bluuebunny/crossref_metadata_2025 huggingface dataset:
Le viol ou comment l'auteur se dispense du consentement de la victime ?
Authors: Louis Coste François
Published: January 2022

La question du consentement étant plus proche du droit des contrats que de la relation amoureuse, il n'est pas étonnant que la personne récusant l'accusation de viol dise, plutôt que "nous nous sommes aimés", "elle était consentante", autrement dit soumise, ce qui permet de ne pas recourir aux moyens agressifs constitutifs du viol. L'argument du consentement n'est ainsi qu'un moyen de défense tendant à présenter l'accusé comme victime d'un malentendu. Mais que dire lorsque la patiente n'a pas d'autre choix que de recourir au médecin ? Car l'homme de l'art sait que tout client est contraint de s'en remettre à lui. Profiter d'une dépendance pour abuser d'autrui, n'est-ce pas tirer parti d'une contrainte pour se dispenser du consentement et commettre le viol ?
Mineurs, sexualité et consentement en droit pénal
Authors: Saas Claire
Published: January 2022

Jusqu'à l'entrée en vigueur de la loi n° 2021-478 du 21 avril 2021, le droit positif incriminant les infractions sexuelles à l'encontre de mineurs prenait en considération l'âge de la victime et de l'auteur, la nature des actes sexuels, les moyens employés, les relations entre le mineur et le mis en cause, les conséquences des violences ou menaces exercées. L'ensemble des actes de nature sexuelle d'un adulte sur un mineur de quinze ans était pénalisé, soit par le biais du viol et de l'agression sexuelle qui impliquent un forçage du consentement, soit par le biais de l'atteinte sexuelle pour laquelle le consentement est indifférent. La volonté de protéger le mineur de quinze ans de toute activité sexuelle initiée par un adulte était clairement affirmée, d'autant plus que la loi du 3 août 2018 avait simplifié la caractérisation de la contrainte morale. A la suite d'un débat médiatique assez houleux et juridiquement flou, le législateur a, tout en conservant le droit positif antérieur, créé de nouvelles infractions de viols et d'agressions sexuelles sans contrainte, menace, violence ou surprise. Sans prendre le temps d'une réflexion pluridisciplinaire et de distance à l'égard de revendications parfois radicales, le législateur a complexifié l'état du droit et l'a rendu incertain.
À la recherche du juste consentement en matière de soins
Authors: Girer Marion
Published: January 2022

La relation de soins implique un accord entre un patient qui exprime une demande de soins et accepte une atteinte potentielle à son intégrité physique et un professionnel de santé qui délivre des soins. L'atteinte portée au corps humain ne peut être autorisée que parce que l'esprit a consenti : le consentement libre et éclairé du patient est la pierre angulaire d'une relation fondée sur la confiance. En pratique, l'expression de la volonté du malade fait l'objet d'un fort encadrement juridique, à propos duquel il est possible de se demander s'il permet réellement d'atteindre un « juste consentement ».
Hissène Habré, « le petit oiseau sur la branche » et les défis de la justice pénale internationale
Authors: Hazan Pierre
Published: January 2022

Le procès de l'ex-dictateur tchadien, Hissène Habré, à Dakar en 2015 fut historique pour au moins trois raisons : ce fut la première fois que l'Union africaine créait une Cour pénale régionale pour juger un ex-chef d'État. Ce fut aussi la première fois qu'un ex-chef d'État africain était jugé dans un autre pays africain que le sien pour des violations massives des droits de l'homme. Ce fut encore la première fois qu'un ex-chef d'État était condamné pour des viols qu'il a lui-même commis. C'est dire que le procès Habré constitue un moment important dans le processus de lutte contre l'impunité sur le continent africain, tout en soulevant des interrogations majeures sur la mise en place de cette justice ad hoc.
Les partenaires sociaux à l’épreuve du genre et de l’intersectionnalité dans l’Union européenne
Authors: Jacquot Sophie , Ledoux Clémence
Published: January 2022

Confrontés à une féminisation croissante et aux préoccupations de leurs membres et des mouvements sociaux, faisant face à des injonctions des gouvernements nationaux ou des acteurs européens, les partenaires sociaux nationaux et européens ont été travaillés ces trente dernières années par le genre et son articulation à d’autres dimensions de la vie sociale, également sources d’inégalités et de discriminations. Ce texte s’intéresse à la façon dont les partenaires sociaux ont été mis à l’épreuve du genre et de l’intersectionnalité, et il présente les principaux apports de la littérature qui s’est penchée sur la structuration des relations entre partenaires sociaux, genre et intersectionnalité.
Les partenaires sociaux européens et la politique d’égalité de genre : de la méfiance à l’empêchement
Authors: Jacquot Sophie
Published: January 2022

Ce texte vise à analyser la nature et l’évolution du rôle joué par les organisations représentatives du marché du travail dans la fabrique de la politique européenne d’égalité de genre. Il fait ressortir trois séquences d’action publique distinctes : une relation marquée par la méfiance jusqu’à la fin des années 1980 ; puis avec le développement du dialogue social européen et jusqu’à la fin des années 2000, une relation contrainte ; enfin la période la plus récente est celle d’une relation empêchée : la position institutionnelle privilégiée des partenaires sociaux est remise en question, ce qui réduit leur capacité à jouer un rôle central dans l’élaboration et l’orientation de la politique d’égalité de genre, leur conception restreinte du principe d’égalité contribue de plus à entraver le développement de mesures transformatrices.
Esquisse d’une solution alternative à la Juridiction unifiée du brevet (Unified Patent Court)
Authors: De Visscher Fernand
Published: January 2022

L’Accord sur la Juridiction unifiée du brevet (Unified Patent Court Agreement) et le système du brevet dit unitaire dans l’Union européenne ont suscité diverses critiques, partagées par Bernard Remiche. Des améliorations et des solutions alternatives sont envisageables. Cette contribution en propose une qui s’inspire largement de la marque de l’Union européenne et du dessin ou modèle communautaire, moyennant quelques adaptations principalement relatives à l’Office européen des brevets, à la Cour de justice et au contentieux judiciaire
A cross-infection model with diffusion and incubation period
Authors: Pang Danfeng , Xiao Yanni , Zhao Xiao-Qiang
Published: January 2022

In this paper, we study a cross-infection model with diffusion and incubation period. Firstly, we prove the global attractivity of the infection-free equilibrium and infected equilibrium for the spatially homogeneous system. Secondly, we establish the threshold dynamics for the spatially heterogeneous system in terms of the basic reproduction number \begin{document}$ \mathcal{R}_0 $\end{document}. It turns out that the infection-free steady state is globally attractive if \begin{document}$ \mathcal{R}_0<1 $\end{document}; and the system is uniformly persistent if \begin{document}$ \mathcal{R}_0>1 $\end{document}. Finally, we explore the influence of different diffusion coefficients, spatial heterogeneity of the disease transmission rate and the incubation period on \begin{document}$ \mathcal{R}_0 $\end{document}. Our numerical results show that \begin{document}$ \mathcal{R}_0 $\end{document} are decreasing functions of the diffusion coefficients and the incubation period, respectively, while it is increasing with respect to the spatial heterogeneity.
Qualitative analysis of nonlinear impulse langevin equation with helfer fractional order derivatives
Authors: Rizwan Rizwan ,   Department of Mathematics, University of Buner, Buner, Pakistan, Lee Jung Rye , Park Choonkil , Zada Akbar ,   Department of Data Science, Daejin University, Kyunggi 11159, Korea,   Research Institute for Natural Sciences, Hanyang University, Seoul 04763, Korea,   Department of Mathematics, University of Peshawar, Peshawar 25000, Pakistan
Published: January 2022

In this manuscript, a class of impulsive Langevin equation with Hilfer fractional derivatives is considered. Using the techniques of nonlinear functional analysis, we establish appropriate conditions and results to discuss existence, uniqueness and different types of Ulam-Hyers stability results of our proposed model, with the help of Banach's fixed point theorem. An example is provided at the end to illustrate our results.
A mathematical model for imaging and killing cancer cells by using concepts of the Warburg effect in designing a Graphene system
Authors: Fioranelli Massimo ,   Department of Human Sciences, Guglielmo Marconi University, Via Plinio 44, Rome 00193, Italy, Ahmad Hijaz , Sepehri Alireza , Roccia Maria Grazia , Aziz Faissal ,   Information Technology Application and Research Center, Istanbul Ticaret University, Istanbul 34445, Turkey,   Department of Mathematics, Faculty of Humanities and Social Sciences, Istanbul Ticaret University, Istanbul 34445, Turkey,   Istituto Terapie Sistemiche Integrate, Via Flaminia 449, Rome 00181, Italy,   Laboratory of Water, Biodiversity, and Climate Change, Faculty of Sciences Semlalia, Cadi Ayyad University, B. P. 2390, Marrakech 40000, Morocco
Published: January 2022

According to the Warburg effect, there are some significant differences between metabolisms, products and process of respirations of cancer cells and normal cells. For example, normal cells absorb oxygen and glucose and give water molecules, carbon dioxide, ATP molecules and some number of spinors; while cancer cells take glucose and give lactate, less number of ATP molecules and different number of spinors. Using this property, we can design a system from two graphene sheets that are connected by pairing the fourth free electrons of carbons. Then, we can break some pairs and produce some holes. The number of these holes should be equal to the number of radiated spinors by normal cells. Near a normal cell, all holes are filled and the graphene system doesn't emit any electrical current or wave. However, near a cancer cell, some extra holes or spinors remain that their motions produce some electrical currents. These currents force on cancer cell membranes and destroy them and consequently, cause the cell death. Also, these currents emit some electromagnetic waves which detectors could take them out of the human's body and consequently, they could play the main role in imaging.
Autoencoder-aided analysis of low-dimensional Hilbert spaces
Authors: Žlabys Giedrius , Račiūnas Mantas , Anisimovas Egidijus
Published: January 2022

Keywords: feedforward autoencoder, low-dimensional Hilbert spaces, numerical ground-state estimation

We study the applicability of feedforward autoencoders in determining the ground state of a quantum system from a noisy signal provided in a form of random superpositions sampled from a low-dimensional subspace of the system’s Hilbert space. The proposed scheme relies on a minimum set of assumptions: the presence of a finite number of orthogonal states in the samples and a weak statistical dominance of the targeted ground state. The provided data is compressed into a two-dimensional feature space and subsequently analyzed to determine the optimal approximation to the true ground state. The scheme is applicable to single- and many-particle quantum systems as well as in the presence of magnetic frustration.
Voices in audiodescription: Neutrality and pleasantness
Authors: Machuca María J. , Matamala Anna , Ríos Antonio
Published: January 2022

The aim of this study is to analyse the prosodic features of a corpus of audio descriptions in Spanish in order to determine the neutrality and the pleasantness in the prosody used by the speakers. The analysis involves a revision of the recommendations found in guidelines and standards on the voices of the audio describers. According to the Spanish standard by Asociación Española de Normalización (UNE 153020), speech in audio description (AD) must be neutral, and emotional intonation should be avoided.
The corpus is obtained from professional male and female speakers. The duration, pitch and amplitude of AD units have been analysed. Then, a perception test has been carried out to assess the neutrality of the voices of the describers, which were chosen by means of an acoustic analysis, and the relationship between neutrality and pleasantness. Perception tests results were analysed taking into account two separate groups: on the one hand, persons with sight loss and, on the other hand, persons without sight loss. The results of this study can help to better select audio description voices depending on the specific task to be performed and can also help to identify differences depending on the user profile.
Pour une genèse de l’énonciation diaristique : le journal de jeunesse de Blossom Margaret Douthat (1943-1958), lectrice de Beauvoir
Authors: Walsh Francis
Published: January 2022

Comment analyser la genèse d’un journal, texte par définition sans avant-texte, et dont la finalité est moins l’œuvre que la vie ? Cette question, d’abord posée par P. Lejeune, ouvre la possibilité de penser une génétique de l’énonciation, du dire, de l’entre-deux de l’écriture et de la vie. La présente étude cherche en ce sens à suivre, à partir de l’exemple concret du journal de Blossom M. Douthat, le mouvement d’une « scénographie diaristique » (D. Maingueneau). Le corps de l’étude consiste en l’analyse d’une séquence de « scènes de véridiction » (M. Foucault), des scènes fondatrices où la diariste élabore les conditions de possibilité d’une transformation de soi par la vérité, et où S. de Beauvoir jouera le rôle capital de destinataire et de juge virtuel. En plus de permettre de décrire le mouvement d’une scénographie judiciaire de soi, cette forme hétérodoxe d’enquête génétique permet de penser une pratique diaristique dont la finalité serait l’écriture, c’est-à-dire ni l’œuvre ni la vie, mais l’entre-deux lui-même : la fabrique de significations. En dernière analyse, la genèse diaristique est alors l’étude de la production d’une production à la fois éthique et poétique.
Investigation the Effect of Nano Silica Dioxide Additives on the Properties of Epoxy Resin for Using in Industrial Applications
Authors: Abdel-Rahim Ruaa Haitham , Attallah Marwah Subhi , Mohammed Reem Alaa
Published: January 2022

The addition of ceramic nanoparticles to the polymer resin enhances the performance of the composite, enabling the use of such materials in industries such as automobiles and aircraft. This work aims to evaluate the characteristics of epoxy resins by introducing (1%, 3%, 5%, and 7% wt. nano dioxide silica). Using the "hand lay-up " process, about 125 samples were prepared for conducting tests (Hardness, Tensile strength, Impact, Water Absorption) and analyzing results by (SPSS-Scheff). The addition of 7% nano-silica dioxide particles to epoxy considerably raises the hardness values (85.350+.5150 shore D), according to the hardness results. The best average values of the tensile strength and impact (292± 2.828MPa, 54.00 ± 2.828 J/m2) were at the samples (Epoxy- 3% nano-silica dioxide) when compared with other samples. The values of elongation at break reduce through rising concentration, weight fractions of nano-silica dioxide in epoxy, and the best average values of the elongation at break (3.150± .2300 %) were at the samples (Epoxy- 1% nano-silica dioxide). The percentage of water absorption values improved by increasing the weight fraction concentrations of nano-silica dioxide in epoxy, and the best water absorption percentage was (.017 ±.003414%) in the samples (epoxy-1% nano-silica dioxide). Statistically, very large variations were observed of hardness, tensile strength, elongation at break, impact strength, and water absorption (Sig 0.01, 0.04, 0.003, 0.02, and 0.002) respectively, and this indicates an improvement in the properties when addition nano-silica dioxide to the epoxy resin
A rare presentation of neonatal retrobulbar orbital abscess secondary to acute dacryocystitis
Authors: Gabba Harshdeep S , Garg Gaurav , Warkade Rukmendra P S , Agarwal Abhishek , Mehta Ayush , Agarwal Rajul
Published: January 2022

Clinical presentation of a neonate with acute dacryocystitis may vary considerably. A retrobulbar orbital abscess secondary to pediatric acute dacryocystitis is extremely rare. Currently, the treatment of choice is a surgical intervention in view of the life-threatening condition. Our short report shows a 28-day-old neonate with bilateral pediatric acute dacryocystitis, preseptal cellulitis, and retrobulbar orbital abscess in the right eye. Radiological examination of the orbit showed bilateral lacrimal sac mucocele and intra-orbital large abscess in the right eye. A trial of medical management in the form of microbial culture and sensitivity-proven intravenous antibiotics were given because of parents' hesitancy toward surgical intervention. The neonate had a successful anatomic and functional outcome.
Bowman's membrane corneal dystrophy in a case of McDonough syndrome
Authors: Jain Parul , Arora Ritu , Sanoria Abhilasha , Singh Akshay K
Published: January 2022

Ocular features described as part of the McDonough syndrome include eyelid anomalies like blepharophimosis and ptosis in conjunction with motility defects of the eye with the presence of strabismus. We report a unique case of an 11-year-old child with facial and systemic features characteristic of the McDonough syndrome who presented with decreased vision in both eyes secondary to Bowman's membrane corneal dystrophy. This could represent a new association in the spectrum of the features of the McDonough syndrome or it could even represent a syndrome that has not yet been described. Moreover, it is important to rule out the presence of Bowman's membrane dystrophy as a cause for decreased vision in such patients.
A case of atypical peripheral intraocular cysticercosis
Authors: Hao Xinlei , Yuan Man , Chen Liugui , Jin Wei , Yang Anhuai
Published: January 2022

Intraocular cysticercosis results from the larval of the pork tapeworm, Taenia solium. Diagnosis has traditionally been based on fundus dilation examination, B ultrasonography, and optical coherence tomography. We describe herein a rare case of atypical peripheral intraocular cysticercosis in the calcification stage, which was diagnosed with the help of ultrawide fundus fluorescein angiography and intraocular fluid detection. A relatively conservative surgical plan was performed without removing cyst.
Neurosyphilis rebound in youth
Authors: Urbinati Facundo , Zamorano-Martín Francisco , Gutiérrez-Castaño Patricia , García-Lorente María , Pérez de Pedro Iván , Jódar-Márquez Margarita
Published: January 2022

Syphilis is a systemic sexually transmitted disease that can be presented with very varied ocular symptoms. We present the case of a 27-year-old patient with ocular inflammation and bilateral papilledema who was finally diagnosed as neurosyphilis. We want to highlight the importance of taking this diagnosis into account in the event of any ocular inflammation of unknown cause.
Cosmetic iris prosthesis and severe visual loss
Authors: Dayal Ashutosh , Annadurai Parivadhini , Khurana Mona , Vijaya Lingam
Published: January 2022

We report a case of a 39-year-old male who presented with bilateral severe diminution of vision, raised intraocular pressures despite maximal therapy, and corneal edema with endothelial decompensation six years following cosmetic iris prosthesis implantation. Right eye had progressed to glaucomatous optic atrophy, while the left eye showed advanced glaucomatous damage. The patient underwent iris implant removal with Ahmed glaucoma valve implantation in the left eye to achieve adequate control of the intraocular pressures. This case report highlights the dangers and risk of serious vision-threatening complications associated with these implants. Patients must be made aware of the possible complications, and their use should be discouraged in normal eyes.
Epithelial hypertrophy - an unusual representation of herpes simplex keratitis
Authors: Potti Sudhakar , Sakare Eswar Rao
Published: January 2022

Herpes simplex virus (HSV) keratitis is believed to be an important cause of infectious blindness, mainly resulting from stromal opacification. It has multiple manifestations with involvement of the individual layers of the cornea (epithelium, stroma, and endothelium). We report a rare presentation of HSV keratitis, a clinical representation that includes epithelial hypertrophy and subepithelial activity with the appearance of multiple fronds of vessels arising from superficial vascularization with infiltration, which reduced on administration of topical corticosteroids and systemic antivirals. Epithelial hypertrophy also regressed over time.
Postoperative high astigmatism - Refractive surprise following manual small-incision cataract surgery
Authors: Balasaraswathy  , Priya Arut A , Narendran Kalpana , Sagam Navaneeth
Published: January 2022

Postoperative astigmatism plays an important role in the final visual outcome of cataract surgery. In small-incision cataract surgery, proper tunnel construction is of utmost importance for good structural integrity, leading to sutureless self-sealing wounds with lesser astigmatism. We report a case of postoperative high astigmatism following manual small-incision cataract surgery due to large, irregular, superficial, and more anterior corneal entry that lead to poor tunnel valve effect and wound sagging. This resulted in a poor postoperative unaided visual outcome.
A perplexing case of bilateral Vogt-Koyanagi-Harada syndrome
Authors: Rasheed Rehna , Shah Kannisha , Pillai Gopal S , Mithun CB , Radhakrishnan Natasha , Kandula Pooja
Published: January 2022

Vogt–Koyanagi–Harada (VKH) disease presents as a bilateral granulomatous panuveitis with systemic manifestations. We report a 60-year-old female who presented with features suggestive of VKH and was treated with steroids and immunosuppression. Although thorough investigation ruled out tuberculosis (TB) at presentation, she developed neurotuberculosis 2 months after initiating treatment. The primary diagnosis of VKH was hence revisited. Since both VKH and TB uveitis can present as chronic granulomatous panuveitis, it is important to differentiate between them. Once started on immunosuppression, patients should be kept on close follow-up for early detection of development of infections or reactivation of latent TB.
An atypical case of viral endotheliitis
Authors: Prasad K Srinivas , Hansraj Saarang
Published: January 2022

A 48-eight-year-old male presented with redness and blurred vision in his right eye for the past 10 days, sudden in onset, with circumciliary congestion and corneal edema. On examination localized disciform corneal edema, with multiple keratic precipitates, was seen and diagnosed as corneal endotheliitis. Specular microscopy showed endothelial morphological changes with pseudoguttae. Anterior chamber paracentesis subjected to polymerase chain reaction detected varicella zoster virus. He was treated with topical 3% acyclovir gel, homatropine eye drops, 1% prednisolone acetate, and 0.5% timolol maleate. Prednisolone acetate was tapered over 14 weeks. His visual acuity at presentation was 6/36, which improved to 6/9 after 4 weeks of treatment and the final visual acuity was 6/6.
Ivabradine-induced photosensitivity and phosphenes
Authors: Bhatt Nikunj K , Phadke Aniruddha , Patwardhan Sourabh D , Patwardhan Nidhi S
Published: January 2022

Ivabradine is a novel antianginal drug that acts by reducing the heart rate of the patient by acting on hyperpolarization-activated cyclic nucleotide–gated ion channels. Here, we report a case of a 39-year-old female who was taking ivabradine for the prevention of heart failure due to dilated cardiomyopathy and was noticing an increased photosensitivity and phosphenes after 1 year of treatment. The side effects of the medication were serious enough to affect the quality of the life of the patient. The patient became asymptomatic after stopping the medication.
A rare case of bilateral superior ophthalmic vein thrombosis presenting simultaneously with central retinal vein occlusion and cerebral venous sinus thrombosis
Authors: Panigrahi Pradeep K , Samant Swati , Dhar Srikant K
Published: January 2022

A 57-year-old female presented with redness in both eyes and headache for 1-month duration. The clinical examination showed bilateral episcleral vessels congestion and central retinal vein occlusion. Optical coherence tomography scans were normal in both eyes. Radiological examination revealed bilateral superior ophthalmic vein thrombosis and venous sinus thrombosis involving the left terminal sigmoid sinus. The serum homocysteine level was elevated. The patient was treated with anticoagulants and vitamin B12 supplements. Three months following the initial presentation, there was a reduction in the episcleral vessel congestion and retinal hemorrhages. The magnetic resonance venography at the end of 3 months showed a partially recanalized left jugular bulb with chronic thrombosis of the left terminal sigmoid sinus.
Modified split tendon nasal transposition of lateral rectus muscle in third nerve palsy
Authors: Murthy Sowmya Raveendra
Published: January 2022

Complete third nerve palsy presents with large-angle exotropia and hypotropia in varying degrees, posing a challenge for surgical correction. Nasal transposition of lateral rectus, either full tendon or split tendon or in its adjustable and enhanced modifications, have shown to correct exotropia in third nerve palsy. We present a further modification of split tendon nasal transposition of lateral rectus to correct the large vertical deviation in complete third nerve palsy.
Cataract following Nd
Authors: Subudhi Praveen , Patro Sweta , Sitaram Silla , Subudhi B N R
Published: January 2022

A 27-year-old female presented with defective vision in her right eye for the past 6 months. Her presenting visual acuity was 4/60. She had a history of axial myopia since childhood. She underwent Phakic IOL surgery 3 years prior. On clinical examination, there was a patent peripheral iridotomy with an underlying focal anterior capsular and a subcapsular cataract with a posterior subcapsular component. She was scheduled for removal of the phakic IOL and phacoemulsification of the cataractous lens with implantation of a multipiece monofocal lens. The postoperative UDVA was 6/9, and the near visual acuity was N8. The patient had persistent good vision for the first postoperative year.
Multimodal imaging in a case of acute idiopathic maculopathy
Authors: Kothari Akshat , Chugh Manpreet , Saurabh Kumar , Roy Rupak
Published: January 2022

Bacillary layer detachment (BLD) is an optical coherence tomography (OCT) finding depicting split within the inner segment of myoids. We present a case of acute idiopathic maculopathy in a young female who presented with sudden painless diminution of vision in the left eye without a prodromal viral illness. On the OCT splitting of ellipsoid and myoid zone of rod, inner segments were noted suggestive of BLD, whereas optical coherence tomography angiography showed flow void areas on choriocapillaris slab. BLD in acute idiopathic maculopathy occurs due to poor choroidal perfusion leading to stress and splitting of bacillary layer. However, once choroidal perfusion improves, BLD resolves and hence no treatment is required.
Mirror, mirror in the orbit
Authors: Likhari Kamalpreet
Published: January 2022

A 23-year-old lady was working at her sewing machine when she was struck in the left eye by something, probably a piece from a hand mirror, which her children were playing with. She presented with a hard object palpable just above and behind her left upper lid. CT scan revealed a large foreign body, which was subsequently surgically removed. The need for extreme caution as well as the surgical plan and procedure for removing such brittle and hazardous objects from the orbit are discussed in this report.
Misalignment of a toric introaocular lens and reoperation after phacoemulsification with implantation of AT TORBI 709M
Authors: Gao Chao , Lin Xiaolei , Luo Yi
Published: January 2022

We aimed to report a case of two-time misalignment of a toric intraocular lens (IOL) AT TORBI 709M shortly after cataract surgery and the solution to the problem. A 53-year-old man had progressively decreased vision in his left eye (OS) for more than 5 years. The uncorrected visual acuity was 20/100 in the left eye. Phacoemulsification and toric IOL implantation (AT TORBI 709M, +16.5D with cyl +2.5D) were smoothly performed in the left eye. Only 1 week after surgery, the toric IOL became misaligned. So repositioning surgery was performed 1 month later. However, the toric IOL misalignment reoccurred only 1 day after repositioning surgery. Finally, 2 weeks after repositioning surgery, toric lens replacement (Rayner T-flex Aspheric, +17.0D with cyl +2.5D) was performed in the left eye. The toric IOL became stable in the next 2 months. We concluded that Toric IOLs with larger size are more stable in larger eyes.
An alternative technique for persistent Descemet's membrane detachment following phacoemulsification
Authors: Bhatia Rahul , Beri Nitika , Sahu PK , Das GK
Published: January 2022

Descemet's membrane detachment (DMD) is an uncommon complication of cataract surgery. The prognosis depends upon the prompt recognition and management of DMD. The use of various modalities such as AS OCT, Schiemflug imaging and pachymetry helps in proper diagnosis and selecting appropriate management options. Majority of the DMD are small and spontaneously resolve on their own. For small and limited DMD, Medical management with observation are suffice. For persistent large DMD, descemetopexy with the use of expansile gases have been used to tamponade the DM. Use of HELP algorithm has led to objective assessment of DMD and thinning the grey line between either going for observation or intervention with various modalities available. If descemetopexy fails, corneal venting incision can be used as a last resort before going for Keratoplasty. Keratoplasty still remain the treatment of choice for long standing and persistent DMD.
Roberts syndrome with bilateral corneal opacity
Authors: Ciftci Mukaddes Damla , Degirmenci Cumali , Biler Elif Demirkilinc , Atik Tahir , Uretmen Onder
Published: January 2022

Roberts syndrome (RBS) is a rare autosomal recessive genetic disorder. Mutation in the ESCO2 (establishment of cohesion 1 homologue 2) gene has been reported to cause disease. Patients with RBS may have many ophthalmologic pathologies such as hypertelorism, down slating palpebral fissures, corneal opacity, and congenital cataract. Here, we report the case of two siblings who were diagnosed with RBS and were followed in our clinic.
Clinical and genetic aspects of a child with monilethrix and visual rehabilitation
Authors: Mohan Monisha , Shetty Shashikant , Perumalsamy Vijayalakshmi , Prakash C , Sundaresan Periasamy
Published: January 2022

Monilethrix is a rare genodermatosis, presented to us with predominant ocular manifestations. The affected proband was typically characterized by severe photophobia, defective vision, and hypotrichosis with brittle and stubby hair. Here, we report a rare case of a 9-year-old male child who has been affected by monilethrix with severe ocular complications including blepharitis, madarosis, and corneal pannus with lamellar cataract. The child has undergone cataract surgery and visual rehabilitation was provided with low-vision devices.
Use of volumetric analysis in the management of recurrent dermis fat graft hypertrophy
Authors: Salim Shebin , Noronha Olma V , Mukherjee Bipasha
Published: January 2022

Autologous dermis fat graft is an option commonly used for volume replacement in congenital anophthalmic sockets. Hypertrophy of the graft is a very rare complication that can be managed by debulking the graft. Volumetric analysis by computed tomography or magnetic resonance imaging helps in calculating the amount of fat to be excised while debulking. We report a case of recurrent dermis fat graft hypertrophy managed by debulking with the aid of volumetric analysis. The patient underwent dermis fat grafting at the age of 1, followed by graft hypertrophy at the age of 2 years and recurrent hypertrophy at the age of 6 years. Debulking was done with the aid of volumetric analysis when hypertrophy recurred. The patient is doing well with a stable cosmesis at the last follow-up after 1 year.
Inadvertent antihypertensive double dosing with concurrent Tadalafil use - A double whammy on the optic nerve!
Authors: Minaker Samuel A , Sundaram Arun N E
Published: January 2022

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common acute unilateral optic neuropathy in adults over the age of 50. Nocturnal hypotension has been hypothesized as the potential cause of NAION. Phosphodiesterase type 5 inhibitor (PDE5I) has been a known cause of NAION. We report an interesting case of NAION that was triggered by inadvertent double dosing of antihypertensive medication and concurrent use of a PDE5I.
Papilledema associated unilateral juxtafoveal choroidal neovascularization in a patient of intracranial chondrosarcoma
Authors: Samanta Ramanuj , Sood Gitanjli , Kumawat Devesh , Saraswat Neeraj , Agrawal Ajai , Garai Arnab
Published: January 2022

Skull base chondrosarcomas are rare intracranial neoplasms. Although peripapillary choroidal neovascularization (CNV) has infrequently been noted in papilledema secondary to other pathologies, juxtafoveal CNV following intracranial chondrosarcomas have never been reported earlier. We report a case of a 50-year-old lady with operated intracranial chondrosarcoma who presented with progressive diminution of vision in the right eye. Detailed ophthalmic evaluation and ancillary investigations confirmed the diagnosis of papilledema associated juxtafoveal CNV in the right eye, and she received two intravitreal bevacizumab injections with guarded outcome. We have also described the probable differentials of the current case and highlighted the need for a high index of suspicion among neurologists as well as ophthalmologists for this rare but vision-threatening complication.
A case of adult-onset cyclic esotropia combined with hypotropia
Authors: Li Yueping , Zhang Wei
Published: January 2022

A 39-year-old woman presented with 48 hours periodic esotropia and hypotropia after vitreoretinal surgery for retinal detachment and then loss of vision in the left eye. The ocular motility revealed the limitation of supraduction and abduction of the left eye on strabismic days and full duction on good days. After strabismic surgery only for correcting esotropia, the patient changed to hypotropia on the previous strabismic days and exotropia on the previous good days alternatively in a 48-hour period. Its pathogenesis is still unknown. We supposed the patient had similar neurological mechanisms as ocular neuromyotonia and secondary cyclic oculomotor palsy.
“Inert” cotton fibers – Gossypiboma in silicone oil-filled eyes
Authors: Patel Rushik , Delhiwala Kushal , Khamar Bakulesh
Published: January 2022

Retained cotton fibers (gossypiboma) are known following anterior segment surgeries. There is only one case report of pre retinal gossypiboma (retained cotton fibers; RCF) following pars plana vitrectomy (PPV) with silicone oil tamponade (SOI) for proliferative diabetic retinopathy. It was associated with dense exudation surrounding it. We report three cases (two retrolental and one preretinal) of inert RCF (gossypiboma), following PPV-SOI for rhegmatogenous retinal detachment.
Fine-needle aspiration biopsy along with vitrectomy in the diagnosis of primary intraocular lymphoma - An enhanced diagnostic approach
Authors: Iyer Vandana A , Rishi Pukhraj , Biswas Jyotirmay , Rishi Ekta
Published: January 2022

A 70-year-old lady presented with left eye subretinal mass, diagnosed as posterior uveitis previously. Fine-needle aspiration biopsy via transvitreal route proved to be a minimally invasive and effective diagnostic modality for sample collection with minimal complications and of high diagnostic potential.
Objective Scheimpflug imaging of the healing cascade and repair process of striate keratopathy with the concept of optical blooming
Authors: Ramesh Prasanna V , Ramesh Shruthy V , Aji K , Ray Prajnya , Ramesh Meena K , Rajasekaran Ramesh
Published: January 2022

To our knowledge, assessment of striate keratopathy (SK) is subjectively done with slit-lamp bio-microscopic examination, which is the most common practice. In this manuscript, we have reported the role of objective scheimpflug imaging modality, in decoding the healing and repair process of SK, post prolonged cataract surgery. The quantitative and qualitative framing of this pathology with hyperreflective and hyporeflective hot spots (optical blooming) has never been reported in the literature before. In addition to the imaging of the cascadic events of SK in default colour, the role of digital calipers in the measurement of corneal thickness in SK (in inverse colour) is also highlighted. This manuscript throws light on the unique features of scheimpflug imaging technology, for the possible consideration of it as a routine post-operative investigation in patients undergoing prolonged or complicated cataract surgery, in quantifying their SK.
Acute Flaccid Quadriparesis
Authors: Sharma Vishal Chandra , Nandakrishna B. , Vidyasagar Sudha , Varma Muralidhar
Published: January 2022

Acute flaccid quadriparesis is a common presentation to the emergency department with multiple etiologies such as paralytic snakebite, Guillain–Barre Syndrome, and periodic paralysis. Periodic paralysis is a rare entity where the patient presents with weakness, proximal more than distal. The cause for periodic paralysis may vary from hypokalemia to thyrotoxicosis. Thyrotoxicosis commonly presents with weight loss, heat intolerance, tachycardia, and nonspecific symptoms such as fatigue and diarrhea. Neurologic manifestations such as thyroid eye disease and proximal myopathy are commonly seen with Grave's disease. We present a case of 24-year-old male presenting with acute onset weakness of both lower limbs and found to have low potassium. Thyrotoxic periodic paralysis was diagnosed from clinical and investigation findings. Weakness improved with potassium supplementation. Hyperthyroidism was treated with carbimazole and propranolol.
Platelets Derived Microparticles in COVID-19
Authors: Abdelmaksoud Mariam Fathy , Abdelmaksoud Sahar Samir , Abdelsamee Hanaa Fathy , Ezzelregal Hieba Gamal , Alfeky Mervat Abdalhameed
Published: January 2022

BACKGROUND:

Evidences indicate that COVID-19 infection causes hypercoagulable state with micro and macrovascular thrombosis. Platelet-derived microparticles (PDMPs) have inflammatory and diverse coagulant roles.

AIM:

The aim of the study was to assess PDMPs in patients with active and convalescent post COVID-19 infection and correlate PDMPs with clinical, radiological and laboratory findings used in follow up.

PATIENTS AND METHODS:

The study enrolled 25 patients during active COVID-19 (Group A), of them five patients had thromboembolic events (TEE); and Group B including 32 patients during post COVID-19 stages. Clinical and radiological assessment, routine biomarkers, and detection of PDMPs levels, using enzyme-linked immunosorbent assay method, were done for all patients.

RESULTS:

In addition to significant differences detected regarding hemoglobin level, total leukocyte count, absolute neutrophil count, absolute lymphocyte count, C-reactive protein level, D-dimer, and serum ferritin, and high significant differences in PDMPs levels were elicited between groups A and B (mean ± standard deviation: 38.7 ± 10.6 IU/mL, and 18.9 ± 15.3 IU/mL) respectively, with discriminative level at 20.5 IU/mL. PDMPs showed nonsignificant difference between patients with and without TEE and no correlation was detected between PDMPs and clinical or radiological severity in post-COVID-19 patients.

CONCLUSION:

In COVID-19 infection, PDMPs are related to viral activity, and their major role is inflammatory associated.
Central Nervous System Involvement
Authors: Farheen Shifa , Singh Abhishek , Yadav Poonam , Tripathi Preeti , Sen Arijit
Published: January 2022

Extramedullary involvement in multiple myeloma (MM) is seen in 7%–18% of cases. The common organs involved are skin and upper respiratory tract. The uncommon organs involved include the liver, spleen, kidney, pleura, lymph nodes, and soft tissue. Central nervous system (CNS) involvement is extremely rare and occurs in only about 1% of patients. We present an interesting case of nonsecretory MM (NSMM) with atypical involvement of the liver, spleen and CNS. An elderly female patient initially presented with low backache. Skeletal survey showed multiple lytic bony lesions. An initial diagnosis of plasma cell neoplasm was made based on the biopsy of the sacral lytic lesion. No monoclonal gammopathy was found in the serum or urine electrophoresis. A diagnosis of NSMM was made and the patient was started on bortezomib, dexamethasone, lenalidomide (VRD regime). However, over the next 2 months or so, the patient was found to have involvement of liver, spleen, and meninges on imaging despite chemotherapy. The plasmablastic lesions were confirmed on liver biopsy, bone marrow, and cerebral spinal fluid study. Patient showed remarkable clinical improvement on addition of daratumumab to the VRD regime and is currently under maintenance therapy. Repeat imaging shows the reduction in lytic lesions. This case is reported as a rare combination of NSMM with CNS involvement.
Successful Use of Steroids in the Management of Two Patients of Diarrhea-Associated Adult Hemolytic Uremic Syndrome
Authors: Jaryal Ajay , Vikrant Sanjay , Verma Balbir Singh , Gautam Sachin , Kumar Dinesh
Published: January 2022

Diarrhea-associated hemolytic uremic syndrome (HUS) occurs sporadically in the community. It is well known in the pediatric age group but also occurs in the adults, albeit with lower frequency. Prompt recognition of diarrhea-associated HUS is important, as it can be easily overlooked, as prerenal acute kidney injury. Besides this, management of diarrhea-associated HUS is different; varying from supportive care with meticulous observation for spontaneous recovery to occur, or to institute specific therapy such as plasmapheresis or immunosuppressant drugs, if it evolves into organ or life-threatening thrombotic microangiopathy (TMA). HUS is one type of TMA. Steroids have been used anecdotally either standalone or in combination with other therapies, in the management of TMA, especially if it is immune-mediated TMA. In our two cases of diarrhea associated TMA/HUS, we used steroids successfully as an empiric therapy for life threatening TMA.
Attitudes to Eye Health
Authors: Ibanga Affiong A. , Essien Emmanuel A. , Etim Bassey A. , Udofia Owoidoho
Published: January 2022

Introduction:

In spite of the comparatively high rate of blindness and other visual impairments in Nigeria, access to orthodox eye care remains low. Religion has been shown to have important effects on health behavior but such effects as regards access to eye health care remains insufficiently explored in local research.

Objective:

This study aims to assess the knowledge and attitudes as regard eye care and health, among religious leaders in Calabar, Cross River State, Nigeria.

Methods:

Using a qualitative design, the study was conducted among 15 religious leaders from the Christian religion in Calabar. A focus group discussion was conducted which lasted about 90 minutes and was moderated by trained staff. Audio recordings were made and transcribed for qualitative content analysis.

Results:

Participants exhibited some basic knowledge of eye disease and causes of blindness. They found yearly eye-checks acceptable and generally agreed that they would encourage their church members to see a doctor when they had eye symptoms. There was also the opinion that the need to go to the hospital was dependent on the church member’s faith and the spiritual understanding of illness etiology.

Conclusion:

There is a need to further engage religious leaders to improve their knowledge and attitudes to eye health and care. Due to the strong influence of religious leaders in a religious country such as Nigeria, they could influence their congregations positively and improve the general resort to orthodox care for eye symptoms.
Overcoming the Barriers to Cataract Surgical Uptake in a Tertiary Hospital − How Patients Do It
Authors: Obasuyi Osamudiamen C. , Uhumwangho Odarosa M. , Ukponmwan Catherine U.
Published: January 2022

Objectives:

To identify the various means by which patients overcome barriers to cataract surgery in a tertiary hospital.

Materials and methods:

This was a descriptive hospital-based study of the barriers to the uptake of cataract surgical services in Irrua Specialist Teaching Hospital and how patients overcome them. Four hundred patients who presented to the eye clinic participated in this study. Patients, who had surgery within the study period at least more than a week from counseling and when a clinical decision to have surgery was made, were asked to describe the ways they overcame their barriers to surgery and the responses were collated and analyzed using the IBM SPSS version 21.

Results:

The study recruited 400 consecutive patients attending the eye clinic who had a cataract or were yet to have cataract surgery. There were 217 males (54.3%) and 183 females (45.8%), a ratio of 1.2:1. One hundred and eighty-five (84.5%) participants had delayed cataract surgery during the study period with finance (51.4%) and a lack of felt need (28.6%) playing a major role in delaying surgeries. Fear of outcome (12.4%) also played a role in delaying surgery. Free cataract surgical services helped sort out the economic constraint among some participants, whereas support from relations, as well as motivation from relatives and other people who had good outcome from surgeries, helped overcome other barriers such as fear of outcome and lack of escort to the hospital.

Conclusion:

Motivators may play a huge role in improving the uptake of cataract surgery. These motivators may be cataract evangelists or relatives themselves. Economic constraints may be tackled by free eye surgeries, reduced cost of eye care, and/or improving efficiency in the course of providing eye-care services.
Refractive Changes in Pregnant Nigerian Women
Authors: Nwajei EC , Achigbu EO , Nkwogu FU , Ogborogu EU , Dike KC
Published: January 2022

Objective:

The aim of the study is to determine the changes in refraction that occur amongst healthy pregnant women in South-Eastern Nigeria.

Materials and methods:

This was a hospital-based prospective longitudinal study. Forty-six healthy pregnant women and an equal number of healthy nonpregnant women, designated as cases and controls, respectively, were recruited from the antenatal clinic (ANC) of Federal Medical Centre Owerri and followed up from the first trimester of pregnancy to 6 weeks postpartum. All participants underwent ocular examinations and intraocular pressure measurement using Perkins handheld applanation tonometer and refraction (subjective and objective). These examinations were repeated and recorded during the second trimester, third trimester, and 6 weeks postpartum follow-up visits. Data obtained were entered and analyzed using the Statistical Package for Social Science version 21. P < 0.05 was considered statistically significant.

Results:

A myopic shift in the mean refraction of the pregnant women as the pregnancy advanced was observed. This change in the refractive state was however not statistically significant (P = 0.14) and it did not have any significant effect on their distance visual acuity (P ≥ 0.11) and near visual acuity (P ≥ 0.10).

Conclusion:

Normal pregnancy is associated with changes in refraction; nonetheless, these change maybe innocuous and gradually resolves following delivery. Clinicians may need to delay spectacle correction for pregnant women who experience visual symptoms from physiological changes in refraction unless it is deemed necessary.