bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrieving an Incomplete Flap With a Femtosecond Laser in the Same Sitting
Authors: Mohan Sujatha , Sankaran Mathangee
Published: June 2021

PURPOSE:

To report a case of a 35-year-old woman who had an incomplete flap during laser in situ keratomileusis with the Amadeus II microkeratome (Amadeus; Ziemer Ophthalmic Systems AG) in the right eye.

METHODS:

There was an incomplete flap in the right eye due to electric failure of the microkeratome at the beginning of flap creation. The incomplete flap was retrieved using the femtosecond laser flap creation technique in the same sitting and excimer laser ablation was performed.

RESULTS:

Postoperative uncorrected distance visual acuity was 20/20 in both eyes. Postoperative aberration of both eyes was not significant and there was no associated glare or halos. The patient was satisfied with the result.

CONCLUSIONS:

There are several reports of incomplete flap retrieved using a microkeratome, but this is the first case report in which a femtosecond laser was used to complete the flap in the same sitting.

[
Journal of Refractive Surgery Case Reports.
2021;1(1):e6–e9.]
Interface Fluid Syndrome After Descemet Membrane Endothelial Keratoplasty
Authors: Wolf Bella J. , Ma Laiyin , Batta Priti
Published: June 2021

PURPOSE:

To describe a case of interface fluid syndrome in a patient with a remote history of laser in situ keratomileusis (LASIK) and recent staged cataract surgery and Descemet membrane endothelial keratoplasty (DMEK).

METHODS:

A 65-year-old man presented with visual impairment in the left eye in the setting of Fuchs' endothelial dystrophy and cataract. Cataract surgery followed by DMEK 3 months later were performed in the left eye.

RESULTS:

Following DMEK, a cleft of interface fluid was documented at the LASIK flap interface via anterior segment optical coherence tomography (AS-OCT) 4 days postoperatively. The DMEK graft was fully attached and intraocular pressure (IOP) was low to normal when the interface fluid was first observed. This interface fluid persisted despite management with IOP-lowering drops. IOP consistently measured low, and the DMEK graft subsequently detached inferiorly. The decision was made to perform Descemet stripping automated endothelial keratoplasty (DSAEK), after which the interface fluid resolved and visual acuity improved significantly.

CONCLUSIONS:

Interface fluid syndrome can occur years after LASIK, especially following intraocular surgery. This patient may have developed interface fluid syndrome following DMEK due to endothelial dysfunction in the setting of DMEK graft incompetence. Resolution of interface fluid in this patient was achieved after DSAEK.

[
Journal of Refractive Surgery Case Reports.
2021;1(1):e15–e18.]
Admissible function spaces for weighted Sobolev inequalities
Authors: Anoop T. V. , Biswas Nirjan , Das Ujjal
Published: June 2021

Let \begin{document}$ k,N\in \mathbb{N} $\end{document} with \begin{document}$ 1\le k\le N $\end{document} and let \begin{document}$ \Omega = \Omega_1 \times \Omega_2 $\end{document} be an open set in \begin{document}$ \mathbb{R}^k \times \mathbb{R}^{N-k} $\end{document}. For \begin{document}$ p\in (1,\infty) $\end{document} and \begin{document}$ q \in (0,\infty), $\end{document} we consider the following weighted Sobolev type inequality:

\begin{document}$\begin{align} \int_{\Omega} |g_1(y)||g_2(z)| |u(y,z)|^q \, {\rm d}y {\rm d}z \leq C \left( \int_{\Omega} | \nabla u(y,z) |^p \, {\rm d}y {\rm d}z \right)^{\frac{q}{p}}, \quad \forall \, u \in \mathcal{C}^1_c(\Omega), \\(0.1)\end{align}$\end{document}

for some \begin{document}$ C>0 $\end{document}. Depending on the values of \begin{document}$ N,k,p,q $\end{document} we have identified various pairs of Lorentz spaces, Lorentz-Zygmund spaces and weighted Lebesgue spaces for \begin{document}$ (g_1, g_2) $\end{document} so that (0.1) holds. Furthermore, we give a sufficient condition on \begin{document}$ g_1,g_2 $\end{document} so that the best constant in (0.1) is attained in the Beppo-Levi space \begin{document}$ \mathcal{D}^{1,p}_0(\Omega) $\end{document}-the completion of \begin{document}$ \mathcal{C}^1_c(\Omega) $\end{document} with respect to \begin{document}$\|\nabla u\|_{L p(\Omega)}$\end{document}.
Admissibility and generalized nonuniform dichotomies for discrete dynamics
Authors: Silva César M.
Published: June 2021

We obtain characterizations of nonuniform dichotomies, defined by general growth rates, based on admissibility conditions. Additionally, we use the obtained characterizations to derive robustness results for the considered dichotomies. As particular cases, we recover several results in the literature concerning nonuniform exponential dichotomies and nonuniform polynomial dichotomies as well as new results for nonuniform dichotomies with logarithmic growth.
Hrvatska u konfliktnoj kohabitaciji (Milanović – Plenković)
Authors:   Faculty of Law, University of Zagreb, Kostadinov Biljana
Published: June 2021

Posebnost hrvatskog iskustva kohabitacije pokazuje da se sukob visokog intenziteta između predsjednika Vlade i predsjednika Republike ne vodi isključivo na političkom području, već se žele izmijeniti i ustavne ovlasti sudionika, ustavna “pravila ratovanja”. Trajnost Ustava i ustavne diobe ovlasti između predsjednika Republike i predsjednika Vlade i Hrvatskog sabora dobivaju manju težinu i zaštitu. Odbačen je siguran putokaz za očuvanje hrvatskog ustavnog sustava, uputa iz razdoblja prve francuske kohabitacije u Petoj Republici (1986. – 1988.): Povratak na Ustav, samo Ustav i ništa osim Ustava. Ustavni sustav je zakočen.
“Mora se Konkordatu još i danas pripoznati pravna snaga, jer on izmedju valjano proglašenih zakona ne može iznimku činiti”
Authors:   Faculty of Law, University of Zagreb, Krešić Mirela
Published: June 2021

Nakon ukidanja neoapsolutizma i povratka ustavnosti raspravljalo se o valjanosti austrijskih propisa uvedenih putem patenata, pa tako i o valjanosti Konkordata. Stajališta o tome nerijetko su bila oprečna te se o tom pitanju raspravljalo ne samo s pravnog stajališta već i kao o važnom nacionalno-političkom te crkvenom pitanju. Na temelju spisa iz fonda Stola sedmorice Hrvatskog državnog arhiva u povodu tužbe o nasljednom pravu nakon smrti biskupa Strossmayera u radu se rekonstruira pravni okvir uređenja oporučnog nasljeđivanja iza prelata te se analiziraju presude Sudbenog stola u Osijeku, Banskog stola te Stola sedmorice, odnosno argumentacija tih sudova kojom je pola stoljeća nakon sklapanja Konkordata (ponovno) potvrđena njegova valjanost.
Obiteljska medijacija i mogućnosti primjene u slučajevima međunarodne otmice djece
Authors:   Faculty of Law, University of Zagreb, Branica Vanja , Majstorović Irena ,   Faculty of Law, University of Zagreb, Šimović Ivan ,   Faculty of Law, University of Zagreb
Published: June 2021

Međunarodna otmica djece fenomen je koji dugo zaokuplja pozornost stručnjaka. Ipak, pozornosti unatoč, čini se da su načini prevladavanja ovih teških situacija nerijetko predmetom spoticanja različitih struka. Svrha je ovoga rada stoga višestruka. Prvo, iz zajedničke perspektive prava i socijalnog rada dodatno rasvijetliti mogućnosti koje obiteljska medijacija općenito nudi kao instrument rješavanja složenih sukoba i obiteljskih sporova. Drugo, analizirati prednosti koje korištenje obiteljske medijacije donosi u predmetima međunarodne otmice djece. I konačno, nastojati interdisciplinarno ujediniti uvid u ključne pravne izvore sa spoznajama o praktičnim izazovima provedbe medijacijskih postupaka kako bi vrijednost medijacije u predmetima međunarodne otmice djece postala što prepoznatija.
The Manuscripts of Galen in the Library of Cardinal Bessarion: A Reappraisal
Authors: Giacomelli Ciro
Published: June 2021

Le présent article offre une vue d’ensemble sur les manuscrits de Galien conservés dans la bibliothèque du cardinal Bessarion (m. 1472), qui fit don de sa riche collection de manuscrits grecs à la République de Venise entre 1468 et sa mort. Après avoir présenté les manuscrits galéniques de Bessarion, tout en corrigeant et intégrant les descriptions jusqu’ici publiées, nous nous attachons à un groupe de sept manuscrits récents, copiés dans les dernières années de la vie de Bessarion par différents scribes travaillant à Rome à son service. Les éléments codicologiques, paléographiques et textuels ici présentés nous permettent de mieux comprendre un jalon important dans la réception de Galien en Occident, ouvrant la voie à la révolution médicale du xvie siècle.
Faire bouger les représentations. Sens et usages d’une métaphore pédagogique
Authors: Goubet Jean-François
Published: June 2021

« Faire bouger les représentations » est une expression assez courante dans les milieux de la formation. On en fait principalement deux usages. Le premier concerne l’enfant, notamment lorsqu’il apprend les sciences expérimentales. Le second touche le maître, qui devrait faire le deuil de certaines conceptions lorsqu’il se professionnalise. Le sens de l’expression, par ailleurs, peut être très divers. Trois acceptions sont distinguées : celle du mouvement comme désobstruction d’un obstacle, celle du mouvement comme transformation d’une opinion en une idée correcte, celle, enfin, du mouvement comme déplacement d’un quantum d’affect misé sur une représentation. Au travers des reprises que font de Bachelard certains représentants de la didactique des sciences contemporaine d’expression française, nous essayons de comprendre exactement ce que peut bien vouloir dire, selon les contextes, « faire bouger les représentations ».
Représentation et théorie : une analyse critique du point de vue constructiviste
Authors: Firode Alain
Published: June 2021

De nombreux didacticiens des sciences contemporains estiment qu’un apprentissage réussi implique une « transformation des représentations » de l’élève. Cet article se propose de montrer, en utilisant des analyses issues de l’épistémologie poppérienne, que ce point de vue repose sur une confusion : confusion entre, d’une part, les effets psychologiques qui résultent parfois de l’appropriation d’une connaissance scientifique et, d’autre part, le travail intellectuel par lequel cette appropriation s’effectue. Selon Karl Popper, en effet, le processus par lequel nous parvenons à connaître un objet intellectuel, telle qu’une théorie scientifique, s’apparente à celui par lequel nous apprenons à connaitre un objet physique quelconque. Il consiste essentiellement dans l’acquisition progressive d’une forme de familiarité opératoire avec un « objet du monde 3 » et n’implique en lui-même aucun bouleversement mental soudain, aucun modification interne de nos « représentations ».
Le concept de représentation en didactique des sciences : sa nécessaire composante épistémologique et ses conséquences
Authors: Orange Christian , Ravachol Denise Orange
Published: June 2021

Bien que venant de la psychologie, le concept de représentation a nécessairement, en didactique des sciences, une référence épistémologique. Partant du rôle fondateur de ce concept en didactique, cet article en discute la mise en place et montre les difficultés à échapper aux réifications de différentes natures. Puis, à partir d’un cadre didactique et épistémologique particulier, celui de la problématisation, il montre comment un tel cadre intervient dans le renouvellement des problématiques liées aux représentations.
Rupture épistémologique et travail sur les représentations
Authors: Fabre Michel
Published: June 2021

Cet article fait le point sur l’idée de travail sur les représentations dans une perspective bachelardienne. A partir de l’exemple de l’enseignement de l’astronomie, développé par Gaston Bachelard lui-même, il identifie les stratégies cathartiques de la psychanalyse de la connaissance dans leur dimension topique (prise de conscience), énergétique (déplacement d’investissement) et dynamique (surveillance intellectuelle de soi). Gaston Bachelard définit ainsi une dialectique de continuité et de rupture (et non de coupure) dans laquelle la psychologie intervient pour débarrasser la raison des obstacles qui l’entravent. Dans cette perspective, le travail sur les représentations est pensé comme problématisation, c'est-à-dire passage d’une opinion à un savoir raisonné.
Pratiques langagières et savoirs en jeu en français au cycle 3
Authors: Delbrayelle Anne
Published: June 2021

L’article pose une question : en quoi les pratiques langagières d’un même enseignant varient-elles en fonction du savoir en jeu ? Le travail se centre donc sur les pratiques langagières d’un enseignant de cycle 3 (CM2, élèves de onze ans) dans deux séquences d’enseignement apprentissage : les jeux de langage et la littérature. Il s’agit de savoir quelles sont ces pratiques langagières et si elles varient en fonction du savoir en jeu au-delà même d’une régularité personnelle et propre à l’enseignant. L’analyse des séances dans leur déroulement et aussi dans les différents moments qui les composent, montre que les prises de parole de l’enseignant ne sont pas de la même densité tant dans leur nombre que dans leur teneur en fonction de la séance. Enfin, en convoquant la théorie de l’action conjointe, le découpage des séances atteste d’une nette différence quant au moment de ces prises de parole, permettant ainsi de répondre à la question posée initialement.
Les enjeux de l’enseignement pour les professeurs d’université au Québec
Authors: Deschenaux Frédéric
Published: June 2021

Au Québec, la tâche des professeurs d’université doit se partager entre trois principales composantes que sont l’enseignement, la recherche et les services à la collectivité. Or, toutes ces tâches ne sont pas d’égale valeur aux yeux des professeurs dans un contexte où la recherche est très valorisée. Alors que l’enseignement constitue une source tangible de satisfaction au travail pour plusieurs professeurs, des travaux montrent que dans les conditions actuelles, l’enseignement universitaire génère des situations stressantes qui affectent la santé psychologique du corps professoral jusqu’à conduire certains professeurs à l’épuisement professionnel. L’analyse qualitative des données d’une question ouverte (768 réponses recueillies par un sondage en ligne) permet de dégager trois enjeux préoccupants pour les professeurs à propos de l’enseignement universitaire : le déséquilibre entre les tâches, les menaces à la qualité de l’enseignement et le rapport au savoir des étudiants. Ces éléments conduisent à remettre en question « l’idée d’université » préconisée par les professeurs québécois de même que la transmission des savoirs à l’université.
Eduquer et soigner : une éthique commune ?
Authors: Durand Guillaume
Published: June 2021

L’éthique médicale et l’éthique enseignante ont toutes les deux à résoudre un problème fondamental : concilier le respect de la liberté et la contrainte bienfaisante. Dans le soin, il s’agit bien souvent, pour le bien du malade, tel un schizophrène par exemple, de le contraindre à un traitement. Dans l’éducation, si l’idéal pour tout professeur serait que ses élèves consentent et désirent toujours apprendre, la réalité de la relation éducative est un va-et-vient constant entre la contrainte et la liberté, entre le refus de travailler et le désir d’apprendre. Il s’agit de fonder aujourd’hui, dans l’éducation et dans le soin, une éthique de l’autonomie qui soit une troisième voie, entre un paternalisme radical désuet et illégitime, et un minimalisme moral qui risque de réduire les relations entre les acteurs à de pures relations contractuelles.
Le développement des espoirs et des peurs envers l’avenir dans le domaine scolaire chez les élèves de cycle 3
Authors: Lefe Gaëlle , Guimard Philippe , Florin Agnès
Published: June 2021

Les espoirs et les peurs des enfants peuvent être conceptualisés en psychologie sous les termes de « sois espérés » et de « sois à éviter », qui renvoient à un concept plus général, les « sois possibles ». Ces derniers s’entendent comme les descriptions des personnes dans leur futur, leurs représentations d’eux-mêmes dans l’avenir. L’objectif de cette recherche exploratoire est d’examiner l’évolution des sois possibles, et notamment ceux relatifs au domaine scolaire, chez les enfants, population peu prise en considération jusque-là dans les recherches sur cette thématique. Une première version d’un questionnaire auto-évaluatif des sois possibles a été construite et proposée à 124 élèves de cycle 3 suivis longitudinalement pendant trois ans (enfants âgés de huit à dix ans). Au-delà du fait que les élèves sont capables de se projeter dans le futur, les résultats de cette étude montrent que le domaine scolaire est perçu comme de plus en plus important mais aussi inquiétant, au fur et à mesure de l’avancée en âge. En conclusion, cet article souligne l’intérêt d’étudier les espoirs et les peurs dans le domaine scolaire chez les jeunes enfants, notamment à l’approche des transitions scolaires.
An Optimal NIDS for VCN Using Feature Selection and Deep Learning Technique
Authors: Keserwani Pankaj Kumar , Govil Mahesh Chandra , Pilli E. S. , Govil Prajjval
Published: June 2021

In this modern era, due to demand for cloud environments in business, the size, complexity, and chance of attacks to virtual cloud network (VCN) are increased. The protection of VCN is required to maintain the faith of the cloud users. Intrusion detection is essential to secure any network. The existing approaches that use the conventional neural network cannot utilize all information for identifying the intrusions. In this paper, the anomaly-based NIDS for VCN is proposed. For feature selection, grey wolf optimization (GWO) is hybridized with a bald eagle search (BES) algorithm. For classification, a deep learning approach - deep sparse auto-encoder (DSAE) is employed. In this way, this paper proposes a NIDS model for VCN named - GWO-DES-DSAE. The proposed system is simulated in the python programming environment. The proposed NIDS model's performance is compared with other recent approaches for both binary and multi-class classification on the considered datasets - NSL-KDD, UNSW-NB15, and CICIDS 2017 and found better than other methods.
Towards Reviewing an Immediate Impact of COVID-19 on the Integrative World Economy
Authors: Alankar Bhavya , Kaur Harleen , Ahsaan Shafqatul , Sharma Gaurav , Chang Victor
Published: June 2021

On 31 December 2019, WHO received inputs of pneumonia cases in Wuhan city of China, but the cause of infection could not be known initially. However, after some time, the medical researchers of China disclosed a novel coronavirus as the cause on 7 January 2020, named “2019-nCoV.” The coronavirus (CoV) belongs to Severe Acute Respiratory Syndrome (SARS) species that leads to infection, causing illness, which ranges from the common cold to serious sickness. Finally, on 11 March 2020, the WHO Director-General Dr. Tedros Adhanom Ghebreyesus announced the outbreak as a pandemic. As the fear and ambiguity rose among companies and firms, the profit rate seemed to be lower due to the COVID-19 global impact. Nearly US$6 trillion in wealth from 24th to 28 February 2020 of the stock market has been wiped out. There was a great decrease in value over the S&P index, which abolished over $5 trillion in the same week. However, the largest 10 companies of S&P faced a loss of $1.4 trillion. The investors make an analytical prediction that firms' profits may drop in response to the impact of coronavirus. The prime focus is on the importance of digital business practices and how different sectors have been affected in terms of economic loss during this pandemic outbreak in this paper.
La musica e il canto corale come terapia: l’esperienza del Fuckcancer Choir
Authors: S. Crivellari  , S. Delfanti  , M. Dacquino  , A. Maconi  , F. Grosso
Published: June 2021

La musicoterapia come parte integrante del percorso terapeutico-assistenziale dei pazienti oncologici e dei relativi caregivers può portare a una migliore gestione del dolore e dell’ansia, promuovendo il rilassamento, facilitando le capacità espressive e il corretto incanalamento delle emozioni e, in ultima analisi, offrendo supporto durante l’esperienza del lutto. Il FuckCancer Choir, nella realtà alessandrina, rappresenta un esempio di canto corale che apporta benefici nell’area psico-sociale riferiti dagli stessi partecipanti (pazienti, caregivers e operatori sanitari).
The Unexplored Value of “Normal”
Authors: Logiudice Andrew , Sibbald Matthew , Monteiro Sandra
Published: June 2021

In this article, we highlight how standard assessments in the health professions pay little attention to “normal” cases – i.e. those without pathology – and as a result may be overlooking a skill that lies at the heart of efficient health care. The issue is explored with two overarching questions in mind: What specifically might be missed by excluding these normal cases from high-stakes assessment? And what broader implications does this have for medical practice? Drawing upon a large body of research on diagnostic expertise and clinical reasoning, we argue that accurate categorization of a case as either abnormal or normal represents a key diagnostic skill, and that this skill may be neglected in many standardized assessments because they consist almost entirely of abnormal cases. Unforeseen consequences of this structure are then discussed in terms of curriculum design and trainee perceptions. If discerning “abnormal versus normal” is as critical as the literature suggests, then perhaps our typical assessment strategies need to be re-evaluated. This under explored topic warrants further research.
Long Standing Paraparesis
Authors: Kumar Pankaj , Dhillon Prabhjot , Jindal Geetanjali , Randev Shivani , Guglani Vishal
Published: June 2021

Neurologic manifestations can accompany systemic diseases, and primary disease can be identified with a careful history, physical examination, and laboratory investigations. Renal tubular acidosis (RTA) is an important differential diagnosis in any child presenting with failure to thrive. Hypokalemic distal RTA, also known as classic RTA or type 1 RTA, may present, though not so frequently, with weakness consequent upon hypokalemic paralysis, compounded by rickets.
History of Psychiatric Rehabilitation in India
Authors: Kakunje Anil , Mithur Rajesh , Puthran Sowmya , Joy Anjana , Shetty Shwetha
Published: June 2021

Psychiatric rehabilitation is a therapeutic approach in the management of mental illness which encourages people to recover from the illness and achieve their fullest potential through learning and environmental support. The method involves adapting the patient to his environment or modifies the environment to meet the patient's needs. The concept of psychiatric rehabilitation has a long history in India. In its difficult journey from colonial ages to post independence it has come across many hurdles. With the hard work of few pioneers, institutes and government reforms we have reached a significant stage today. We will discuss psychiatric rehabilitation from the Vedic period, ancient India, British rule, post-independence to the current status. Also covering the laws related to the field, achievements, people and Institutions involved. People say past is where we learn lesson and future is where we apply them. After this long fascinating journey through development of psychiatric rehabilitation in India, we can find that the development in this field is still inadequate. With multiple deficiencies in funding, infrastructure and work force this unique multidisciplinary field has a long way to go in this country..
Prognostic Markers in Acute Liver Failure - Alpha Feto Protein
Authors: Gayathri P. , Krishnamoorthy Smitha , Chandra Subhash , Pillai MGK , Menon Raviraj , Iyer Mahesh Subramania
Published: June 2021

Background and Aim:

Acute liver failure is associated with high mortality and only about 40% patients survive without liver transplantation. The available prognostic models failed to predict the outcome correctly. Here, we aimed to determine if alpha-fetoprotein (AFP) can be used as a prognostic marker in acute liver failure.

Materials and Methods:

For this prospective observational study, sixty patients with the diagnosis of acute liver failure were allocated and serum AFP ratio was measured on days 1 and 3 of admission. AFP ratio was calculated as day 3 AFP/day 1 AFP value. Other laboratory parameters and various etiological factors of acute liver failure were also studied.

Results:

The average AFP ratio among survivors was 1.77 ± 0.94 and among patients who died, the average ratio was 0.68 ± 0.58. Hence, AFP ratio is an important prognostic tool in predicting mortality with a P < 0.001. Majority of patients (80.6%) of patients whose AFP ratio was <0.7 died while majority of patients whose AFP ratio was >0.7 survived (70.4%). Hence, we concluded that AFP values change dynamically during the course of acute liver failure and AFP ratio can be used as a prognostic marker in acute liver failure. AFP ratio showed statistically significant negative correlation with prothrombin time and international normalized ratio, serum globulin, and the levels of indirect bilirubin, especially on the third day after admission and the variables were significantly elevated in the patients who died.

Conclusions:

AFP ratio can be used as a predictor of mortality in acute liver failure patients. Higher the ratio more are the chances of survival.
Evaluation of Bite Force in Patients with Cleft Lip and Palate and Its Comparison with Normal Patients
Authors: Bhat Vidya , Reddy Harikrishan , Razdan Sanha , Shetty Sanath
Published: June 2021

Aim and Objectives:

This in vivo cross-sectional study aimed to measure and correlate the average and maximum bite forces between cleft and noncleft individuals.

Materials and Methods:

The study was conducted on thirty cleft and thirty noncleft lip and palate patients who were belonging to the age group of 14–30 years with unrepaired unilateral cleft lip and palate under treatment at the Craniofacial Center, Yenepoya Dental College, Mangalore, and G. S. R Craniofacial Center, Hyderabad, India. Dental Prescale® sheet was used to record the bite force of the patients and the test sheet was scanned with an Epson v330 color HD photo scanner, and the bite force was evaluated by an FDP 8010 analyzing system. The data were analyzed statistically by the Student's data t-test.

Results:

The control group had a statistically significantly higher mean pressed area on the left side (P = 0.034), maximum pressure on the left side (P < 0.001), mean maximum pressure on the right side (P = 0.024), and mean average pressure on the left side (P = 0.038). There was no statistically significant difference in the mean pressed area on the right side (P = 0.569) and average pressure on the right side of the control and study groups (P = 0.358).

Conclusions:

There was a statistically significant difference in the mean maximum pressure (P = 0.001) and average pressure (P = 0.039) among cleft lip and palate patients when compared with that of the control group. There was no significant difference between male and female subjects of both the groups.
Androgen Receptor in Breast Cancer
Authors: Chavan Sneha , Ravindra Savithri
Published: June 2021

Background and Aim:

Breast carcinoma is the most common malignant tumor and the leading cause of cancer deaths in women. The incidence of breast cancer in India has been gradually raising accounting for 25%–33% of all cancers in women. Breast carcinomas are a heterogeneous group of tumors which show varied behavior and response to therapeutic agents. Androgen receptors (ARs) have been studied in great detail in prostate cancers, now being studied in breast cancers, but its role in breast cancer has not been elucidated completely. The aim of our study was to evaluate the expression of AR in invasive carcinoma of the breast and to evaluate its relation to estrogen receptor (ER), progesterone receptor (PR), and Human Epidermal growth factor Receptor2 (HER2) expression on tissue microarray (TMA) sections.

Materials and Methods:

This was a descriptive study which included 53 cases of breast carcinoma. The specimens were fixed in 10% formalin, routinely processed. A master block for TMA was made by taking 2 mm cores from paraffin blocks containing tumor. Sections were taken and stained for ER, PR, AR, and HER2.

Results:

A total of 53 cases were studied. Around 63% of breast carcinomas were positive for AR.

Conclusion:

AR expression can be used as an additional biomarker in breast carcinomas, and a large number of cases can be studied by TMA sections.
Assessment and Comparison of the Mental Health Status of Patients Seeking Psychiatry Facilities in Prelockdown and Postlockdown Period of the COVID-19 Pandemic
Authors: Sharma Devesh , Garg Sunny , Sharma Anchal , Sharma Dinesh Dutt , Sharma Nidhi , Gupta Simran , Sharma Shivam
Published: June 2021

Background and Aim:

The servicing and framework for mental health care accessible to population have been affected during the unprecedented times of the coronavirus disease (COVID-19) pandemic. The new and almost exclusive method to maintain a therapeutic alliance with these patients has been the recently evolving telepsychiatry services. The main aim of the study is to assess and compare the mental health status of patients seeking psychiatry facilities in prelockdown and postlockdown period during the COVID-19 pandemic.

Materials and Methods:

This was a ambirespective study which was conducted in a tertiary care hospital in a hilly region of North India in which the registered data were analyzed between January 1, 2020 and March 21, 2020 (prelockdown phase) and from May 3, 2020 to September 30, 2020 (postlockdown phase, after the resumption of outpatient department services in the institute), to gather the information of patients about sociodemographic profile and clinical diagnosis on the basis of International Classification of Diseases-10. A total sample size of 1000 patients was included. Chi-square test and Student's t-test were used to compare the patient presentation before and after the lockdown periods.

Results:

Majority of the patients were male (66%) and within 19–60 years of age (85%–90%). The average age of the patients (39.17 years, standard deviation = 14.37) was significantly higher in postlockdown phase. As compared to prelockdown period (499 patients), a significantly (P < 0.001) lower number of patients diagnosed with substance use disorders and a significantly (P < 0.001) higher number of patients diagnosed with psychotic disorders along with anxiety disorders, availed the available psychiatry services in the period of COVID-19 pandemic (501 patients).

Conclusions:

Sudden cessation of the psychiatry services further precipitated the deterioration of mental health of the patients. There is an urgent demand for services to adapt to changing scenarios with emphasis on practical approaches to help the mentally ill people, especially in geographically difficult hilly areas.
Lichenoid Drug Eruption Due to Isoniazid Presenting as Generalized Exfoliative Dermatitis in an Immunocompromised Patient
Authors: Sinha Preema , Bhatt Siddharth , Kinra Prateek , Radhakrishnan Subramaniyan , Awasthi Shivali
Published: June 2021

Lichenoid drug eruption is characterized by multiple discrete violaceous shiny papules often becoming confluent. It is a common benign adverse drug reaction and has been extensively described in the literature with various drugs. Here, we report an unusual presentation of lichenoid drug eruption in the form of generalized exfoliative dermatitis with hair loss in a patient of human immunodeficiency virus infection due to isoniazid.
Generalized Bullous Fixed Drug Eruption Due to Fluconazole
Authors: Bansal Anuva , Relhan Vineet , Sahoo Bijaylaxmi
Published: June 2021

Fixed drug eruption (FDE) is characterized by the development of well-demarcated erythematous to violaceous plaques, within minutes to hours of the intake of an offending drug. It is known as “fixed” because subsequent exposure to the implicated drug leads to the development of lesions at the same sites that were involved at the time of the previous drug exposure. Fluconazole, a widely used antifungal agent, has a good safety profile, and limited data exist on the development of bullous FDE due to fluconazole. Herein, we report a series of two cases presenting with a generalized bullous FDE (GBFDE), following the consumption of fluconazole. A temporal correlation, typical morphological features, symptoms, and a past history of FDE due to fluconazole were essential clues to the diagnosis. Furthermore, we utilized the Naranjo adverse drug reaction probability scale for causality assessment. Discontinuation of the drug was followed by the resolution of lesions in 7–10 days. GBFDE is an uncommon entity and requires immediate diagnosis as well as prompt discontinuation of the offending agent to minimize the complications.
Ligelizumab
Authors: Godse Kiran , Patil Anant D. , Godse Gauri
Published: June 2021

Chronic spontaneous urticaria may pose challenges for the treatment in some patients. Different options for the management of chronic urticaria include second-generation antihistamines, leukotriene receptor antagonists, omalizumab (anti-IgE antibody), and immunosuppressants. Omalizumab, a monoclonal antibody, is a valuable option for patients not responding to up-dosing (up to 4 times) of second-generation antihistamine. However, in about one-fourth of the patients, omalizumab may not be effective in controlling symptoms. Considering this, there is a need to identify the drugs for effective treatment. Ligelizumab is a novel anti-IgE monoclonal antibody with higher affinity to IgE than omalizumab. In phase 2b clinical trial, it is found to be effective and well tolerated in patients with chronic spontaneous urticaria. When approved, it may be beneficial for patients who cannot receive or have suboptimal efficacy with omalizumab.
Magnetic resonance imaging in rhino-orbital-cerebral mucormycosis
Authors: Sreshta Kanduri , Dave Tarjani Vivek , Varma Dandu Ravi , Nair Akshay Gopinathan , Bothra Nandini , Naik Milind N , Sistla Srinivas Kishore
Published: June 2021

Coronavirus disease-associated mucormycosis (CAM) is an established clinical entity in India. In the past 4 months, there has been a sharp upsurge in the number of CAM cases in most parts of the country. Early diagnosis can be lifesaving. Magnetic resonance imaging (MRI) imaging remains the corner stone of management in patients with ROCM. This review discussed the utility of MRI imaging in ROCM with an emphasis on the ideal MRI protocol in a suspected case of ROCM, the pathways of spread of infection, the classic diagnostic features, MRI for staging of the disease, MRI for prognostication, MRI for follow up, and imaging features of common differentials in ROCM. The pit falls of MRI imaging and a comparison of CT and MRI imaging in ROCM are discussed. The clinical interpretation of areas of contrast uptake and those of necrosis and its relevance to treatment are discussed. This review aims to familiarize every member of the multidisciplinary team involved in managing these patients to be able to interpret the findings on MRI in ROCM.
Comparison of effects of mydriatic drops (1% cyclopentolate and 0.5% tropicamide) on anterior segment parameters
Authors: Tasci Yelda Yildiz , Yesilirmak Nilufer , Yuzbasioglu Sema , Ozdas Demet , Temel Berke
Published: June 2021

Purpose:

The purpose of this study is to investigate and compare the effects of cyclopentolate and tropicamide drops on anterior segment parameters in healthy individuals.

Methods:

Two hundred and fifty-eight eyes of 129 healthy volunteers were included in this randomized clinical study. Cyclopentolate 1% drop was applied to 75 (58%) participants (group 1) and tropicamide 0.5% drop was applied to 54 (42%) participants (group 2). Flat keratometry (K1), steep keratometry (K2), axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), white-to-white (WTW) distance, pupil diameter, total pupil offset and intraocular lens (IOL) power were measured before and after drops, using Lenstar 900 optical biometry.

Results:

The increase in CCT, ACD, pupil diameter, and pupil offset was significant in group 1 after the drop (P < 0.05), while the increase in ACD, pupil diameter, and pupil offset was significant in group 2 (P < 0.05). When the two groups were compared, there was no significant difference in K1, K2, CCT, ACD, WTW, pupil diameter, pupil offset, and IOL power (using Sanders–Retzlaff–Kraff T formula) changes after drops (P > 0.05), whereas the change in AL was significant (P = 0.01).

Conclusion:

The effects of cyclopentolate and tropicamide drops on anterior segment parameters were similar; they did not make significant changes in K1, K2, AL, WTW, and third-generation IOL power calculation. However, ACD values significantly changed after these drops; thus, measuring anterior segment parameters before mydriatic agents should be taken into account particularly for fourth-generation IOL formulas and phakic IOL implantation. The change in pupil offset, which can be important in excimer laser and multifocal IOL applications, was not clinically significant.
Changes in intraocular pressures associated with inhalational and mixed anesthetic agents currently used in ophthalmic surgery
Authors: Senthil Sirisha , Nakka Mamata , Rout Umashankar , Ali Hasnat , Choudhari Nikhil , Badakere Swathi , Garudadri Chandrasekhar
Published: June 2021

Purpose:

The aim of this study was to measure changes in intraocular pressures (IOPs) associated with inhalational and mixed anesthetic agents currently used for general anesthesia (GA) in ophthalmic surgery.

Methods:

In a cross-sectional study, 48 eyes from 48 consecutive subjects that underwent ophthalmic surgery under GA were included. Mixed anesthetics were used in 26 eyes and sevoflurane in 22 eyes. IOPs of the nonsurgery eyes were recorded at T1 (5 min before induction of anesthesia), T2 (5 min after intubation), and T3 (at the conclusion of surgery before extudation) using ICare PRO and Perkins tonometers. Linear mixed-effects models were used to compare differences in IOPs at various time points. Outcome measures were changes in IOP after induction of GA, intubation, and just before extubation and comparisons of decreases in IOPs induced by sevoflurane and mixed anesthetics.

Results:

Mean preanesthesia IOP for patients in this study (mean age ± standard deviation = 26.9 ± 18.3 years; range: 5–70 years) was 17.9 ± 4.9 (range: 10–30) mm Hg. There was a significant decrease in the mean IOP (standard error (SE) (in mm Hg) at T2 (Perkins: –4.65 (0.57); ICare PRO: –5.16 (0.56) and T3 (Perkins: –5.63; ICare PRO: –5.36) as compared to the IOP at T1 (P < 0.001). The decreases in IOPs at T2 and T3 were similar in both anesthetic groups (T2:P = 0.60; T3: P = 0.33).

Conclusion:

Significant decreases in IOPs after GA were observed and the differences were not significantly different between sevoflurane and mixed anesthetic agents. For management decisions in pediatric glaucoma, the IOP measurements under GA are crucial, the underestimation of IOP as noted with currently used anesthetic agents has to be accounted for and decisions are taken appropriately.
Reversibility of retinochoroidal vascular alteration in patients with obstructive sleep apnea after continuous positive air pressure and surgical intervention
Authors: Jayakumar Kalaivani , Bansal Sandeep , Markan Ashish , Agarwal Aniruddha , Bansal Reema , Mahajan Sarakshi , Agrawal Rupesh , Gupta Vishali
Published: June 2021

Purpose:

The aim of this work was to study various retinochoroidal parameters in patients with obstructive sleep apnea syndrome (OSAS) and the effect of interventions on these parameters at 6 months follow-up.

Methods:

A total of 36 patients were recruited prospectively from the otorhinolaryngology clinics of a large tertiary center between September 2018 to March 2020. The subjects were divided into three groups depending upon intervention chosen for OSAS: Group A (surgery, i.e., uvulopalatopharyngoplasty), group B (medical therapy, i.e., continuous positive air pressure) and group C (no intervention). Various retinochoroidal parameters which were studied included retinal thickness (RT), choroidal thickness (CT), choroidal vascularity index (CVI), arteriovenous ratio (AVR), capillary density index (CDI) in superficial and deep retina, at baseline and 6 months of follow-up after the intervention.

Results:

In group A, CT increased significantly at 6 months (332.76 ± 86.41 um) compared to baseline (306.28 ± 78.19) (P = 0.0004). Similarly, CDI at both superficial and deep capillary plexus increased significantly at 6 months (superficial CDI: 0.65 ± 0.04, deep CDI: 0.38 ± 0.01) compared to baseline (superficial CDI: 0.62 ± 0.03, deep CDI: 0.36 ± 0.02) (P = 0.004 and 0.002 respectively). In group B, CT increased significantly at 6 months (361.38 ± 78.63 um) compared to baseline (324.21 ± 76.97 um) (P = 0.008). Also, CVI showed a significant decrease at 6 months (65.74 ± 1.84%) compared to baseline (67.36 ± 1.57%) (P = 0.019). In group C, all except CDI in deep capillary plexus showed a significant decrease at 6 months (0.35 ± 0.01) compared to baseline (0.36 ± 0.02) (P = 0.003).

Conclusion:

OSAS alters various retinochoroidal parameters and timely intervention in patients with OSAS can prevent these alterations. Also, these retinochoroidal parameters could serve as one of the markers to monitor the disease progression.
Role of improved distance and near visual acuity with low vision aids to enhance stereopsis in retinal diseases
Authors: Sodhi Punita Kumari , Gautam Akanksha , Sharma Nandini , Anand Kamlesh , Sodhi Ramneeq Singh
Published: June 2021

Purpose:

The purpose of this study was to examine role of improved distance and near best-corrected visual acuity (DBCVA and NBCVA) with use of magnification devices to enhance stereopsis in low vision (LV) subjects having retinal diseases.

Methods:

In a cross-sectional observational study without control, 84 subjects having LV due to retinal diseases were examined for an improvement of BCVA with use of magnifying low vision aids (LVAs) (2X for DBCVA and 3X for NBCVA). The stereopsis scores on titmus fly test were recorded with near refractive correction “on” and then with 3X magnification. The improvement in stereopsis for distance was however estimated through statistical correlation values.

Results:

The DBCVA (P < 0.001), NBCVA (P < 0.001) and stereopsis (P < 0.001) improved statistically significantly (SS) following magnifying LVA. There was no correlation between pre-LVA stereopsis and pre-LVA DBCVA (r = 0.059; P = 0.444;NSS) and post-LVA DBCVA (r = 0.054; P = 0.487;NSS); and no correlation between post-LVA stereopsis and pre-LVA DBCVA (r = 0.042; P = 0.592;NSS) and post-LVA DBCVA (r = 0.08; P = 0.920;NSS). There was no correlation between pre-LVA stereopsis and pre-LVA NBCVA (r = 0.044; P = 0.572;NSS) and no correlation between post-LVA stereopsis and pre-LVA NBCVA (r = 0.108; P = 0.165;NSS). But positive correlation between pre-LVA stereopsis and post-LVA NBCVA (r = 0.347; P < 0.001) and between post-LVA stereopsis and post-LVA NBCVA (r = 0.445; P < 0.001) was SS.

Conclusion:

The use of magnification as LVA improves both the BCVA and stereopsis. The increase in DBCVA with LVA improves the stereopsis for distance though it may not be SS while improvement in NBCVA with LVA enhances stereopsis for near objects in SS manner.
Subretinal hyperreflective material morphology in neovascular age-related macular degeneration: A case control study
Authors: Alex Divya , Giridhar Anantharaman , Gopalakrishnan Mahesh , Indurkhya Swati , Madan Shivam
Published: June 2021

Purpose:

The aim of this study was to evaluate the association of morphological features of subretinal hyperreflective material (SHRM) with visual acuity (VA), geographic atrophy (GA) and scar formation in eyes with neovascular age-related macular degeneration (neovascular AMD) and to compare with controls of neovascular AMD without SHRM.

Methods:

Retrospective analysis of 157 wet AMD eyes with SHRM and 50 eyes without SHRM treated with Anti-VEGF. Baseline spectral domain-OCT characteristics (SHRM location, height, width, area, reflectivity, border definition) were collected and were correlated with VA at baseline, 3, 6, 12 months and looked for development of scar and geographical atrophy (GA) and were compared to the control group.

Results:

When compared to the control, baseline parameters with a significant predictive value of 12-VA were presence of SHRM, foveal involvement of SHRM, high reflective SHRM, well-defined SHRM borders and thick SHRM. VA was decreased with greater SHRM height, width and area (P < 0.001). Decreasing reflectivity of SHRM lesions and disappearance of SHRM correlated with better VA at 12 months (P < 0.05). At 12 months, scar and GA was present more often in eyes with persistent SHRM than in eyes with SHRM that resolved and those without SHRM in the control group.

Conclusion:

SHRM can be considered as a surrogate OCT biomarker in predicting final visual outcome in neovascular age-related macular degeneration. Baseline parameters predicting poorer vision at 12-follow-up were presence of SHRM involving the fovea, well-defined SHRM borders, greater SHRM height, width and area and persistence of SHRM with Anti-VEGF therapy.
Wound integrity of modified anterior stromal hydration Vs. conventional hydration after clear corneal incision phacoemulsification
Authors: Lohmror Isha , Sharma Pankaj , Kalia Sonal
Published: June 2021

Purpose:

To compare the self-sealing ability of temporal clear corneal incisions for phacoemulsification using conventional stromal hydration (CH) with two modified methods: the anterior stromal pocket hydration (ASPH) and the modified stromal pocket hydration (MASH).

Methods:

Patients undergoing routine phacoemulsification surgeries were randomized to receive the CH, ASPH, and MASH (n = 30 eyes in each group). In the ASPH, an anterior stromal pocket was created superficial and parallel while in the MASH; it was superficial and perpendicular to the plane of the main incision. The primary outcome measure was wound leakage assessed after applying firm downward pressure on the posterior lip of the main corneal incision, simulating eye rubbing.

Results:

On application of pressure to the posterior lip, leakage was seen from 19 eyes (63%) in the CH group, while this was seen in only two eyes (7%) each in the ASPH and MASH groups (P < 0.001). The likelihood of wound leak after applying pressure to the posterior lip reduced by 86% in the ASPH and MASH groups compared to CH (Odds ratio = 0.14, 95% CI = 0.05 – 0.35, P < 0.001). The mean surgically induced astigmatism was 0.18 ± 0.14D and there were no differences in SIA across the three groups (P = 0.42). More eyes in the ASPH required conversion to CH (n = 4, 13%) due to difficulty in localizing the pocket compared to MASH (n = 0, P = 0.03)

Conclusion:

Both, the ASPH and MASH techniques reduce the risk of wound leakage and do not induce astigmatism. The MASH technique makes it easier to consistently localize the pocket.