. It also offers ways small businesses can counteract cultural and economic challenges that influence corrupt behaviour.Value: This study improves the understanding of the role of the supply-side of corruption. It also explains how the lens of anomie theory leads to a better understanding of the mechanism of action of inducements to deviate from the norm, as happens in corrupt behaviour practices.
Determining the business environmental factor constructs relevant to small and medium-sized enterprises trade credit management
Authors: Otto Werner H. , Botha Ilse , Els Gideon
Published: April 2023

Background: Within the conceptual paradigm that the business environment of South Africa could significantly impact on small and medium-sized enterprises, (SMEs) management of trade credit, the need exists for internal and external business environmental factors to be constructed, in order to understand how SMEs rate these factors.Aim: The research purpose was to identify and construct relevant internal and external business environmental factors and obtain SME ratings for these factors to statistically test the validity and reliability of the measurement instrument.Setting: This study was conducted by administering an online questionnaire.Method: Quantitative research design with purposive sampling as the sampling method, administrated to 10 450 SMEs within South Africa.Results: A descriptive statistical analysis revealed that the highest quality internal and external business environmental components were managerial competencies and ethics, respectively. Factor analysis resulted in the formulation of five internal and six external business environmental factors. In addition, SMEs do not rate internal and external business environmental factors equally. Managerial competencies obtained the highest overall mean score for all business environmental factors, including the highest for internal factors. Small and medium-sized enterprise and debtor ethical performance obtained the highest means score for external factors.Conclusion: The formulation of newly constructed internal and external business environmental factors relevant to SMEs’ management of trade credit.Contribution: As far as can be established, research identifying variables and constructing internal and external business environmental factors relevant to SME management of trade credit has not been conducted in South Africa. The newly formulated internal and external business environmental factors broaden SMEs’ understanding of which business environmental factors are relevant to SMEs’ management of trade credit, including how SMEs rate these factors.
Grotesque bodies in the book of Job: A psychoanalytic perspective
Authors: Van der Zwan Pieter
Published: April 2023

Job is suffering from illness without understanding it. His impairment and exclusion render him disabled in an abled, gloating but threatened society for which he is the laughing stock despite his exceptional piety. His psychic and spiritual breakthrough comes when God makes him reflect on and in the mirror of the wild and disorderly bodies of the two monstrosities, Behemoth and Leviathan, elsewhere in the Hebrew Bible exemplifying chaos, but now unexpectedly celebrated. Even as possible relief thanks to light-hearted humour these grotesque bodies emancipate the object of body-politics by subverting the centre of certainty and power. In this study the Bakhtinian critique of the ‘monologisation’ of the human body and its experience promised to be fruitfully combined with psychoanalytic insights about imprisoned body-images to enrich the relevance of the book of Job.Intradisciplinary and/or interdisciplinary implications: The interface of biblical hermeneutics and exegesis with other research fields in the social sciences and humanities such as psychoanalytic theory and literary criticism expanded the horizon of insight for all parties involved, not only for biblical studies.
‘Sinawe’ [we are with you]: Local churches as change agents in the lives of traumatised youth
Authors: Knoetze Johannes J. , Black Timothy J.
Published: April 2023

The church has a key role to play in addressing the chronic levels of grief and trauma experienced by the youth in South Africa. It has a biblical mandate to bring hope and healing and has a unique station within South African society that positions it to bring about real transformation. ‘Sinawe’ (Zulu for [we are with you]) is a programme developed by Scripture Union South Africa to equip local churches as change agents through a relational youth ministry model that engages trauma, grief and holistic needs, both physically and spiritually. This is an important first step for churches wanting to reach and minister to young people.The South African church has an important and legitimate role to play in the lives of young people. Research indicates that although the church is considered by local residents as an important community resource, it remains ineffectual in intentional community-based youth ministry that leverages significant opportunity. This research identifies the church as an important community change agent and encourages church leaders to step into the open gap to reach local young people while providing the methodology with which to do so. This research paper examines the current South African social context, outlines a theological mandate for church involvement and presents a methodology for a supportive and effective approach to community engagement in the lives of young people led by local churches.Interdisciplinary: The article is relevant to the following disciplines within theology; missiology, family and youth ministry and pastoral care. It also has interfaces with education and sociology.
A mission made to last: Paul as a sustainable leader according to the Book of Acts
Authors: Stenschke Christoph W.
Published: April 2023

This essay examines how the Book of Acts portrays Paul as a sustainable leader. Paul not only preached the Gospel, but also gathered his converts into communities, trained and installed their leaders, visited these communities regularly, and co-operated with a large group of co-workers whom he would train to take over from him. He readily made himself available as an example for others to follow. Paul established churches in major urban centres, which would take the Gospel to their surrounding areas. In all of this, he not only followed some early Jewish practises but also emulated the example of Jesus, who likewise carefully prepared a group of people to continue his ministry after his departure. While Paul’s circumstances and strategies cannot simply be copied in the different contexts, this presentation closes by describing what can be learnt from this portrayal for sustainable leadership in today’s churches and other organisations.Intradisciplinary and/or interdisciplinary implications: This article not only contributes to our understanding of the Book of Acts but also the way it characterises the ministry of Paul who dominates the second half of the Acts. In some instances, this portrayal challenges the understanding of Paul as he is seen in much of New Testament scholarship based solely on the letters of Paul. The research also contributes to practical theology/Christian leadership studies as it, based on the historical Paul, indicates some ingredients of sustainable leadership in Christian and in secular contexts. The research is also of relevance for secular leadership studies and social sciences.
Of seduction and male abuse: Exploring the less-talked-about using Tamar’s stratagem (Gn 37–38)
Authors: Mwandayi Canisius
Published: April 2023

Gender-based violence has often been framed and perceived as exclusively a women’s issue. As a result, terms such as ‘violence against women’ and ‘gender-based violence’ have often been understood and used interchangeably. In the fight and campaign against gender-based violence, men have been reckoned to be the most common culprits behind fuelling violence against women. While indeed to a large extent men are the perpetrators of gender-based violence, little attention, however, has been paid to at least two things: the loose usage of the term ‘gender’ as if exclusive of men, as well as the violence that some men suffer at the hands of some women. It was the thrust of this article to bring on the table the less-talked-about sexual abuse that some men suffer at the hands of some young women using Tamar’s trapping of Judah as an entry point into the discussion. Using a socio-anthropological approach, the article argued that the behaviour of some young women towards men older than themselves through manipulating their sexual weakness is a form of gender-based violence that calls for a redress.Intradisciplinary and/or interdisciplinary implications: The theme of gender-based violence is by definition of multidisciplinary interest. This contribution highlighted the less-talked-about abuse of men, which is also of significance within multiple disciplines including biblical studies, social anthropology, theology, cultural studies and even history.
A rare case of a recurrence of inflammatory myofibroblastic tumor involving the meninges and skull
Authors: Halldorsdottir Karen , Tranmer Bruce , DeWitt John , Thomas Alissa A.
Published: April 2023

Inflammatory myofibroblastic tumors (IMTs) are rare tumors of mesenchymal origin, which infrequently involve the central nervous system. Neuroradiological features are nonspecific and they can mimic other tumor-like intracranial lesions. Local recurrence is rare and has been associated with a mutation in the anaplastic lymphoma kinase (ALK) gene. We report a case of recurrent meningeal IMT 15 years after complete resection, without carrying the ALK mutation. This case emphasizes the need to consider IMT in the differential diagnosis as well as the possibility of a late recurrence, suggesting a need for a long-term follow-up and surveillance imaging.
An intraparenchymal meningioma mimicking glioma
Authors: Kommu Venkateswara Rao , kodandapani Susheela , Perubhotla Lakshmi Manasa , Sudhir Rashmi
Published: April 2023

Meningiomas rarely exhibit cystic lesions with mural nodules and may be misdiagnosed as intraparenchymal cystic tumors. We herein present a 52-year-old man with amulti-locilar cystic lesion with heterogeneous enhancement in the right frontotemporal lobe accompanied by peritumoral brain edema. Differential diagnoses included low-grade gliomas and cystic meningioma. The patient underwent right frontotemporal craniotomy and near-total excision of the tumor. Intraoperatively tumor is cystic and firm inconsistency with no clear plane of dissection between tumor and brain parenchyma. Histopathological examination revealed grade 2 atypical meningioma
Contact lenses for the treatment of ocular surface diseases
Authors: Sah Ramkishor , Sharma Namrata , Priyadarshini K , Titiyal Jeewan S
Published: April 2023

Contact lens wear is useful in ocular conditions such as high refractive errors, irregular astigmatism, corneal ectasias, corneal dystrophies, post-keratoplasty, post-refractive surgeries, trauma, and ocular surface diseases. The new innovations of highly oxygen-permeable contact lens materials have broadened the applications of contact lens suitability. Therapeutic contact lenses are medically used in the management of a wide variety of corneal conditions and ocular surface diseases. These lenses aid in pain relief, enhance corneal healing, maintain ocular homeostasis, and act as a drug delivery system. Drug delivery applications of contact lenses hold promise for improving topical therapy. The modern rigid gas permeable scleral contact lens provides symptomatic relief in painful corneal diseases such as bullous keratopathy, corneal epithelial abrasions, and erosions. It has been useful in therapeutic management as well as visual rehabilitation by enhancing the ocular surface and protecting the cornea from adverse environmental conditions. This review provides a summary of contact lenses used for the treatment of ocular surface diseases based on the current evidence available in the literature. This can help enhance the understanding and management of ocular surface diseases with respect to contact lens use in our day-to-day ophthalmology practice.
Ocular surface staining: Current concepts and techniques
Authors: Srinivas Sanjeev P , Rao Srinivas K
Published: April 2023

The health of the ocular surface is vital for clear vision and comfort. Various factors can adversely influence the ocular surface and tear film homeostasis, and these include procedures like cataract and corneal refractive surgery. It is, therefore, important to assess the integrity of the ocular surface in a rapid, predictable, and consistent manner in the clinic. Various tests and devices have been described, and while these are useful, this article highlights the importance of using fluorescein staining of the ocular surface in detecting changes. This is a simple, inexpensive, rapidly performed test that is available in most eye clinics. However, a proper technique of dye instillation and assessment is important to recognize the changes that can occur. Once detected, these changes can be quantified, and the location and patterns can be used to diagnose the diseases that are present; these changes can also be used to monitor treatment outcomes and disease progression. The article discusses the technique, assessment, and interpretation of fluorescein staining of the ocular surface, along with the role of the two other vital dyes – rose bengal and lissamine green.
E-PIX: An enhanced grading for acute ocular burns
Authors: Iyer Geetha , Srinivasan Bhaskar , Agarwal Shweta , Fogla Rajesh
Published: April 2023

An enhanced online and manual grading system, based on the I’s and E’s, for acute ocular chemical injuries is being proposed. E-PIX is designed to be an online/manual grading system that includes all the parameters that adversely affect the outcome of acute chemical injuries. The importance of addressing the I’s and E’s in chemical burns cannot be underestimated. These include the need for the documentation and management of epithelial defect (E), intraocular pressure (P) (IOP), ischemia (scleral) (I), and exposure (X) (acronym - E-PIX). Epithelial defect includes that involving the limbus (L), along with conjunctival (C), corneal (K), and tarsal (T). These additional parameters are graded and represented as an annotation along with the limbal grade providing a comprehensive grading for the injury. A manual entry sheet and a freely accessible online grade generator are a part of the system. The proposed enhanced grading offers a final annotation that provides a clear understanding of all factors that can lead to vision-threatening complications ensuring their assessment and hence subsequently their addressal to improve outcomes, if abnormal. The prognostication continues to be based on the grade of limbal involvement. The additional annotations impact prognosis and outcome if not addressed. Including the laterality of injury provides, in addition, a futuristic understanding of available options. The grade generator retains the flexibility to be dynamic with changes reflecting upon the healing process in the acute stage. The proposed system aims to provide primary and tertiary caregivers alike with a uniform grading system.
Ocular surface changes following vitreoretinal procedures
Authors: Venkatesh Ramesh , Jayadev Chaitra , Mangla Rubble , Chitturi Sai Prashanti , Mohan Sashwanthi , Ratra Dhanashree
Published: April 2023

Dry eye disease (DED) can lead to ocular discomfort as well as visual disturbances. Older adults are more likely to develop DED. They are also more likely to develop retinal diseases such as diabetic retinopathy and age-related macular degeneration, which may require vitreoretinal surgeries, lasers, and intravitreal injections. Posterior segment surgery may cause or worsen existing dry eye symptoms, albeit temporarily. Despite good anatomic and functional outcomes, ocular surface dysfunction can have a significant impact on the quality of life, lowering a patient’s satisfaction with the retinal treatment. Preexisting DED, intraoperative tissue handling, and postoperative treatment may all contribute to the severity of ocular surface dysfunction. In this article, we have reviewed all relevant studies on the development of ocular surface changes and DED, as well as the impact of vitreoretinal surgeries and procedures on the ocular surface.
Prevalence of dry eye, its categorization (Dry Eye Workshop II), and pathological correlation: A tertiary care study
Authors: Bhatt Kriti , Singh Satyaprakash , Singh Kamaljeet , Kumar Santosh , Dwivedi Kshama
Published: April 2023

Purpose:

To study the prevalence of dry eye disease (DED), further categorize using DEWS II protocol, grade squamous metaplasia in each group, and determine associated risk factors in a tertiary care hospital.

Methods:

This cross-sectional hospital-based study screened 897 patients ≥30 years via systematic random sampling. Patients with both symptoms and signs as defined by the Dry Eye Workshop II protocol were considered as DED, further categorized, and subjected to impression cytology. Categorical data were assessed using the Chi-square test. P value < 0.05 was considered statistically significant.

Results:

In total, 265 (of 897) patients were defined as DED based on the presence of symptoms (DEQ-5 ≥6) and at least one positive sign (fluorescein breakup time [FBUT] <10 s or OSS ≥4). DED prevalence was thus 29.5% with aqueous deficient dry eye (ADDE), evaporative dry eye (EDE), and mixed type seen in 92 (34.71%), 105 (39.62%), and 68 (25.7%) patients, respectively. The risk of developing dry eye was higher in the age above 60 years (33.74%) and in the third decade. Females, urban dwellers, diabetics, smokers, history of previous cataract surgery, and usage of visual display terminal devices were found to be significantly associated with risk factors of DED. Squamous metaplasia and goblet cell loss were more severe in mixed compared to EDE and ADDE.

Conclusion:

Hospital-based prevalence of DED is 29.5% with a preponderance of EDE (EDE 39.62%, ADDE 34.71%, and mixed 25.71%). A higher grade of squamous metaplasia was seen in the mixed type compared to other sub-types.
Lacrimal and meibomian gland evaluation in dry eye disease: A mini-review
Authors: Singh Swati , Donthineni Pragnya Rao , Srivastav Saumya , Jacobi Christina , Basu Sayan , Paulsen Friedrich
Published: April 2023

Lacrimal and meibomian glands contribute to the aqueous and lipid components of tear film, respectively. Their evaluation remains central to diagnosing and managing dry eye disease (DED). The review discusses the differences and reliability of various diagnostic tests and commercially available devices used for DED diagnosis. Slit-lamp-based techniques are direct palpebral lobe and tear flow assessment, Schirmer test, meibum quality and expressibility, and evaluation of tear meniscus height. Non-invasive tear meniscus height (TMH), tear break-up time (TBUT), lipid layer thickness (LLT), and meibography are machine-based diagnostic tests. The structure–function correlation of the tear-producing glands gives more comprehensive details than either information alone. Many devices are available in the market, which make DED diagnosis an easy feat, but the tests should be interpreted keeping in mind the intra-observer and inter-observer repeatability. Also, the tear film displays a huge variability as per the environmental conditions and impact of blinking. Hence, the examiner should be well versed with the techniques and repeat the test two to three times to obtain an average reading, which is more reliable. The recommended sequence of tests for diagnosing DED is a dry eye questionnaire, TMH, LLT, NIBUT (FBUT if non-invasive test is unavailable but should be performed after osmolarity), tear osmolarity, meibography, and ocular surface staining. Invasive tests such as Schirmer should be performed after the non-invasive tear film diagnostic testing.
5-Fluorouracil as a targeted lacrimal gland therapy for chronic Stevens-Johnson syndrome: A pilot study
Authors: Singh Swati , Basu Sayan
Published: April 2023

Purpose:

The surgical technique of periglandular 5-fluorouracil (5-FU) injection and its effects on the morphology and function of the main lacrimal gland of patients with severe dry eye disease due to Stevens–Johnson syndrome (SJS) are reported.

Methods:

5-FU, as a potential antifibrotic agent, is given in the dose of 0.1 ml (50 mg/ml), subconjunctivally into the periglandular fibrosed area of the palpebral lobe of the main lacrimal gland. The injection is given using 30G needle into the subconjunctival plane and not into the substance of palpebral lobe.

Results:

Eight eyes (eight lobes) of seven chronic SJS patients (mean age, 32.5 years, <5 mm Schirmer) received the injection. All eight lobes demonstrated a visible reduction in the conjunctival congestion and scarring over the lobar area. The mean OSDI scoring improved from 65.3 to 51.1. Three patients with mean pre-injection Schirmer I values of 4 mm showed a mean change of 1 mm at four weeks following a single injection. The tear flow rate per lobe for the above three patients improved from 0.22, 0.12, and 0.16 µl/min to 0.31, 0.12, and 0.21 µl/min, respectively. Another patient with pre-injection Schirmer of 4 mm showed no change in tear flow. Three eyes with zero baseline Schirmer values (no visible secretory opening) had no improvement in tearing or ocular surface staining.

Conclusion:

Local 5-FU injection alters morphology of the conjunctiva overlying the palpebral lobe in SJS patients, but fails to show any significant effect on tear secretion.
Comparing the efficacy of sodium hyaluronate eye drops and carboxymethylcellulose eye drops in treating mild to moderate dry eye disease
Authors: Salim Sreelakshmi , Kamath Sumana J , Jeganathan Sangeetha , Pai Shobha G , Mendonca Teena Mariet , Kamath Ajay R
Published: April 2023

Purpose:

Aim of this study was to compare the efficacy of sodium hyaluronate (SH) and carboxymethyl cellulose (CMC) eye drops in treating mild to moderate dry eye disease in terms of relief of symptoms, mean change in tear film breakup time, Schirmer’s test, and impression cytology of conjunctiva from baseline.

Methods:

An observational study was carried out during a 2-year period in our tertiary referral hospital. The study consisted of 60 patients randomly allotted to two groups to receive SH and CMC eye drops for an 8-week period. Ocular surface disease index, tear film breakup time, and Schirmer’s test were performed at baseline visit and 4 and 8 weeks of treatment, and impression cytology of conjunctiva was performed at baseline and 8 weeks.

Results:

Significant improvement in patient symptoms, tear film breakup time, and Schirmer’s test from baseline was seen in both SH and CMC groups at 8 weeks posttreatment, whereas impression cytology of conjunctiva in both groups did not show significant improvement at 8 weeks of treatment. Data analysis using unpaired t-test showed comparable results.

Conclusion:

Both CMC and SH demonstrated equal efficacy in treating mild to moderate dry eye disease.
Dry eye disease in diabetics versus non-diabetics: Associating dry eye severity with diabetic retinopathy and corneal nerve sensitivity
Authors: Mangoli Mitali V , Bubanale Shivanand C , Bhagyajyothi BK , Goyal Dhruv
Published: April 2023

Purpose:

To compare the prevalence of dry eye disease (DED) and assess corneal nerve sensitivity (CNS) in diabetic and non-diabetic patients. To study the association of severity of DED in patients with diabetic retinopathy (DR) and CNS in DED.

Methods:

A cross-sectional prospective comparative study was conducted on 400 patients attending the ophthalmology OPD. The patients above 18 years of age were divided into two groups—diabetic (T2DM) and non-diabetic. All patients were subjectively assessed for DED based on Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire and objectively, using Schirmer’s II test and Tear Film Break-Up Time (TBUT). Visual acuity assessment, anterior segment, and posterior segment evaluation were done.

Results:

Considering the SPEED score, Schirmer II values, TBUT values, and Dry Eye Work Shop (DEWS) II diagnostic criteria, mild DED was seen in 23% diabetic and 22.25% non-diabetic groups, moderate DED in 45.75% diabetic and 9.75% non-diabetic groups, and severe DED in 2% diabetic and 1.75% non-diabetic groups. Moderate DED was more common within all grades of DR. CNS was reduced more in diabetic group and also in patients with higher degree of DED.

Conclusion:

Prevalence of DED is more in the patients with T2DM. CNS was reduced more in patients with T2DM and in patients with moderate DED. Our study also correlated that severity of DR affects the severity of DED.
Dry eye symptoms and digital eyestrain - Emerging epidemics among university students due to online curriculum amid the COVID-19 pandemic. A cross-sectional study
Authors: Jakhar Fiza , Rodrigues Gladys R , Mendonca Teena M , Nayak Rajesh R , Kamath Gurudutt , Kamath Sumana J , Kamath Ajay
Published: April 2023

Purpose:

Increased screen time has been a major concern among the students who have adopted the online curriculum amid the pandemic. The study was conducted to shed light on the changing trends of symptoms pertaining to dry eye disease and digital eyestrain due to the online curriculum and its negative implications on the ocular health of students.

Methods:

A cross-sectional study was conducted among students of Manipal Academy of Higher Education who are currently following the E-learning curriculum amid the COVID-19 pandemic the participants were surveyed using a pre-validated structured questionnaire.

Results:

The mean age of study participants was 23.33 ± 4.604 years. In total, 97.9% (321/352) of the respondents experienced at least three symptoms associated with the usage of digital devices. 88.1% of the participants were exposed to an average screen time of more than 4 hours per day. An increased number of hours of digital device usage was found to be associated with higher total symptom scores (P = 0.04). The total symptom scores were found to be considerably higher for those with continuous contact with the screen (P = 0.02). Headache (69.9%, n = 246) is the most commonly reported symptom followed by neck pain (65.3%, n = 230), tearing (44.6%, n = 157), eye pain (40.9%, n = 144), and burning sensation (40.1%, n = 141).

Conclusion:

This study highlights a tremendous increase in the prevalence of symptoms related to dry eye and digital eyestrain among students attending online classes during the COVID-19 pandemic. Eye care professionals need to be aware of this emerging public health threat and the appropriate measures for its prevention.
Ocular disease as the presenting sign of rheumatoid arthritis – An observational case series
Authors: Ravulaparthi Gayatri , Bandla Bhavagna , Visala N Venkata
Published: April 2023

Rheumatoid arthritis (RA) is an inflammatory auto-immune multi-system disorder affecting the synovial joints. Ocular manifestations occur in a significant proportion of patients with RA. Although there are literature studies available indicating that ocular involvement can be the presenting sign in RA, reports available are sparse. Our case series is a report of seven patients presenting with ocular manifestations of RA. It highlights the fact that familiarity with the characteristic features of RA among ophthalmologists and physicians helps in making a timely diagnosis, assessing the disease activity, and understanding how a diagnosis of systemic disease made on ocular manifestations can alter the course of the disease in terms of reducing morbidity and prolonging life expectancy.
Study of dry eye disease in type 2 diabetes mellitus and its association with diabetic retinopathy in Western India
Authors: Mansuri Farhad , Bhole Pradnya K , Parmar Dipali
Published: April 2023

Purpose:

The study was conducted to evaluate occurrence of dry eye disease (DED) in type 2 diabetes mellitus (DM) and its association with diabetic retinopathy (DR) in the affected patients in western India.

Methods:

One hundred and five type 2 diabetic patients referred to a tertiary eye care center were consecutively selected. A detailed systemic history was evaluated. DED was assessed by Ocular Surface Disease Index questionnaire, Schirmer’s test, tear breakup time (TBUT), and fluorescein staining of cornea and conjunctiva, graded according to the National Eye Institute workshop grading. All patients underwent detailed fundus evaluation and DR, if present, was graded according to Early Treatment Diabetic Retinopathy (ETDRS) criteria.

Results:

Prevalence of DED in type 2 diabetics was 43.81% (92/210 eyes). The prevalence and severity of DED was found to be more in patients having higher glycosylated hemoglobin levels (P < 0.0001). Prevalence of DED was found to be high in those not taking any treatment (P < 0.0001). A statistically significant association was found between duration of DM and presence of DED (P = 0.02). Among the patients with DED, a majority had proliferative diabetic retinopathy (PDR; 57/92 eyes, 61.96%).

Conclusion:

The study highlights a significant correlation between DED and DM, and hence, examination for DED with fundus examination should be an integral part of the assessment of type 2 diabetics.
A comparative study to evaluate the effect of various postoperative treatment protocols on dry eye and patient satisfaction after phacoemulsification
Authors: Bharucha Khurshed , Zanzarukiya Jatin , Hegade Atul , Deshpande Rahul , Shetty Rakesh , Deshpande Madan
Published: April 2023

Purpose:

Foreign body sensation and irritation are common after cataract surgery, as is the exacerbation of dry eye disease if present. This study compared postoperative dry eye treatments and patient satisfaction.

Methods:

Age-related cataract patients undergoing phacoemulsification were recruited and were divided randomly into 4 postoperative treatment groups: Group A: Antibiotic + Steroids; Group B: Antibiotic + Steroids + Mydriatic; Group C: Antibiotic + Steroids + Mydriatic + Non-steroidal Ant-inflammatory drugs (NSAIDs); Group D: Antibiotic + Steroids + Mydriatic + NSAID + Tear substitute. Patients were assessed at 1, 3, and 5 weeks post-operatively for uncorrected distance and near vision, best corrected visual acuity (BCVA) for distance and near, Schirmer’s-1 test, and Tear Film Break-Up Time test. At each visit, patients were assessed for dry eye-related subjective parameters using Ocular Surface Disease Index questionnaire.

Results:

Study participants numbered 163. (87 male and 76 female patients). No statistically significant difference was present in visual acuity for near and distance. The mean values of Schirmer’s test and TFBUT were better in group D patients at each postoperative visit, with significant differences noted in comparison with other groups. The patient response to pain and dry eye symptoms was superior in groups C and D, with group D producing the best results. Compared to group A, patients in groups C and D were more satisfied with their vision and surgery.

Conclusion:

The addition of tear substitutes to steroids and NSAIDs has been associated with decreased dry eye-related symptoms and a better subjective feeling of vision, although no significant difference was noted in vision measured objectively.
A study on correlation of computer vision syndrome and dry eye disease and knowledge regarding its associated factors amongst health professionals
Authors: Patel Haji , Jain Rashmi , Kamath M Atul , Bappal Anupama
Published: April 2023

Purpose:

To know the magnitude and determinants of dry eye syndrome among health professionals and to study the correlation of computer vision syndrome with dry eye disease.

Methods:

In total, 501 participants took part in the study, which included history followed by baseline ocular examination, which included visual acuity using Snellen’s chart and anterior segment examination using a slit lamp. Later, a questionnaire was administered to health professionals to be filled out for analysis in the present study.

Results:

The symptoms reported occasionally were burning (35.5%), itching (34.5%), foreign body sensation 22.6%, and tearing (35.3%). The majority of participants used mobiles and laptops (56.1%) as a display. Also, 53.3% of participants have heard about dry eye syndrome, and the source of information was from friends and doctors in 17% of participants. One hundred twenty-one participants (24.2%) had taken the consultation for ocular symptoms. Eighty-six participants had mild, 29 participants had moderate, and 6 participants had severe dry eye disease, respectively.

Conclusion:

The pandemic effect, and the drastic shift of educational media from the classroom to the digital platform have increased the use of mobiles, laptops, or other digital pads for learning. This has increased the risk for health professionals.
Contact lenses in dry eye disease and associated ocular surface disorders
Authors: Chaudhary Simmy , Ghimire Deepak , Basu Sayan , Agrawal Vinay , Jacobs Deborah S , Shanbhag Swapna S
Published: April 2023

Dry eye disease (DED) is prevalent in all age groups and is known to cause chronic ocular discomfort and pain, and greatly affects the quality of life. Patients with ocular surface disease (OSD) may also have reduced tear secretion due to lacrimal gland damage, thus leading to aqueous deficient DED. Even with conventional management modalities such as lubricating eyedrops, topical corticosteroids, autologous serum eyedrops, or punctal plugs, many patients continue to suffer from debilitating symptoms. Contact lenses are increasingly being used in OSD providing surface hydration, protection from environmental insults, mechanical damage from abnormal lids, and as a modality for constant drug delivery to the ocular surface. This review describes the role of soft lenses and rigid gas-permeable scleral lenses in the management of DED associated with OSD. The efficacy of contact lenses, lens selection, and optimal lens fit are reviewed for specific indications.
Dry eye among medical students before and during COVID-19
Authors: Lulla Nandini H , Loganathan M , Balan Madhu V G , Swathi S
Published: April 2023

Purpose:

Dry eye is a multifactorial disease of the ocular surface. It showed an increased incidence during the pandemic situation, which may be due to long hours of exposure to electronic gadgets. We aimed to find the prevalence of dry eye disease among medical students during the coronavirus disease 2019 (COVID-19) pandemic and pre-pandemic periods.

Methods:

This was a cross-sectional study conducted in a tertiary care teaching institute. This was an institution-based, cross-sectional study conducted among medical students. A modified Ocular Surface Disease Index (OSDI) questionnaire was used to find the severity and prevalence of dry eye disease. Considering 95% confidence interval (CI) and prevalence as 50%, the calculated sample size was 271. Online responses were collected and entered in an Excel sheet. The Chi-square test, univariate and multivariate logistic regression were used for statistical analysis.

Results:

Data were collected from 271 medical students; the prevalence of dry eye disease was 41.5 and 55.19 during the pre-pandemic and pandemic periods, respectively. There was a significant rise in dry eye disease cases during the pandemic when compared to pre-pandemic period (P < 0.05). The odds of getting dry eye disease were 1.7 times more during the pandemic than pre-pandemic.

Conclusion:

The lockdown situation during the pandemic forced people to use electronic gadgets for work, recreation, and academics. Prolonged screen time predisposes to the development of dry eye disease.
Omega-3 fatty acids supplements for dry eye - Are they effective or ineffective?
Authors: Bhargava Rahul , Pandey Kankambari , Ranjan Somesh , Mehta Bhavya , Malik Anu
Published: April 2023

Purpose:

To evaluate effectiveness of omega-3 fatty acid supplements in relieving dry eye symptoms and signs in symptomatic visual display terminal users (VDT).

Methods:

A randomized controlled study was done; eyes of 470 VDT users were randomized to receive four capsules twice daily for 6 months (O3FAgroup), each containing 180 mg of eicosapentaenoic acid and 120 mg docosahexaenoic acid. The O3FA group was compared with another group (n = 480) who received four capsules of a placebo (olive oil) twice daily. Patients were evaluated at baseline, 1, 3, and 6 months, respectively. The primary outcome was improvement in omega-3 index (a measure of EPA and DHA ratio in RBC membrane). Secondary outcomes were improvement dry eye symptoms, Nelson grade on conjunctival impression cytology, Schirmer test values, tear film breakup time (TBUT), and tear film osmolarity. Means of groups (pre-treatment, 1, 3, and 6-months) were compared with repeated measure analysis of variance.

Results:

At baseline, 81% patients had low omega-3 index. In the O3FA group, a significant increase in omega-3 index, improvement in symptoms, reduction in tear film osmolarity, and increase in Schirmer, TBUT, and goblet cell density was observed. These changes were not significant in the placebo group. Improvement in test parameters was significantly (P < 0.001) better in patients with low omega3 index (<4%) subgroup.

Conclusion:

Dietary omega-3 fatty acids are effective for dry eye in VDT users; omega-3 index appears to be the predictor to identify potential dry eye patients who are likely to benefit from oral omega-3 dietary intervention.
Benzalkonium chloride-induced dry eye disease animal models: Current understanding and potential for translational research
Authors: Thacker Minal , Sahoo Abhishek , Reddy A Aniruth , Bokara Kiran K , Singh Swati , Basu Sayan , Singh Vivek
Published: April 2023

Dry eye disease (DED) is an emerging health issue affecting people worldwide. There have been rapid advances in the development of novel molecules and targeted therapies for the treatment of DED in the recent past. For testing and optimizing these therapies, it is necessary to have reliable experimental animal models of DED. One such approach is the use of benzalkonium chloride (BAC). Several BAC-induced DED models of rabbits and mice have been described in literature. BAC induces high levels of proinflammatory cytokines in the cornea and conjunctiva, along with epithelial cell apoptosis and reduction of mucins, which leads to tear film instability, thereby successfully simulating human DED. The stability of these models directs whether the treatment is to be applied while BAC is being instilled or after its cessation. In this review, we summarize the previously described BAC animal models of DED and present original data on rabbit DED models created using 0.1%, 0.15%, and 0.2% BAC administration twice daily for two consecutive weeks. The 0.2% BAC model sustained DED signs for 3 weeks, while 0.1% and 0.15% models sustained DED signs for 1–2 weeks after BAC discontinuation. Overall, these models look promising and continue to be used in various studies to investigate the efficacy of therapeutic drugs for DED treatment.
Newer approaches to dry eye therapy: Nanotechnology, regenerative medicine, and tissue engineering
Authors: Joshi Vineet Pramod , Singh Swati , Thacker Minal , Pati Falguni , Vemuganti Geeta K , Basu Sayan , Singh Vivek
Published: April 2023

Definitive treatment of dry eye disease (DED), one of the commonest ocular surface disorders, has remained elusive despite several recent advances in better diagnostics and the introduction of newer therapeutic molecules. The current treatment paradigms rely heavily on lubricating eye drops and anti-inflammatory agents that may need to be used long-term and are mainly palliative. Research is ongoing not only for a curative treatment option but also to improve the potency and efficacy of existing drug molecules through better formulations and delivery platforms. In the past two decades, significant advancement has been made in terms of preservative-free formulations, biomaterials such as nanosystems and hydrogels, stem cell therapy, and creation of a bioengineered lacrimal gland. This review comprehensively summarizes the newer approaches to DED treatment, which are biomaterials such as nanosystems, hydrogels, and contact lenses for drug delivery, cell and tissue-based regenerative therapy for damaged lacrimal gland and ocular surface, and tissue engineering for developing artificial lacrimal gland. Also, their potential efficacies in animal models or in vitro studies and possible limitations are discussed. The ongoing research looks promising and needs to be supported with clinical efficacy and safety studies for human use.
Dry eye module – An application intelligence platform for diagnosing and monitoring dry eye disease
Authors: Iyer Geetha , Srinivasan Bhaskar , Agarwal Shweta , Chatterjee Sumana , Swarup Rishi , Srinivas Priya
Published: April 2023

Dry Eye Module (DEM), a software application, was developed to facilitate the streamlining of dry eye evaluation and documentation, to unify diagnostic jargon, and to analyze data input to generate a dry eye diagnostic report. This diagnostic report generated is based on the current understanding of dry eye diagnostic algorithms (Dry Eye Workshop 2 [DEWS2]/Asia Dry Eye Society [ADES]). Apart from its plausible role in aiding unprecedented multicentric dry eye demographic data collection, the application software can generate a customized referral letter to the rheumatologist, highlighting the salient ophthalmic features to be shared. DEM uses schematic illustrations to depict eyelid, conjunctival, and corneal parameters that impact the ocular surface in dry eyes that can be captured and compared during serial visits. Furthermore, DEM displays a symptom sign trend chart that graphically represents improvement/stability or worsening of the subjective and objective dry eye status. DEM can generate a curated prescription using preloaded advice templates. DEM includes facility for state-of-the-art advanced dry eye diagnostic reporting for super specialty use. The addition of DEM to the dry eye diagnostic armamentarium would help bridge the current unmet needs of dry eye evaluation. These are lack of uniform reporting, lack of multicentric data on a unified platform, the inability to ensure complete evaluation, inability to avoid lacunae during follow-up visits, and the lack of a simple patient-ophthalmologist and an ophthalmologist–rheumatologist interface.
Keratoprosthesis in dry eye disease
Authors: Sharma Supriya , Donthineni Pragnya Rao , Iyer Geetha , Chodosh James , de la Paz Maria Fideliz , Maskati Quresh , Srinivasan Bhaskar , Agarwal Shweta , Basu Sayan , Shanbhag Swapna S
Published: April 2023

Bilateral corneal blindness with severe dry eye disease (DED), total limbal stem cell deficiency with underlying corneal stromal scarring and vascularization, combined with adnexal complications secondary to chronic cicatrizing conjunctivitis is a highly complex situation to treat. In such eyes, procedures such as penetrating keratoplasty alone or combined with limbal stem cell transplantation are doomed to fail. In these eyes, keratoprosthesis (Kpro) or an artificial cornea is the most viable option, eliminating corneal blindness even in eyes with autoimmune disorders such as Stevens–Johnson syndrome, ocular mucous membrane pemphigoid, Sjogren’s syndrome, and nonautoimmune disorders such as chemical/thermal ocular burns, all of which are complex pathologies. Performing a Kpro in these eyes also eliminates the need for systemic immunosuppression and may provide relatively early visual recovery. In such eyes, the donor cornea around the central cylinder of the Kpro needs to be covered with a second layer of protection to avoid desiccation and progressive stromal melt of the underlying cornea, which is a common complication in eyes with severe DED. In this review, we will focus on Kpro designs that have been developed to survive in eyes with the hostile environment of severe DED. Their outcomes in such eyes will be discussed.