bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Controlled Blood Pressure among Hypertensive Patients and Determinants of Hypertensive Complications in a Nigerian Population
Authors: Kassy Chukwukasi W. , Okeke Chinyere C. , Ndu Anne C. , Umeobieri Ancilla K.
Published: June 2022

Background:

The impact of uncontrolled hypertension results in undesirable cardiovascular events. Hence, there is a need to emphasize on adequate control of blood pressure.

Objectives:

The objectives of this study were to determine the prevalence and determinants of controlled blood pressure and the complications of hypertension in a tertiary hospital in Nigeria.

Materials and Methods:

This was a retrospective study of 257 patients of Cardiology Unit of University of Nigeria Teaching Hospital diagnosed with hypertension from 2014 to 2018. A proforma-designed questionnaire was used to retrieve responses from the patients’ medical records. Data were entered and analyzed using Statistical Package for Social Sciences version 20. The level of significance was set at 0.05.

Results:

The prevalence of controlled blood pressure was 35.8% with mean blood pressure of 112.39/72.72 mmHg. Adherence to drug therapy was found to be associated with controlled blood pressure (χ2= 8.370,P= 0.005). Two-thirds of patients diagnosed with hypertension developed complications of which hypertensive heart disease, stroke, and chronic kidney diseases were the commonest. Age (χ2= 9.629,P= 0.008) and the initial presenting diagnosis (χ2= 7.662,P= 0.004) were factors associated with the development of complications.

Conclusion:

Adequate blood pressure control is still a challenge among hypertensive patients in the study population. A comprehensive program is advocated for the control of blood pressure that will accommodate drug adherence in addition to education, and socio-behavioral change modifications.
Management of acute corneal hydrops with compression sutures and air tamponade
Authors: Singh Mamta , Prasad Nagendra , Sinha Bibhuti P
Published: June 2022

Background:

Acute corneal hydrops is a vision threatening complication of corneal ectasia like keratoconus, keratoconus, keratoglobus, Pellucid marginal degeneration, Terrien’s marginal degeneration and post refractive surgery keratectasia. The associated risk factors for development of corneal hydrops (CH) are early onset of keratoconus, microtrauma associated with contact lens use, eye rubbing, allergic conjunctivitis, atopy, and Down’s syndrome. With the conservative approach of management of CH, it takes longer time (in months) for corneal oedema to get resolved and there is development of vascularization and scarring. This video presents the simple technique of using compression sutures along with pneumodescemetopexy by intracameral air injection for management of CH. It led to rapid resolution of corneal oedema. It is a simple technique, with no need of special gases like C3F8 or SF6 and can be easily performed at a very basic set up.

Purpose:

To highlight the efficacy of simple technique of applying compression sutures and air tamponade in management of CH and to demonstrate the efficacy of anterior segment OCT in diagnosis and to assess the prognosis of a case of CH.

Synopsis:

A 9-year-old boy presented with CH, with anterior segment OCT showing torn descemet’s membrane and fluid pockets in corneal stroma. Four full-thickness compression sutures were applied and intracameral sterile air was used for pneumodescetopexy. The serial post operative clinical and OCT picture showed rapid resolution of corneal oedema.

Highlights:

This video highlights the use of OCT imaging in the diagnosis of CH and full-thickness compression sutures as the safe and effective technique in the management of acute CH.

Video link:

https://youtu.be/54C3hJB_WTM
The undesirable wink
Authors: Backiavathy Varsha , Pal Soham , Poonam Nisar Sonam , Subramanian Nirmala
Published: June 2022

Background:

Marin-Amat syndrome is a rare acquired oculofacial synkinesis first reported in 1918. It manifests as involuntary eyelid closure on jaw opening or on lateral movement of the jaw following a peripheral facial nerve palsy. The increased orbicularis tone due to aberrant connections between the cranial nerve (CN) V and CN VII results in an undesirable wink with major psychosocial impact.

Purpose:

Most cases in literature were either observed or administered botulinum toxin injection to the orbicularis muscle. There are few sporadic reports of surgical interventions with successful outcomes.Hence there was a need to generate awareness regarding various modes of management of this rare entity.

Synopsis:

We present a video on the clinical presentation and management of six such patients, of whom one was bilateral. Five patients were females. Traumatic facial nerve paralysis and Bell’s palsy was previously diagnosed in one and five patients respectively. The mean age was 52 ± 9.48 years. The mean MRD (margin reflex distance) 1 and MRD 2 was 3.17 ± 0.60 and 5.33± 0.65 mm respectively. On smiling or on movement of the jaw the MRD 1 and 2 was reduced by 2. 50±0.40 and 1.50+/-0.40 mm respectively. Of the six patients four patients opted for nil intervention.

Highlights:

Botulinum toxin injection and preseptal orbicularis resection in the upper and lower eyelid along with blepharoplasty was performed in 1 patient each. Satisfactory reduction in the synkinetic movement was achieved in both. Marin-Amat syndrome is a rare often underdiagnosed synkinetic disorder following peripheral facial nerve palsy. Botulinum toxin injection and preseptal orbicularis resection are viable management options.

Video link:

https://youtu.be/YQbRecp449w
Vitrectomy with arteriotomy and neurotomy in retinal artery occlusion – A case series
Authors: Cisiecki Sławomir , Bonińska Karolina , Bednarski Maciej
Published: June 2022

Purpose:

This study aimed to investigate the visual outcomes and anatomical changes after vitrectomy for retinal artery occlusion.

Methods:

Twelve patients with retinal artery occlusion (11 central retinal artery occlusion and 1 branch retinal artery occlusion) were part of this study. Our patients were treated with vitrectomy with arteriotomy or with neurotomy and arteriotomy. Complete ophthalmic examination was performed preoperatively, at 2 weeks, and 1, 3, 6, 9, and 12 months after surgery.

Results:

The mean preoperative best-corrected visual acuity (BCVA) was 1.94 logMAR, and the final BCVA after 12-months follow-up was 2.04 logMAR. After vitrectomy with arteriotomy, the BCVA in patients treated with neurotomy and arteriotomy was 1.65 and 2.45, respectively (P = 0.038).

Conclusion:

No benefits have been achieved from using vitrectomy in retinal artery occlusion cases.
Clinical and mycological profile of fungal keratitis from North and North-East India
Authors: Tawde Yamini , Singh Shreya , Das Sourav , Rudramurthy Shivaprakash M , Kaur Harsimran , Gupta Amit , Kataki Mounjuri , Gogoi Pranami , Ghosh Anup K
Published: June 2022

Purpose:

To study the clinical presentation, mycological profile, and risk factors of fungal keratitis (FK) cases presenting at two tertiary-care centers, one each at North (Chandigarh) and Northeast (Assam) India, and to compare the spectrum of fungi recovered from the clinical and environmental samples at both locations.

Methods:

All patients with suspected FK were enrolled from both the centers between January 2018 and December 2019. Corneal samples were collected and processed as per standard laboratory protocols. Demographic details and clinical and mycological profiles were noted in all patients. Environmental sampling from the soil, air, and the vegetative matter was performed from both locations and neighboring districts.

Results:

Of the 475 suspected cases, 337 (71%) were diagnosed as FK (median age: 50 years; 77.2% males). The presence of diabetes, hypertension, blurred vision, and corneal discoloration was significantly higher in patients with FK compared to those without FK. Aspergillus sp. (52.1%) and Fusarium sp. (47.61%) were the predominant etiological agents isolated from cases in North and Northeast India, respectively. FK due to melanized fungi was associated with diabetes, trauma with animal tail, and corneal discoloration. A similar spectrum of fungi was seen in environmental and clinical samples in both the regions.

Conclusion:

The difference in etiological agents of FK and environmental fungal isolates in North and Northeast India highlights the need to identify the ecological niche of potential fungal pathogens. Prospective, multicenter studies, systematic environmental sampling, and the evaluation of the differences in causative agents and clinical presentation of FK from different parts of the country can substantially improve our understanding of its region-specific clinico-epidemiological profile.
Newer advances in medical management of glaucoma
Authors: Mohan Neethu , Chakrabarti Arup , Nazm Nazneen , Mehta Rajvi , Edward Deepak P
Published: June 2022

The burden of irreversible vision loss from Glaucoma continues to rise. While the disease pathogenesis is not well understood, intraocular pressure (IOP) is the only modifiable risk factor identified to prevent glaucomatous vision loss. Medical management remains the first-line of treatment in most adult glaucomas and the evolution of medical therapy for glaucoma has followed an exponential curve. This review tracks the rapid development of new medications and drug delivery systems in the recent years. Introduction of Rho kinase inhibitors with an entirely new mechanism of action from that of the currently used anti glaucoma medications has been a significant milestone. Latanoprostene Bunod is a novel, single molecule which provides two active metabolites that work through two different pathways for reducing intra ocular pressure. Bimatoprost implants and travoprost punctum plugs attempt to ease chronic medication use in glaucoma patients. Nanotechnology is an evolving route of drug delivery. Role of cannabinoids in medical management of glaucoma remain equivocal. The relatively short term effect on IOP, the risks of developing tolerance and side effects impacting patients’ neurocognitive health greatly outweigh the potential benefit. Research on Latrunculin B, Adenosine receptor agonists, Specific gene silencing and Stem cell therapy are poised to make an impact on glaucoma treatment. While there is some evidence to support the role of Brimonidine in neuroprotection, further research is needed to clarify the role of Memantine and Neurotrophins. Evidence for benefit from dietary supplementation with Alpha lipoic acid, Forskolin , and Ginko Biloba is limited
Repeated use of fibrin sealants kept at room temperature in conjunctival autografting: An animal study
Authors: Zor Kürşad Ramazan , Çınaroğlu Selim , Küçük Erkut , Keleş Hacı , Öztürk Ali
Published: June 2022

Purpose:

In this study, our aim was to investigate if fibrin adhesives used in conjunctival wound surgery with autologous conjunctival grafts could be used repeatedly at different times after surgical opening.

Methods:

40 New Zealand rabbits were used in the study. These animals were divided into four groups, each consisting of 10 rabbits, and hence 20 eyes. In the first group (control group), Tisseel fibrin sealant was used on the day the eye was first opened surgically; in the second group, it was used on the seventh day; on the third group, it was used on the 14th day; and in the fourth group, it was used 28 days after surgical opening. The graft from the inferior bulbar conjunctiva was attached using Tisseel fibrin glue to the superior scleral bed at the location where the superior bulbar conjunctiva was excised in the same eye.

Results:

No microbial growth was detected in the cultures of the samples tested. There were two partial graft loss in group 2 and there was one partial graft loss in each group of the other groups, and further total graft loss was present in one rabbit in group 3. None of the rabbits had any complications like granuloma, Corneal dellen or infection.

Conclusion:

Based on these results, fibrin sealants can be used repeatedly by storing them at room temperature. Repeated use of fibrin adhesives will reduce the cost of ophthalmologic surgeries and non-ophthalmologic surgeries.
Current estimates of the economic burden of blindness and visual impairment in India: A cost of illness study
Authors: Mannava Sunny , Borah Rishi Raj , Shamanna B R
Published: June 2022

Purpose:

Currently, there are an estimated 4.95 million blind persons and 70 million vision impaired persons in India, out of which 0.24 million are blind children. Early detection and treatment of the leading causes of blindness such as cataract are important in reducing the prevalence of blindness and vision impairment. There are significant developments in the field of blindness prevention, management, and control since the “Vision 2020: The right to sight” initiative. Very few studies have analyzed the cost of blindness at the population level. This study was undertaken to update the information on the economic burden of blindness and visual impairment in India based on the prevalence of blindness in India. We used secondary and publicly available data and a few assumptions for our estimations.

Methods:

We used gross national income (GNI), disability weights, and loss of productivity metrics to calculate the economic burden of blindness and vision impairment based on the “cost of illness” methodology.

Results:

The estimated net loss of GNI due to blindness in India is INR 845 billion (Int$ 38.4 billion), with a per capita loss of GNI per blind person of INR 170,624 (Int$ 7,756). The cumulative loss of GNI due to avoidable blindness in India is INR 11,778.6 billion (Int$ 535 billion). The cumulative loss of GNI due to blindness increased almost three times in the past two decades. The potential loss of productivity due to vision impairment is INR 646 billion (Int$ 29.4 billion).

Conclusion:

These estimates provide adequate information for budgetary allocation and will help advocate the need for accelerated adoption of all four strategies of integrated people-centered eye care (IPCEC). Early detection and treatment of blindness, especially among children, is very important in reducing the economic burden; thus, there is a need for integrating primary eye care horizontally with all levels of primary healthcare.
Effects of low-concentration atropine eye drops on the optical quality of the eyes in myopic children
Authors: Li Weiran , Cao Yiting , Zhou Jibo
Published: June 2022

Purpose:

The present study was performed to compare the optical quality of the eyes of myopic children before and after treatment with atropine eye drops of different concentrations.

Methods:

In the study population of 71 patients (131 eyes), 34 patients (63 eyes) were given 0.01% atropine eye drops and 37 patients (68 eyes) were given 0.05% atropine eye drops. The modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scattering index (OSI), and predicted visual acuities (PVAs 100%, 20%, and 9%) under different lighting conditions were measured before and after two weeks of atropine treatment.

Results:

After using 0.05% atropine eye drops for two weeks, the Strehl ratio decreased from 0.27 ± 0.07 to 0.23 ± 0.07 (P = 0.0026), PVA 20% decreased from 1.15 ± 0.32 to 1.03 ± 0.36 (P = 0.0344), and PVA 9% decreased from 0.74 ± 0.23 to 0.64 ± 0.23 (P = 0.0073). The OSI was significantly higher after using 0.05% than 0.01% atropine eye drops (P = 0.0396), while both the Strehl ratio and PVA 20% were lower after using 0.05% than 0.01% atropine eye drops (P = 0.0087 and P = 0.0492, respectively).

Conclusion:

The children’s optical quality did not change significantly after using 0.01% atropine eye drops, whereas it decreased after using 0.05% atropine eye drops.
Spectrum of bacterial keratitis in North India: A retrospective analysis of six years at a tertiary care eye center
Authors: Ahmed Nishat H , Mishra Deepanshi , Rathod Prachala , Satpathy Gita , Titiyal Jeewan S , Tandon Radhika , Nandyala Sushma , Agarwal Tushar , Vanathi Murugesan , Sinha Rajesh , Gupta Noopur , Maharana Prafulla K , Kaur Manpreet , Sharma Namrata
Published: June 2022

Purpose:

To analyze the pattern of bacterial pathogens causing infective keratitis and their resistance to the recommended antibiotics over six years.

Methods:

It was a retrospective study of 9,357 cases of bacterial keratitis from January 2015 to December 2020, at a tertiary care ophthalmic center. A total of 9,547 corneal specimens were obtained from the study subjects. Demographic details of the patients, pathogenic bacteria isolated, and their antimicrobial susceptibility were noted and analyzed.

Results:

Bacterial pathogens were identified in 23.52% of the specimens. The most common isolates were coagulase-negative Staphylococci (60.75%), followed by Pseudomonas aeruginosa (14.23%), Staphylococcus aureus (13.92%), gram negative bacilli of the family Enterobacterales (8.64%), Streptococcus spp. (1.72%), Acinetobacter spp. (0.13%), and other non-fermenting gram-negative bacilli (0.57%). In Staphylococci, 55–80% of isolates were resistant to erythromycin, and 40–70% to fluoroquinolones, while no resistance was observed against vancomycin. 40–60% of isolates of P. aeruginosa were resistant to cephalosporins, 40–55% to fluoroquinolones, and 30–60% to aminoglycosides. Also, 40–80% of isolates of Enterobacterales were resistant to cephalosporins, and 50–60% to fluoroquinolones. Most gram-negative isolates were susceptible to carbapenems and polymyxin B.

Conclusion:

To the best of our knowledge, our study is the largest compilation of microbiological profile of bacterial keratitis from North India. It highlights the current trend of the bacterial pathogens that cause infectious keratitis. Staphylococci and Pseudomonas were found to be the most common pathogens. Increased resistance was seen against some of the commonly prescribed empirical antibiotics. Such evidence is useful for restructuring the empirical prescription practices from time to time.
Intraocular lens-blocking technique for intraocular foreign body removal
Authors: Lin Zushun , Ke Zhisheng , Zhang Zongduan
Published: June 2022

The aim of this study was to describe a novel technique for intraocular foreign body (IOFB) removal. Phacoemulsification was performed in all patients, followed by a complete microincision vitrectomy to free all tissues surrounding the IOFB. A three-piece intraocular lens (IOL) was placed in the capsular bag, and an opening was made in the upper center of the capsule. The IOFB was removed and lifted to the anterior chamber through the capsular opening and IOL edge. The IOFB was confined to the anterior chamber by the IOL, and then easily extracted through the main corneal incision. The technique was adopted in six eyes of six patients. All IOFBs were removed successfully in all patients without intraoperative or postoperative complications. The IOL-blocking technique is a useful approach for IOFB removal.
Correlation of quantitative polymerase chain reaction with clinical characteristics of patients with viral retinitis
Authors: Mohan Sashwanthi , Dhanurekha L , Janani M K , Biswas Jyotirmay
Published: June 2022

Purpose:

To evaluate the correlation of quantitative real-time polymerase chain reaction (qRT-PCR) to the clinical characteristics of patients with viral retinitis.

Methods:

Retrospective case series.

Results:

Aqueous or vitreous samples of 20 out of 35 eyes showed qRT-PCR positivity for virus etiology (57.14%). Cytomegalovirus (CMV) was most commonly identified in nine eyes (45%). The mean DNA copy number was 2,68,339.65 copies/mL (range: 90–3205397). DNA copy number significantly correlated with the extent of clinical involvement (P = 0.013); however, there was no correlation between DNA copy number and presenting visual acuity (P = 0.31), macular involvement (P = 0.675), optic nerve involvement (P = 0.14), and development of retinal detachment (P = 0.73). There was a significant correlation between the number of DNA copies and the timing of sampling (P = 0.0005). Samples taken earlier in the course of the disease had higher viral copies than later ones.

Conclusion:

qRT-PCR is useful in confirming a viral etiology in over 50% of cases of suspected viral retinitis. It correlates well with the extent of clinical involvement and timing of sampling.
Ultrasonic fragmentation for removing thick organized clots during diabetic vitrectomy – A novel technique
Authors: Singh Deependra V , Reddy Raja R , Upadhyay Awaneesh , Sharma Yog R
Published: June 2022

A 65-year-old male with proliferative diabetic retinopathy (PDR) and non-clearing vitreous hemorrhage underwent 25G pars plana vitrectomy (PPV). A large disk of thick organized blood of 5 disk diameter (DD) size was encountered in subhyaloid space. All attempts including lower cut rates to remove this disk using a 25G cutter turned futile. We used a 20G fragmatome to safely remove this hard clot from vitreous cavity in 50 s. Surgical time for removal of similar clot of 3 DD by 25G cutter in another eye was 5 min. Removal of thick clotted subhyaloid blood by ultrasonic fragmentation during diabetic vitrectomy is a safe, faster, and useful maneuver.
Comparison of patient satisfaction with red-free (green) versus yellow light using binocular indirect ophthalmoscope for retinal examination
Authors: Sharma Pragya , Dhami Abhinav , Dhami Nimrata B , Dhami Gobinder S
Published: June 2022

Purpose:

Comparison of patient satisfaction with red-free (green) versus yellow light using binocular indirect ophthalmoscope for retinal examination.

Methods:

This is an observational questionnaire-based study of 100 myopes in the age group of 18–40 years coming for a routine check-up or for refractive surgery workup. The examination was done using an indirect ophthalmoscope and a 20D lens with green or yellow light and was assigned in two groups randomly using the coin toss method, following which, a questionnaire was used to assess the following parameters: a) level of comfort, b) any complaints of discomfort during examination, d) preference of the used light source in future, e) grading of discomfort on a linear scale, and f) patient cooperation and duration of examination.

Results:

Patients were randomized for observation with IDO using either green light (n = 55) or yellow light (n = 45) filter. In the study, 46 patients (83.6%) were very comfortable and only 9 patients (16.4%) experienced mild discomfort when using red-free (green) light, while only 3 patients (6.7%) were very comfortable and 31 (68.9%) had mild discomfort when using yellow light. The complaints of watering with yellow and green light were noted in 36 patients (80.0%) and 15 patients (27.3%), pain in 13 patients (28.9%) and 3 patients (5.5%), light sensitivity in 29 patients (64.4%) and 4 patients (7.3%), respectively, all being significantly more in yellow light category (P < 0.001). The time of examination was significantly more in yellow light category with 83 ± 10.75 seconds (P < 0.001).

Conclusion:

Retinal examination using the green filter of indirect ophthalmoscope is more comfortable in examining the patients as compared to routine yellow light with decreased number of complaints, lesser examination time, and better patient cooperation.
Early postoperative astigmatism in 2-mm manual small incision cataract surgery with phacofracture
Authors: Sahu Amulya , Bali Jatinder , Sahu Chinmaya , Mishra Deepak , Heda Aarti , Deori Nilutparna
Published: June 2022

Purpose:

India’s cataract surgery rate has been hovering around a creditable 6000 per million population but the coverage is variable across the geography and demography with sharp urban rural divide. Smaller incisions in manual small incision cataract surgery (MSICS) with phacofracture have been credited with lower astigmatism and faster recovery, which is especially useful for patients traveling for surgeries.

Methods:

In this retrospective chart analysis based observational study of 66 eyes, we describe the early postoperative results with 2 mm MSICS with phacofracture.

Results:

The mean spherical equivalent of the autorefractor measured astigmatic error changed marginally to −0.51 diopters (SD = 0.58) from −0.44 diopters (SD = 0.42) (t = −8.410, P = 0.0) translating to mean change in astigmatism of 0.14 DCyl when the axis was ignored. The keratometric difference between steepest and flattest axis of the anterior surface of the central 3 mm zone of the cornea changed from a mean of 0.89 diopters (SD = 0.55) to 1.39 diopters (SD = 1.03). The visual acuity improved to mean logarithm of the minimum angle of resolution (logMAR) score of 0.27 (SD = 0.33) at 1 week and 0.007 (SD = 0.04) which corresponds to 6/6P on Snellen’s acuity at 1 month or more.

Conclusion:

A 2 mm MSICS with phacofracture can deliver low astigmatism and good visual recovery in cataract surgery. The study underlines the need for considering the refraction at anterior and posterior corneal interfaces when the triplanar incision with separate interfaces is used.
Supplemental nutrition for retinal health: Evidence based analysis of commercial preparations in India
Authors: Sharma Ashish , Kumar Nilesh , Parachuri Nikulaa , Kuppermann Baruch D , Bandello Francesco
Published: June 2022

Purpose:

Antioxidants have been lately postulated as supportive and prophylactic supplements for various retinal disorders, especially age-related macular degeneration (AMD). Forty-eight brands of such supplements containing lutein and zeaxanthin are available in India. The aim of the study was to assess the market leaders in supplements for ophthalmology in view of AREDS recommendations.

Methods:

Descriptive review of top-selling supplements for eye health were compared to the contents of the AREDS-recommended levels.

Results:

None of the top 10 selling brands had exact or near similar composition as recommended in the AREDS-2 study, which is the most widely accepted level-1 evidence in AMD prevention.

Conclusion:

Physicians prescribing these antioxidants, especially for the prevention of advanced AMD, should be vigilant and aware of the contents of the prescribed brands.
Refractive errors, road traffic accidents and long-term spectacle compliance amongst commercial taxi drivers in a major North-East Indian city
Authors: Kumar SG Prem , Basaiawmoit Aaron , Marbaniang Dorcas W , Nongsiej Kyntiew Daplin , Pongen Toshimenla , Basaiawmoit Jennifer Vaid
Published: June 2022

Purpose:

To assess the prevalence of refractive error (RE) and its association with road traffic accidents (RTAs) and the subsequent long-term spectacle compliance and adherence to suggested appropriate strategies In Shillong, India.

Methods:

This prospective study was conducted between July and October 2019 among commercial taxi drivers (CTDs), with follow-up interviews conducted with a subset of respondents to assess long-term spectacle compliance after a year. Gross ophthalmologic examination was performed, including visual acuity and refraction. Descriptive statistics and Chi-square tests were conducted to assess the association between the type of REs, spectacle compliance, and selected sociodemographic and clinical variables. Multiple logistic regression was performed for analysis of the association between RTAs and sociodemographic, clinical, and work characteristics variables.

Results:

A total of 382 (95.5%) CTDs completed interviews and gross eye examination. The prevalence of any RE in the worst eye was 28.8% (95% CI: 24.3–33.6). Presbyopia with or without distance vision was the commonest type of RE with 21.7% (95% CI: 17.7%–26.2). Among those who were prescribed spectacles, 70.5% needed near correction. Drivers with RE were nearly two times (OR: 2.6; 95% CI: 1.4–5.1) more likely to be involved in RTAs compared to those without any RE. Long-term spectacle compliance was at 40.9%. The predominant barrier reported for spectacle compliance was “can manage well without spectacles.”

Conclusion:

This survey has demonstrated a significant relationship between poor vision and occurrence of RTAs. There is an urgent need for tailor-made targeted interventions to address the eye health needs of CTDs in India.
Analysis of COVID-19-associated rhino-orbital-cerebral mucormycosis patients in a tertiary care center in Northern India
Authors: Yadav Himanshu , Sen Snigdha , Nath Tirupati , Mazumdar Shefali , Jain Anu , Verma Pinky , Gupta Preeti
Published: June 2022

Purpose:

An unprecedented surge has been noted in rhino-orbital-Cerebral mucormycosis (ROCM) in times of current COVID-19 pandemic. The present prospective study aims to evaluate clinico-epidemiological profile, risk factors, management, and outcome of the cases of ROCM that presented to our tertiary care center during the study period from April to June 2021.

Methods:

All patients were subjected to complete history taking, ophthalmological examination, and imaging studies. The patients were staged and were treated with intravenous liposomal amphotericin B (AMB) and sino-nasal debridement of local necrotic tissue. Transcutaneous retrobulbar AMB (TRAMB), orbital decompression, and exenteration were instituted as indicated. All patients were followed up for a minimum of 6 months before arriving at the final outcome. Statistical analysis was performed.

Results:

A total of 49 patients presented during the study period, with a mean age of 42.2 years. The major risk factors included uncontrolled diabetes (89.8%), COVID-19 positivity (51.02%), and concurrent steroid use (38.77%). The most common presenting symptom was facial pain/swelling (43.65%), while the most common presenting sign was deterioration in vision (75.51%). Intravenous liposomal AMB was given to all patients along with sino-nasal debridement (85.71%), TRAMB (57.14%), orbital decompression (14.28%), and exenteration (12.24%). Overall, mortality at 6 months was 22.45% (11 patients). Age more than 60 years, intracranial extension, and HbA1c of more than 8.0% were observed to be statistically significant indicators of mortality.

Conclusion:

Early suspicion and timely diagnosis of mucormycosis at rhino-orbital stage is warranted in order to salvage life as well as visual function. TRAMB may prove as potentially favorable treatment modality in cases with limited orbital involvement.
Effects of COVID-19 pandemic on stress level of residents and fellows during ophthalmology training
Authors: Aragão Itamara O , Alencar Tatiana G C , Soares Ana Karine A , da Rocha Camilla S , Ventura Camila V
Published: June 2022

Purpose:

To evaluate the impact of coronavirus disease 2019 (COVID-19) on the mental health of residents and fellows in ophthalmology.

Methods:

A questionnaire composed of 42 questions was applied to Brazilian residents and fellows in Ophthalmology. The questionnaire addressed the demographics of participants, their working conditions before and during the COVID-19 pandemic, and the Perceived Stress Scale (PSS-10).

Results:

The study had a total of 271 participants in Ophthalmology training, from which 100 were fellows and 171 were residents. Before the pandemic, Ophthalmology residents and fellows had a higher workload (P< 0.001), and residents worked more hours than fellows (P= 0.001). During the pandemic, the workload of both residents and fellows decreased and equalized (P= 0.195). No correlation was found between the working hours during the pandemic and their stress level were observed (P= 0.760). Higher stress scores were identified in women ophthalmologists (P= 0.001) as well as in residents and fellows that had their surgical training interrupted during the pandemic (P< 0.001).

Conclusion:

The stress level of residents and fellows during the COVID-19 pandemic was similar, however, those that had their surgical training interrupted during the pandemic presented higher level of stress. Female physicians also presented higher level of stress compared to male physicians.
Reasons for delay in cataract surgery in patients with advanced cataracts during the COVID-19 pandemic
Authors: Vedachalam Rajesh , Yamini Kumaresan , Venkatesh Rengaraj , Kalpana Narendran , Shivkumar Chandrashekaran , Shekhar Madhu , Haripriya Aravind , Sathya Ravilla
Published: June 2022

Purpose:

To analyze the reasons for delay in cataract surgery in patients with advanced cataracts during the COVID-19 pandemic.

Methods:

This was a prospective, cross-sectional, multicenter questionnaire study which included patients with mature cataract, nuclear sclerotic cataract grade IV, and cataracts with best corrected visual acuity (BCVA) <5/60, during the COVID-19 pandemic from December 2020 to April 2021. Reasons for delay in presentation to the hospital were analyzed.

Results:

One thousand four hundred seventy two patients were recruited with advanced cataracts. Absence of ophthalmic care nearby (44.2%), lack of awareness regarding elective surgeries (42.6%), lack of public transportation (37%), fear of contracting COVID-19 (23.4%), and waiting for outreach camps (20.4%) were found to be the reasons behind the delay in cataract surgery. 53.7% of the patients had worsening of defective vision and 55.3% of them had difficulty in carrying out activities of family living. 30.8% of the patients faced difficulty in commuting and 8.4% of the patients suffered a fall during this pandemic due to worsening of the visual acuity.

Conclusion:

The lockdown imposed during the pandemic has created a significant backlog of patients who are progressing to advanced cataracts due to lack of ophthalmic care nearby, lack of awareness regarding elective surgeries, lack of public transportation, and no outreach camps. Proactive measures to deal with this backlog are of utmost need to prevent blindness due to cataract.
Nasal vein occlusion after COVID-19: A case report
Authors: Güven Yusuf Z , Akbalık Turan , Akay Fahrettin
Published: June 2022

To present a case of nasal vein occlusion that has not been reported after the coronavirus disease 2019 (Covid-19) pandemic. A 53-year-old patient reported a complaint of floaters after a recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. His best corrected visual acuity (BCVA) was 20/20 for both the eyes. On examination, a flame-shaped hemorrhage was observed in the left eye around the infero-nasal area adjacent to the optic disc. Temporal branch vein occlusion has been widely reported in association with SARS-CoV-2 infection. We emphasize that nasal vein occlusions triggered by Covid-19, which do not cause vision loss, should also be considered.
Automated and ImageJ thresholding algorithm-based analysis of macular vessel density in diabetic patients
Authors: Kumawat Devesh , Chawla Rohan , Shah Pooja , Sharma Anu , Sachan Anusha , Pandey Veena
Published: June 2022

Purpose:

To assess the macular vessel density (VD) on optical coherence tomography angiography (OCT-A) using proprietary software (automated) and image processing software (manual) in diabetic patients.

Methods:

In a retrospective study, OCT-A images (Triton, TOPCON Inc.) of type 2 diabetics presenting to a tertiary eye care center in North India between January 2018 and December 2019 with or without nonproliferative diabetic retinopathy (NPDR) and with no macular edema were analyzed. Macular images of size 3 × 3 mm were binarized with global thresholding algorithms (ImageJ software). Outcome measures were superficial capillary plexus VD (SCP-VD, automated and manual), deep capillary plexus VD (DCP-VD, manual), and correlation between automated and manual SCP-VD.

Results:

OCT-A images of 89 eyes (55 patients) were analyzed: no diabetic retinopathy (NoDR): 29 eyes, mild NPDR: 29 eyes, and moderate NPDR: 31 eyes. Automated SCP-VD did not differ between NoDR and mild NPDR (P = 0.69), but differed between NoDR and moderate NPDR (P = 0.014) and between mild and moderate NPDR (P = 0.033). Manual SCP-VD (Huang and Otsu methods) did not differ between the groups. Manual DCP-VD differed between NoDR and mild NPDR and between NoDR and moderate NPDR, but not between mild and moderate NPDR with both Huang (P = 0.024, 0.003, and 0.51, respectively) and Otsu (P = 0.021, 0.006, and 0.43, respectively) methods. Automated SCP-VD correlated moderately with manual SCP-VD using Huang method (r = 0.51, P < 0.001) with a mean difference of −0.01% (agreement limits from −6.60% to +6.57%).

Conclusion:

DCP-VD differs consistently between NoDR and NPDR with image processing, while SCP-VD shows variable results. Different thresholding algorithms provide different results, and there is a need to establish consensus on the most suited algorithm.
Comparison of laparoscopic and open surgery in hepatic hydatid disease in children
Authors: Masood Pirzada Faisal , Mufti Gowhar Nazir , Wani Sajad Ahmad , Sheikh Khurshid , Baba Aejaz Ahsan , Bhat Nisar Ahamd , Hamid Raashid
Published: June 2022

Background:

Surgery continues to be the mainstay of treatment of hydatid cysts of the liver. Laparoscopy provides a lesser invasive tool for achieving results same as with the established open surgical techniques. The purpose of the study was to evaluate the feasibility and safety of laparoscopic management of hepatic hydatid disease in children.

Patients and Methods:

It was a prospective randomised study conducted over a period of 7 years. Children with Gharbi Type I, II, III cysts, ≤3 cysts and superficial accessible cysts were treated laparoscopically and their outcomes were compared with matched controls treated by open approach.

Results:

Sixty patients were included in the study with thirty patients in each matched group. Thirty paediatric patients (male 12:female 18) with 35 liver hydatid cysts underwent laparoscopic surgery. The mean cyst size was 8.8 ± 2.39 cm. Two patients needed conversion to open. No significant spillage of cyst contents was observed in any of the patients. Duration of hospital stay, time to removal of drains, duration of parenteral analgesia, severity of pain in postoperative period, time to ambulation and time to return to full orals were significantly lower in laparoscopic group compared to open group. Complication rates in both the groups were similar.

Conclusion:

With proper patient selection, laparoscopic management of hydatid cysts of the liver in children is feasible and safe option with low morbidity, low rates of conversion and minimal complications.
Thyroidectomy using a single-port cervico-mental angle approach
Authors: Li Hua-Shui , Lin Qiang , Xie Wen-Jun
Published: June 2022

Background:

Over the last two decades, several endoscopic thyroidectomy methods have been developed. However, there are some limitations in these procedures. To date, the optimal surgical approach for thyroid cancer has not yet been developed. This study reported the surgical operation steps, clinical outcomes, and experience of 30 patients who underwent trans-cervico-mental angle single-port endoscopic thyroidectomy (TCMASPET) at our centre.

Patients and Methods:

A total of 30 patients were enrolled in the present study. Patients underwent unilateral or bilateral thyroidectomy through a cervico-mental angle incision of 2.48 ± 0.31 cm, after which the lymphoid adipose tissues in the central region were dissected.

Results:

All surgeries were successfully completed. Two patients underwent bilateral thyroid carcinoma resection with bilateral central region lymph node dissection, 23 patients received unilateral thyroid cancer resection with unilateral central region lymph node dissection, four patients underwent unilateral thyroid resection, and one patient received bilateral thyroid resection with unilateral central region lymph node dissection. No permanent post-operative complications were observed.

Conclusions:

TCMASPET was a safe and feasible approach that was relatively easy to perform. This approach may expand the indications for endoscopic thyroidectomy while maintaining excellent cosmetic outcomes.
A Contemporary Overview of Urinary Tract Infection (UTI) in Children
Authors: Roy Ranjit R. , Tonny Rummana T. , Sultana Nadira , Mamun Abdullah Al. , Jesmin Tahmina
Published: June 2022

Urinary tract infection (UTI) is the most common and serious bacterial infection in the pediatric age group. It is more prevalent in girls than in boys, except in early infancy. Escherichia coli is responsible for 80–90% of cases of pediatric UTI. The occurrence and severity of this illness are largely mediated by bacterial virulence factors and host defense mechanism. The clinical manifestations of UTI in children are highly heterogeneous, and non-specific collection of urine sample to diagnose the condition accurately is quiet challenging for young pre-continent children. Till date, urine culture is the gold standard for diagnosing UTI. Selection of appropriate antibiotic for the treatment of UTI must be guided by the local guideline and current sensitivity pattern. Ideal imaging protocol and use of antibiotic prophylaxis are still a matter of debate. Current trend is less use of antibiotic prophylaxis due to increasing antibiotic resistance. Prophylaxis cannot alter the long-term consequences, like renal scarring in selected patients. The debate on the indication and duration of antibiotic prophylaxis is still ongoing. So, this review aimed to provide a contemporary overview on the pathogenesis, clinical findings, diagnosis, imaging investigation, treatment, complications, and preventive measures of UTI including chemoprophylaxis in pediatric population. It also highlights the conflicting recommendations of international guidelines, which reveal the necessity of further research to establish the tailored approach of pediatric UTI.
Renal Replacement Therapy (Hemodialysis) in Acute Pancreatitis with Acute Tubular Necrosis Following Injury by a Cricket Ball
Authors: Ferdaus Tahmina , Afroz Shireen , Baroi Sukrity , Tanjila Umme , Yasmin Farhana , Hanif Mohammod
Published: June 2022

Acute pancreatitis (AP) with severe acute kidney injury (AKI) is rare in children and is associated with high morbidity and mortality rates. We report a case of a 12-year-old boy who presented with upper abdominal pain, vomiting, and anuria following injury by a cricket ball. After resuscitation and investigation of the child, AP with AKI was diagnosed. This severe AKI needs renal replacement therapy (RRT). RRT is used to augment normal kidney function to rapidly remove toxic metabolites. We obtained central vascular access which is appropriate for his body size. We prepared a dialysate solution containing standard bicarbonate-buffered dialysate. Priming the circuit with dilute packed red blood cells was done due to his low hematocrit level. A beneficial effect of using RRT to facilitate recovery of renal function to RRT independence and reduce the long-term risk of chronic kidney disease was observed when used as initial supportive modality. Ultrasound-guided renal biopsy reported acute tubular necrosis and it was performed after recovery from his critical period.
Urinary Calcium and Uric Acid Excretion in Children with UTI Having Vesicoureteral Reflux
Authors: Khatun Sufia , Rahman Md Habibur , Jahan Ishrat , Ashraf Rezwana , Hasan SKM Nazmul , Afroje Nayema , Mamun Abdullah Al. , Islam Mohammad Maajharul , Karim Rezaul
Published: June 2022

Introduction:

Patients with urinary tract infection (UTI) associated with vesicoureteric reflux (VUR) are prone to develop hypercalciuria and hyperuricosuria compared with UTI patients without VUR, which may lead to the formation of stones due to stasis, infection, and inflamed urinary mucosa.

Objective:

To assess calcium and uric acid excretion in children with VUR and without VUR having a history of treatment for UTI.

Materials and Methods:

This cross-sectional and analytical study was conducted in the Department of Paediatric Nephrology and Urology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Sixty-one children of both sex from 2 months to 12 years were treated for UTI 4 weeks prior to enrollment for the study and evaluated by micturating cystourethrogram taking all precautionary measures to detect VUR. Patients were grouped into Group A (30 patients with VUR) and Group B (31 patients without VUR). Fasting urine was analyzed for calcium/creatinine (Ca/Cr) and uric acid/creatinine (UA/Cr) ratios. Urinary calcium and urinary uric acid levels were determined by the colorimetric test, and urinary creatinine was measured by the clinical risk and error analysis method by using the Dimension RxL Max System (SIEMENS) of both groups of patients in the Department of Biochemistry, BSMMU.

Results:

Median (min–max) of Ca/Cr ratio was 0.207 (0.034–0.646) and 0.150 (0.090–0.500) in Group A and Group B, respectively, and the difference between these two groups was statistically significant (P < 0.050). Median (min–max) of UA/Cr ratio was 0.972 (0.307–1.951) and 0.616 (0.500–1.390) in Group A and Group B, respectively, and the difference between these two groups was also statistically significant (P < 0.050). Hypercalciuria was significantly higher in Group A (20.0%) than in Group B (3.2%; P < 0.050). Similarly, hyperuricosuria was significantly higher in Group A (33.3%) than in Group B (6.5%; P < 0.05).

Conclusion:

Children with VUR having UTI may have a higher level of hypercalciuria and hyperuricosuria than those without VUR.
Intellectual Disability in Young Children with Hearing Impairment
Authors: Ferdousy Sheikh Mosammat Fatema , Rahman Md Mizanur , Fatema Kanij , Akhter Shaheen
Published: June 2022

Background:

Hearing impairment (HI) is an important disability hampering the overall development, particularly cognitive domain in children. Coexistence of HI with intellectual disability (ID) affects adversely the overall prognosis of a child. To highlight this underdetermined issue, this study has been done to determine the proportion of ID in children of HI.

Materials and Methods:

This cross-sectional study is held in children with HI of 0–42 months. In the study subjects, psychological assessment was done by Baily Scale of Infant Development III (BSID III). Detailed history was taken; physical examination was done in each patient after taking informed written consent. Hearing assessment was done by an audiologist and was leveled as mild, moderate, severe, and profound.

Results:

The study subject was 203, and mean age was 27.2 ± 8.7 (3–42) months. There was a slight male predominance. Majority of children mode of birth was lower uterine segment cesarean section. Neonatal seizure was significantly associated with intellectual impairment in the study subject (P <0.001). No significant association of the HI was found in different levels of intellectual status of the children; however, 35% of the study subject had borderline intellectual status and most of them belonged to the profound HI.

Conclusion:

A significant proportion of the study subjects had borderline intellectual status, although very limited numbers had ID. Moreover, children with profound hearing loss were most affected.