bluuebunny/crossref_metadata_2025 huggingface dataset:
A bird's eye view on Kantakari Avaleha
Authors: Bhinde Sagar Mahendrabhai , Bhinde Sonam Sagar , Kori Virendra K. , Patel Kalpna S.
Published: December 2022

Avaleha (linctus) is a unique dosage form of Ayurveda pharmaceutics, which is frequently used in various disorders and especially in respiratory disorders. Kantakari Avaleha (KA) is one such formulation being used extensively for Shwasa (asthma) and Kasa (cough) along with its classical use in various other disorders too. Because of its demand in clinical settings, many pharmaceutical companies are also preparing this, and hence freely available in market. This review was carried out to get thorough idea related to its composition, method of preparation, and therapeutic uses along with its pharmaceutical standards. For this review, classical and compiled texts having subject of Ayurveda pharmaceutics were screened from Central Library of Institute of Teaching and Research in Ayurveda, Jamnagar. Out of total 15 texts screened, 7 texts had mentioned KA, and hence reviewed for its ingredients, dose, Anupana, and therapeutic uses. Synonyms, Rasapanchaka (Ayurveda principles of drug action), and Dosha Karma (therapeutic action) of ingredients were compiled from Bhavaprakasha Nighantu. Pharmaceutical parameters of KA were compiled from original research articles from peer-reviewed journals through Google Scholar, PubMed, ResearchGate, and J-Gate portal. After review, it was found that Acharya Sharangdhara (12th Century) had described this formulation for the first time. There are four variations available in formulation composition. Milk or water should be the Anupana for this drug as per Ayurvedic Formulary of India and Pharmacopoeia of India (API). Almost all references have recommended its use in Shwasa and Kasa, along with Arati (distress), Shula (colicky pain), Gulma (a type of lump), Hikka (hiccup), and Hradroga (heart disease) mentioned in one and the other classics. Maximum ingredients of this formulation possess hot potency (12 out of 18 drugs) and pungent biotransformation property (11 out of 18 drugs). As per available original research works, two laboratory samples and one market sample of KA had fulfilled almost all analytical parameters, mentioned in API. The current review work may be helpful as stepping stone for various researches on KA such as network pharmacology, in silico, pharmacology, and longitudinal cross-sectional, clinical study.
The Absent Agent
Authors: Schreer Viola
Published: December 2022

In a time of unprecedented species loss, whose absence matters in international biodiversity conservation? Who or what is made absent in this process, and how? Drawing on scholarship that focuses on the agency of absence, this article explores how the orangutan (Pongo spp.)—a popular conservation flagship species—becomes present in Bornean villagers' lives. It offers a new understanding of flagship species action by examining the complex, often unseen relational dynamics through which orangutans influence community-conservation encounters. As the study shows, conservationists' efforts to mitigate the absence of species through a combination of imaginative, discursive, and material variables inadvertently 'absences' Bornean villagers and their concerns. Reflecting on this process of absencing, the paper moreover discusses how notions of absence inform contemporary conservation thought and action.
Fluoroquinolone resistance in bacterial isolates from ocular infections: Trend in antibiotic susceptibility patterns between 2005-2020
Authors: Chatterjee Samrat , Agrawal Deepshikha , Gomase Sharad N , Parchand Swapnil M , Gangwe Anil B , Mishra Mihir
Published: December 2022

Purpose:

To assess the fluoroquinolone resistance pattern and trends among bacterial isolates from ocular infections over a 16-year period and explore alternative antibiotics in fluoroquinolone-resistant strains.

Methods:

In this retrospective, longitudinal study, the microbiology laboratory records of patients with different ocular infections diagnosed at an eye institute in central India from 2005–2020 were reviewed to determine the pattern of fluoroquinolone (ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin) resistance. Antibiotic susceptibility testing was done using the Kirby–Bauer disc diffusion method.

Results:

In 725 Gram-positive bacteria, the resistance of ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin was 55.9% (95% confidence interval [CI]: 52.2 – 59.6), 42.7% (95% CI: 39.0 – 46.4), 47.6% (95% CI: 43.9 – 51.3), and 45.6% (95% CI: 41.7–49.5), respectively. In 266 Gram-negative bacteria, the resistance of ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin was 57.9% (95% CI: 51.9 – 63.9), 56.0% (95% CI: 49.7 – 62.1), 59.9% (95% CI: 53.8 – 66.0), and 74.3% (95% CI: 68.3 – 80.2), respectively. A declining trend in resistance to ciprofloxacin (P < 0.001), ofloxacin (P < 0.001), and moxifloxacin (P < 0.001) was seen in Gram-positive bacteria, whereas a reduction in resistance to only moxifloxacin (P = 0.04) was seen in Gram-negative bacteria. In fluoroquinolone-resistant Gram-positive bacteria, cefuroxime exhibited the highest susceptibility, whereas in fluoroquinolone-resistant Gram-negative bacteria, colistin exhibited the highest susceptibility.

Conclusion:

Fluoroquinolone resistance was high among bacteria from ocular infections in central India, but a declining trend in resistance to some of the fluoroquinolones was observed in recent times. Cefuroxime and colistin emerged as alternatives in fluoroquinolone-resistant Gram-positive and Gram-negative bacterial infections, respectively.
Efficacy of dorzolamide in improving ocular blood flow in patients with open-angle glaucoma: The Indian carbonic anhydrase inhibitor trial
Authors: Nivean Pratheeba D , Ariga Murali , Chithra M R , Gohil Pooja , Das Sandhya , Jaideep Gogtay
Published: December 2022

Purpose:

Impaired ocular blood flow is an important risk factor in the pathogenesis of open-angle glaucoma (OAG). Studies have reported that dorzolamide 2% may be effective in improving ocular blood flow (OBF) in OAG patients. The objective of this study was to determine the efficacy of dorzolamide 2% (DORZOX, Cipla Ltd.) in improving retrobulbar blood flow in an Indian setting.

Methods:

The study was conducted as an interventional pilot project in 24 healthy subjects and 19 OAG patients. Baseline OBF measurements were done for all glaucoma patients with color Doppler imaging (CDI). Baseline ocular perfusion pressure (OPP) was calculated for all participants. Glaucoma patients were given dorzolamide 2% thrice daily for 12 weeks. The primary efficacy endpoints were mean changes in the CDI parameters of the retrobulbar vessels and OPP posttreatment. The secondary endpoint was mean change in the intraocular pressure (IOP) and adverse events, if any.

Results:

In comparison to healthy subjects, glaucoma patients displayed significantly reduced baseline OPP (P = 0.002). Treatment with dorzolamide 2% for 12 weeks led to a significant increase in OPP (P < 0.001) and a significant increase in end diastolic velocity (EDV) in all major ophthalmic arteries like ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary artery (SPCA) (P < 0.001, P = 0.04, and P = 0.0075, respectively). A significant reduction in the intraocular pressure (IOP; P = 0.007) was observed posttreatment, with no adverse events reported.

Conclusion:

Dorzolamide 2% significantly improved parameters such as the EDV and OPP in major ophthalmic arteries. This pilot study shows promising results on using dorzolamide for treating Indian patients with OAG.
Outcomes of bleb needling in primary glaucoma: A prospective interventional study in a South Indian population
Authors: Das Nikita , Manju M , Chandran Premanand , Dhavalikar Mrunali , Sivakumar Padmavathi , Vimalanathan Menaka , Venkataraman Ganesh
Published: December 2022

Purpose:

This study was conducted to assess the outcomes of bleb needling for the treatment of failure of filtration surgeries in primary glaucoma with a follow-up of six months.

Methods:

This prospective interventional study included patients with primary glaucoma who underwent trabeculectomy or combined glaucoma and cataract surgery with failed or failing bleb after six weeks of surgery and less than two years. A comprehensive examination including best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, gonioscopy, slit-lamp examination, and bleb morphology grading was done. Selected patients underwent a subconjunctival bleb needling with mitomycin C (MMC) (dose 0.2 mg/ml). Postoperatively, patients were followed up on the first, third, and sixth months and were assessed with respect to IOP, need for antiglaucoma medication (AGM), and complications.

Results:

Sixty eyes of 59 patients were included. Preoperatively, 33.3% of patients were on one AGM, whereas postoperatively at the third month 51.7% and at the sixth month 50% of patients were on no AGM. There was a statistically significant decrease in IOP (P < 0.001) from preoperative (mean: 23.8 ± 7.86 mmHg) to postoperative first month (mean: 19.8 ± 9.08 mmHg), third month (mean: 17.4 ± 5.4 mmHg) and sixth month (mean 16.6 ± 4.39). According to the defined criteria in the current study, we achieved 22 (37.9%) successes, 31 qualified successes (53.4%), and 5 (8.6%) failures. Univariate regression analysis showed a higher failure rate among younger age groups. Gender, laterality, and intraoperative complications were not significant statistically.

Conclusion:

Bleb needling is a safe and effective procedure for the treatment of failed filtration surgeries.
Recommended protocol and technique for doing oral fundus fluorescein angiography for adults and children
Authors: Mohan Sashwanthi , Raman Rajiv
Published: December 2022

Fundus fluorescein angiography (FFA) is usually performed intravenously through injection of sodium fluorescein dye. This procedure is difficult to perform in children and patients who are afraid of intravenous needles. Oral FFA can serve as a useful alternative to intravenous FFA in many cases and gives reliable results. We describe the recommended protocol and technique for doing oral FFA in adults and children.
Intraoperative aberrometry versus preoperative biometry for intraocular lens power selection in patients with axial hyperopia
Authors: Bansal Muskaan , Thakur Anchal , Gupta Gaurav , Jurangal Ajay , Khanna Rahul , Malhotra Chintan , Gupta Amit , Jain Arun Kumar
Published: December 2022

Purpose:

This study was conducted to evaluate the accuracy of intraoperative aberrometry (IA) in intraocular lens (IOL) power calculation and compare it with conventional IOL formulas.

Methods:

This was a prospective case series. Eyes with visually significant cataract and axial hyperopia (AL <22.0 mm) underwent IA-assisted phacoemulsification with posterior chamber IOL (Alcon AcrySof IQ). Postoperative spherical equivalent (SE) was compared with predicted SE to calculate the outcomes with different formulas (SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal II and Hill-RBF). Accuracy of intraoperative aberrometer was compared with other formulas in terms of mean absolute prediction error (MAE), percentage of patients within 0.5 D and 1 D of their target, and percentage of patients going into hyperopic shift.

Results:

Sixty-five eyes (57 patients) were included. In terms of MAE, both Hoffer Q (MAE = 0.30) and IA (MAE = 0.32) were significantly better than Haigis, SRK/T, and Barrett Universal II (P < 0.05). Outcomes within ±0.5 D of the target were maximum with Hoffer Q (80%), superior to IA (Hoffer Q > IA > Holladay 2 > Hill-RBF > Haigis > SRK/T > Barrett Universal II). Hoffer Q resulted in minimum hyperopic shift (30.76%) followed by Hill-RBF (38.46%), Holladay 2 (38.46%), Haigis (43.07%), and then IA (46.15%), SRK/T (50.76%) and Barrett Universal II (53.84%).

Conclusion:

IA was more effective (statistically significant) in predicting IOL power than Haigis, SRK/T, and Barrett Universal II although it was equivalent to Hoffer Q. Hoffer Q was superior to all formulas in terms of percentage of patients within 0.5 D of their target refractions and percentage of patients going into hyperopic shift.
Central retinal vein occlusion as primary ocular manifestation of rhino-orbital-cerebral mucormycosis: A case report
Authors: Sethi Neha K , Chadha Charu , Bajaj Manpreet , Moond Harshita
Published: December 2022

Mucormycosis is a serious, rapidly progressing, life-threatening, and sight threatening fungal infection frequently seen in diabetics and immunocompromised patients. We report a rare occurrence of rhino-orbital mucormycosis presenting as unilateral central retinal vein occlusion (CRVO) and no other ocular signs of infection in a 65-year-old diabetic male. The definitive diagnosis was made by nasal biopsy which confirmed broad branching aseptate fungal hyphae. The patient was treated with amphotericin B for mucormycosis and intravitreal anti-vascular growth factor (anti-VEGF) drug for macular edema. To conclude, although ophthalmoplegia is the most common ocular presentation and retinal artery occlusion is the most common cause of visual loss in mucormycosis, it may have many varied presentations including CRVO. A high index of suspicion must be kept in diabetics and immunocompromised patients.
Pathogenesis of Terson syndrome
Authors: Hayreh Sohan S
Published: December 2022

Purpose:

The aim of this experimental study was to investigate the pathogenesis of Terson syndrome (TS), which currently is controversial.

Methods:

The central retinal artery (in 39 orbits), posterior ciliary arteries (in 8 orbits), and central retinal vein (CRV in 21 orbits) were occluded in rhesus monkeys by exposing them to lateral orbitotomy. Fundus examination and fluorescein fundus angiography were performed before and immediately after cutting the vessels and serially thereafter during the follow-up period. The rationale of the experimental study design is discussed.

Results:

In eyes with central retinal artery occlusion, retinal hemorrhages were seen soon after the procedure in 7 eyes, and on follow-up in a total of 15 eyes. In posterior ciliary artery occlusion, retinal hemorrhages were seen soon after the procedure in one eye, and on follow-up in a total of three eyes. In eyes with CRV, all eyes had extensive scattered retinal hemorrhages.

Conclusion:

The findings of this experimental study, and my basic, experimental, and comprehensive clinical studies on CRVO, suggest the following concept of the pathogenesis of TS: Compression of the CRV plays a crucial role in the development of TS. The CRV is compressed, as it lies in the subarachnoid space of the optic nerve sheath, by raised cerebrospinal fluid pressure and/or accumulated blood. This results in retinal venous stasis and raised venous pressure in the retinal veins, leading to venous engorgement, rupture of the retinal capillaries and retinal hemorrhages. The clinical importance of compression of the CRV and not occlusion of CRV in TS is that optic nerve sheath decompression by opening it and releasing the blood and raised cerebrospinal fluid (CSF) pressure, would result in immediate decompressing of the CRV in the subarachnoid space and restoration of normal circulation and prevent visual loss.
Antibiotic susceptibility pattern of bacterial isolates from microbial keratitis in North and Central India: A multi centric study
Authors: Khurana Ashi , Chatterjee Samrat , Gandhi Arpan , Borde Prashant , Chanda Sanjay , Gomase Sharad Nivrutti , Aggarwal Manvi , Parmar Gautam Singh , Majumdar Atanu , Podder Priyanka
Published: December 2022

Purpose:

This study was conducted to examine microbiological profile with their antibiotic sensitivity in cases of bacterial keratitis in north and central India to ensure appropriate use of antibiotics.

Methods:

The microbiology laboratory records of 228 patients with culture-proven bacterial keratitis from 1st January to 31st December 2019 were analyzed. Cultured bacterial isolates were subjected to antimicrobial susceptibility testing to antibiotics commonly used in the treatment of corneal ulcer. Chi-squared or Fisher’s exact test were applied to check the significance of difference between the susceptibility levels of antibiotics.

Results:

The prevalence of Staphylococcus aureus and Pseudomonas aeruginosa–induced keratitis was higher in northern India, whereas that by Streptococcus pneumoniae was more prevalent in central India. In central India, 100% of S. pneumoniae isolates were found to be sensitive to ceftriaxone compared to 79% in northern India (P = 0.017). In comparison to 67% of isolates from north India, 15% of S. aureus isolates from central India were found to be sensitive to ofloxacin (P = 0.009). Similarly, 23% of isolates from central India were found sensitive to amikacin compared to 65% of isolates from north India (P = 0.012). P. aeruginosa isolates from central India were found to be sensitive to ceftazidime in 63% of cases compared to 21% of isolates from north India (P = 0.034).

Conclusion:

Prevalence of bacteria and their susceptibility to antibiotics are not uniform across geography. Vancomycin remained the most effective drug in all gram-positive coccal infections. S. aureus susceptibility to amikacin was significantly greater in north India. P. aeruginosa showed less susceptibility as compared to previous reports.
Topical interferon therapy in uveitic macular edema
Authors: Kawali Ankush , Sanjay Srinivasan , Mohan Ashwin , Mahendradas Padmamalini , Shetty Rohit
Published: December 2022

Purpose:

To evaluate efficacy of topical interferon alfa-2b (IFN) in the treatment of uveitic macular edema (UME).

Methods:

This is a prospective, interventional case study of patients with UME. Injection IFN was reconstituted into eye drops and a four times/day (QID) application was prescribed. Central macular thickness (CMT) on optical coherence tomography (OCT) scan was evaluated. Improvement in CMT by ≥50 mm from the baseline was studied in eyes with presenting CMT ≥400 mm.

Results:

Twenty eyes of 20 patients with UME were studied: anterior uveitis (n = 3), anterior + intermediate uveitis (n = 5), posterior uveitis (n = 3), retinal vasculitis (n = 3), and panuveitis (n = 6). Mean CMT at the presentation was 423.3 mm (range: 270–604 mm), which improved at 1 month (n = 16), 2 months (n = 10), and ≥3 months (n = 11) follow-up, to 415.3 mm (range: 247–579 mm) (P = 0.411), 364.4 mm (range: 258–566 mm) (P = 0.099), 344 mm (range: 258–484 mm) (P = 0.001), respectively. Twelve eyes of 12 patients had presenting CMT ≥400 mm. In these cases, decrease in CMT by ≥50 mm was seen in 4/10, 4/5, and 5/6 eyes at 1 and 2 months and ≥3 months follow-up. Mean follow-up was 4 months (range: 1–17 months). Complete resolution of UME was seen only in three eyes. No ocular or systemic side effects were observed.

Conclusion:

Topical IFN therapy in QID doses is safe but may have limited role in UME. Long-term therapy may improve its efficacy. Larger studies with dose modification, combination with other drugs, and with homogeneous uveitis population are recommended.
Red flags and artifacts in perimetry
Authors: Mansoori Tarannum
Published: December 2022

Background:

As perimetry is a psychophysical test, the thresholds obtained are not only dependent on the functional architecture of the visual system but also on a variety of physical and cognitive factors. Factors such as, Lens rim artifact, improper refraction, miosed pupil and blepharoptosis, can affect luminance thresholds. Additionally, cognitive factors such as patient’s attention, motivation, fatigue, and response bias can influence the obtained thresholds.

Purpose:

The video describes identification of various artifacts in Humphrey visual field printout and it has some useful teaching points to recognize and learn.

Synopsis:

Visual field test is critical for assessment and to document progression of glaucoma, but is prone to errors and artifacts. Fortunately, the patterns of such artifactual field loss are often characteristic and easily recognizable.

Highlights:

Several types of errors can lead to inaccurate results. Proper instructions and patient supervision during the test helps to improve the test results. The technician should ensure correct patient’s data entry. Careful examination of the obtained data on the printout is essential to detect any errors that can lead to misinterpretation of visual field, false alarms, and wrong clinical conclusion.

Video link:

https://youtu.be/OWdFk4pWJkM

Key word: Artifacts, perimetrist, perimetry
Quality of life in glaucoma patients: Comparison of medical therapy, trabeculectomy, and glaucoma drainage device surgery
Authors: Muralidharan Shruti , Kumar Suresh , Ichhpujani Parul , Dhillon Hennaav Kaur
Published: December 2022

Purpose:

To compare the quality of life (QoL) in patients with glaucoma on medical therapy and after trabeculectomy and glaucoma drainage device (GDD) using vision, glaucoma, and surgery-specific questionnaires.

Methods:

This cross-sectional study enrolled 30 patients of moderate to severe glaucoma, each in medical, trabeculectomy, and GDD groups. National Eye Institute Visual Function Questionnaire 25 (NEIVFQ-25), Glaucoma Quality of Life (GQL-15), and Surgery Specific Questionnaire (SSQ) were administered, and cumulative scores were compared.

Results:

The mean age of the participants was 58.95 ± 13.6 years with a male preponderance (73.3%, n = 66). The mean scores (SD) in the medical, trabeculectomy, and GDD groups using NEIVFQ-25 were 68.97 (6.98), 72.83 (7.81), and 75.20 (8.77), respectively, those using GQL-15 were 20.63 (6.00), 26.23 (9.12), and 28.43 (7.74), respectively, and for the SSQ, they were 74.33 (8.75) and 72.10 (5.92) in trabeculectomy and GDD groups, respectively. NEIVFQ-25 showed a better QoL in the GDD group compared to the medical group, whereas GQL-15 showed a better QoL in the medical group and comparable QoL in trabeculectomy and GDD. Both these QoL scores correlated to the LogMAR visual acuity. SSQ scores did not show a significant difference in the QoL across both surgical groups.

Conclusion:

NEIVFQ-25 questionnaire scores provided a holistic measure of QoL. GQL-15 assessed the activity limitation and visual disability of the patients but did not take into account the general health and psychological factors influencing the QoL. We did not find a significant difference between trabeculectomy and GDD using the SSQ. For QoL assessment in medically or surgically treated glaucoma, vision-specific and disease-specific questionnaires should always be used in conjunction.
Retinal nerve fiber layer and ganglion cell complex thickness analysis in patients having relative afferent pupillary defect
Authors: Mishra Aradhna , Ashraf Mohammad , Zaka-ur-Rab Simi , Khan Nida
Published: December 2022

Purpose:

To determine the retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) thickness in patients having relative afferent pupillary defect (RAPD) measured by optical coherence tomography (OCT).

Methods:

This cross-sectional study was conducted on 30 patients with posterior segment disease and glaucoma presenting with RAPD. The control group comprised 30 patients with the aforementioned diseases without RAPD. RAPD was graded using neutral density filters placed over the unaffected eye. Peripapillary RNFL thickness and macular GCC were measured using the Cirrus HD-OCT machine.

Results:

There were 45 males and 15 females. There was a statistically significant (P < 0.05) difference in the mean of average RNFL thickness in patients having RAPD (64.73 ± 15.16 mm in the affected eyes) as compared to sick control (82.73 ± 11.33 mm in the affected eyes). It was further observed that there was a decrease in RNFL thickness with advancing grades of RAPD. There was a statistically significant (P < 0.05) difference in the mean of average GCC thickness in patients having RAPD (51.57 ± 14.96 mm in the affected eyes) as compared to sick control (76.36 ± 8.06 mm in the affected eyes).

Conclusion:

Our study suggests that there is a significant reduction in RNFL thickness and GCC thickness in RAPD patients as compared to the sick control group.
Increase in anterior chamber angle depth after topical pilocarpine measured by spectral domain optical coherence tomography: A possible additional indicator for laser peripheral iridotomy in primary angle-closure suspects in an opportunistic set-up
Authors: Mukhopadhyay Debdas , Patel Khevna , Huda Sadaf
Published: December 2022

Purpose:

Indication of laser peripheral iridotomy (LPI) is often conjectural due to dependency on gonioscopy and strict dichotomous classification of occludability. Indentation gonioscopy is the gold standard but is under-utilized for various reasons. The prevalence of primary angle closure disease (PACD) in eastern India is 1.5–1.9%, with a 22% five-year progression rate. Many angle closure patients may go blind without timely diagnosis and iridotomy. General ophthalmologists need alternate, validated methods for diagnoses. Pilocarpine eye drop causes miosis, and flattens the iris, producing angle changes detectable by spectral domain optical coherence tomography (SD-OCT). We hypothesized that the amount of angle change may be a suitable indicator for iridotomy.

Methods:

Our prospective cross-sectional single-masked observational study evaluated pilocarpine-induced changes in angle parameters detected by SD-OCT. Out of 372 patients enrolled, 273 patients (539 eyes) remained, with a mean age of 48.6 years (SD = 10.36). All eyes were graded by the Van Herick (VH) method, gonioscopy, and anterior segment (AS) SD-OCT and reassessed after pilocarpine drops.

Results:

The sensitivity and specificity of tomography measurements against gonioscopy grades were 61% and 85%, respectively. The receiver operating characteristic (ROC) curve was 0.85. Pilocarpine-induced angle widening was significant in gonioscopically narrower angles. Low Van Herick grades (217 eyes), narrow gonioscopy grades (238 eyes), and a narrow OCT angle value (165 eyes) were candidates for iridotomy.

Conclusion:

Our study results showed that pilocarpine-induced angle widening detected by SD-OCT could be a strong objective indicator for LPI.
Demographic profile of patients seeking teleophthalmology consultations through e-Sanjeevani: Retrospective analysis of 5138 patients from North India
Authors: Markan Ashish , Kishore Alisha , Agarwal Amit , Akella Madhuri , Singh Aruna , Goyal Sonu , Roy Manaswita , Singh Manvi , Singh Meenu
Published: December 2022

Purpose:

To report the demographic profile of patients registered through e-Sanjeevani OPD seeking teleophthalmology services.

Methods:

This was a cross-sectional data analysis of patients with ocular complaints registered through the e-Sanjeevani platform at a tertiary care center. It was a doctor-to-doctor consultation, where teleophthalmology consultants provided teleconsultation services at subcenters (SCs), primary health centers (PHCs), and community health centers (CHCs). Data regarding the patient’s age, gender, residential address, provisional diagnosis, and treatment prescribed were recorded from May 2021 to February 2022 (9 months).

Results:

In total, 5138 patients were teleconsulted from the mean age of the patients was 37.64 ± 19.34 years. Among these patients, 44% were males and 56% were females. Most of the teleconsultation calls were made from Palwal district (19.8%), followed by Hisar (14.5%) and Sonipat. The most common provisional diagnosis was dry eyes (21%), followed by allergic conjunctivitis (18%), refractive error (15%), and cataract (14%). These constituted approximately 70% of the diagnosis made through teleconsultations. The rest of the eye problems were diagnosed as stye, blepharitis, nasolacrimal duct obstruction, pterygium, subconjunctival hemorrhage, etc., The majority of the patients were managed medically (56.6%) and approximately 11.6% of the patients were referred for surgical intervention.

Conclusion:

e-Sanjeevani is an effective way to provide teleconsultations to patients in remote locations. The majority of the patients seeking ophthalmology consultations can be managed conservatively. Patients requiring surgical intervention can be referred timely, thus avoiding any delay in treatment.
Cerebral visual impairment in children: Multicentric study determining the causes, associated neurological and ocular findings, and risk factors for severe vision impairment
Authors: Mohapatra Monalisa , Rath Soveeta , Agarwal Pradeep , Singh Abhishek , Singh Rupali , Sutar Sameer , Sahu Anupam , Maan Veenu , Ganesh Suma
Published: December 2022

Purpose:

To evaluate the causes, associated neurological and ocular findings in children with cerebral visual impairment (CVI), and to identify risk factors for severe vision impairment.

Methods:

A multicenter, retrospective, cross-sectional analysis was carried out from January 2017 to December 2019 on patients less than 16 years of age with a diagnosis of CVI.

Results:

A total of 405 patients were included of which 61.2% were male and 38.8% were female. The median age at presentation was 4 years (range 3 months to 16 years). Antenatal risk factors were present in 14% of the cases. The most common cause of CVI was hypoxic-ischemic encephalopathy (35.1%), followed by seizure associated with brain damage (31.3%). The most common neurological finding was seizure (50.4%), followed by cerebral palsy (13.6%). Associated ophthalmological findings were significant refractive error (63.2%), esotropia (22.2%), exotropia, (38%), nystagmus (33.3%), and optic nerve atrophy (25.9%). Severe visual impairment (<20/200) was associated with optic atrophy (odds ratio: 2.9, 95% confidence interval: 1.4–6.0; P = 0.003) and seizure disorder (odds ratio: 1.9, 95% confidence interval: 1.2–3.3; P = 0.012).

Conclusion:

The various ophthalmic, neurological manifestations and etiologies could guide the multidisciplinary team treating the child with CVI in understanding the visual impairment that affects the neuro development of the child and in planning rehabilitation strategies.
Efficacy and safety of ultrasound cycloplasty in Indian eyes with open-angle glaucoma
Authors: Paul Chandrima , Divya J , Sengupta Subhrangshu , Kamal Richa , Paul Anujeet , Mitra Ishani
Published: December 2022

Purpose:

To evaluate the safety and efficacy of ultrasound cycloplasty in eyes with primary or secondary open-angle glaucoma, not amenable to adequate control of intra-ocular pressure (IOP) with medical treatment.

Methods:

Prospective interventional cohort study of 28 eyes of 28 subjects in a tertiary eye care centre in India in patients with open-angle glaucoma. All enrolled eyes underwent ultrasound cycloplasty with the second-generation probe with six shots of 8 s each, operated by a single surgeon between November 2018 and January 2020. They were followed up for a period of 12 months. The primary treatment outcome was IOP and the secondary outcomes were vision and postoperative complications.

Results:

A total of 28 eyes of 28 patients were studied, and the mean age was 63.82 ± 6.46 years. Primary open-angle glaucoma (75%) was the most common etiology. There was significant reduction in IOP from the baseline (24.93 ± 4.27 mmHg) to the postoperative value (15.82 ± 3.14 mmHg) at the end of 12 months (P < 0.00001). Mean reduction in IOP was 9.14 ± 4.09 mmHg at 12 months (36.66%). Number of ocular hypotensives reduced significantly from baseline (3.32 ± 0.47) to 12-month postoperative follow-up (0.68 ± 0.74) (P < 0.00001). Qualified success was achieved in 89.28% eyes. No major complications were noted.

Conclusion:

Ultrasound cycloplasty is found to be effective and safe in eyes with open-angle glaucoma because of the primary or secondary etiology, being more effective in the former.
Comparative evaluation of outcomes of novel approach of subconjunctival Mitomycin C (MMC) injection at the end of trabeculectomy versus intraTenon injection of MMC prior to the initial conjunctival incision – A pilot study
Authors: Gupta Ved Prakash , Beri Nitika , Rohatgi Jolly
Published: December 2022

Purpose:

To describe a novel approach of subconjunctival injection of mitomycin C (MMC) at the end of trabeculectomy and compare it with intraTenon MMC injection.

Methods:

This pilot study included 40 eyes of 40 patients with uncontrolled primary and secondary glaucoma. Patients below18 years and failed trabeculectomy were excluded. Patients were randomly allocated into groups A and B (20 patients each). Group A patients received subconjunctival MMC injection in the superonasal quadrant at the end of standard trabeculectomy. Group B received an intraTenon MMC injection before the initial conjunctival incision. Outcome measures included intra-ocular pressure (IOP) reduction, bleb morphology, and complication rates. The complete success was defined as an IOP of ≤21 mmHg without antiglaucoma drugs.

Results:

The mean preoperative IOP of 46.00 ± 11.2 mmHg in group A and 43.05 ± 10.3 mmHg in group B reduced to 12.00 ± 2.41 mmHg (P ≤ 0.001) in group A and 13.65 ± 2.76 mmHg in group B (P ≤ 0.001) at last follow-up. Complete success was 95% and 75% in groups A and B, respectively, 19 months after surgery. Avascular microcystic blebs (70% of group A and 45% of group B) were more common than avascular white blebs (15% in group A and 35% in group B). No intraoperative complications were seen. Postoperative wound leak, hypotony, choroidal detachment, or endophthalmitis were not encountered in any group.

Conclusion:

A novel approach of subconjunctival MMC application during trabeculectomy is reported. Both approaches appear to be highly effective in reducing IOP in primary and secondary glaucoma with similar safety profiles and bleb morphology. Subconjunctival MMC yielded a greater success rate (95%) compared to the intraTenon MMC group (75%).
Combining Metabolic Surgery with Medications for Type 2 Diabetes
Authors: Sudlow Alexis , Pournaras Dimitri J. , Roux Carel W. Le
Published: December 2022

Bariatric surgery has been consistently demonstrated in randomized controlled trials to be the most effective treatment currently available for patients with Type 2 diabetes mellitus (T2DM) and obesity. In spite of this, with the emergence of longer-term data, it is now becoming apparent that some of the metabolic benefits afforded by bariatric surgery fatigue with time, prompting clinicians to re-consider how patients should be managed in the postoperative period. As is seen with many other chronic diseases including peripheral vascular disease as well as some cancers, surgery is seen as a means of inducing disease control with medications being employed to maintain sustained remission. In recent years, there have been remarkable advances in pharmacotherapy for the treatment of T2DM as well as additional agents which can produce clinically significant weight loss. Having recognized the potential need for further treatment following bariatric surgery along with the availability of highly effective medical therapies presents the opportunity to explore a multimodal approach to care, combining medications with surgery to potentially improve long-term outcomes.
Behavioral therapy and pharmacotherapy: A case report on right approach for tobacco cessation
Authors: Agarwal Avnica , Das Mayank , Jaiswal Panna Lal , Kashyap Panchali
Published: December 2022

Tobacco is one of the leading causes of various types of cancer, and more than five million people die globally from its ill-effects every year. It is reported that by the year 2040, tobacco-related deaths will exceed ten million annually. Smoking cessation programs are considered very useful in helping tobacco users to quit, but it is a very difficult addiction to break; thus effective approaches are required. The authors present a case of an 84-year-old male patient who was a chronic smoker and used to smoke 35–40 bidis per day. He started to notice the physical addiction and withdrawal symptoms due to which he was not able to quit tobacco on his own. After expert counselling, his habit of smoking gradually decreased and after a few months, he was able to quit tobacco completely with the help of behavioral modification and pharmacotherapy.
Peripheral Blood Mononuclear Cell Cytokine mRNA Profiles in Acute Respiratory Infection Patients
Authors: Plotnikova Marina Alexandrovna , Klotchenko Sergey A. , Lozhkov Alexey A. , Lebedev Kirill I. , Taraskin Alexander S. , Baranovskaya Irina L. , Egorova Maria A. , Ramsay Edward S. , Chebotkevich Vitaly N. , Vasin Andrey V.
Published: December 2022

Introduction:

Respiratory infections, collectively, are one of the World's most common and serious illness groups. As recent observations have shown, the most severe courses of acute respiratory infection, often leading to death, are due to uncontrolled cytokine production (hypercytokinemia).

Methods:

The study involved 364 patients with respiratory illness being treated in clinics in St. Petersburg (Russia) in 2018–2019 and 30 healthy controls. Cytokine analysis was carried out in the acute phase of illness (2–3 days from onset of initial symptoms) and in the stage of recovery (days 9–10). The research presented is devoted to the assessment of mRNA expression of specific cytokines (interleukin [IL]-1b, IL-2, IL-4, IL-6, IL-8, IL-10, IL-18, tumor necrosis factor-α [TNF-α], and interferon-λ) and MxA in whole blood leukocytes, by means of real-time polymerase chain reaction.

Results:

In 70% of patients, bacterial or viral pathogens were identified, with influenza viral infections (types A and B) prevailing. Significant increases in the expression of IL-18, TNF, and IL-10 were observed, relative to controls, only with influenza viral infections. We have shown a difference in IL-6 mRNA expression in patients with bacterial or viral pathogens. No statistically significant difference was found in white blood cells IL-4 expression levels between patients and healthy controls.

Conclusion:

Investigation of the nuances of systemic cytokine production, in response to specific viral and bacterial pathogens, makes it possible to assess the risks of developing hypercytokinemia during respiratory infection with agents circulating in the human population and to predict the pathogenicity and virulence of circulating threats.
Robotic-assisted excision of splenic epidermoid cyst in an adolescent patient in a new robotic platform: A case report
Authors: Khanna Subhash , Barua Areendam , Haloi Dhanjit
Published: December 2022

Laparoscopic management of non-parasitic cysts (NSCs) of the spleen is currently the standard of care. There is a paucity of data of robotic management of NSCs. Here, we report a case of a NSC in a 13-year-old male. The patient presented to us with the chief complaints of pain in abdomen and feeling of a left upper abdomen lump for the last 3 months. The spleen being an important organ for immunity, we decided to opt for splenic preservation. Since minimal access methods offer the best outcome and we wanted to go with a safe option, we settled for near-total cystectomy of the splenic cyst. Here, we review the literature regarding the surgical management of NSCs and discuss the robotic technique for the accomplishment of the surgery.
An association between copy number variation of enhancer involved in craniofacial development and biogeographic ancestry
Authors: Linkowska Katarzyna , Malyarchuk Boris A. , Derenko Miroslava V. , Grzybowski Tomasz
Published: December 2022

Human facial morphology is a combination of many complex traits and is determined by a large number of genes and enhancers. Here, we report a Copy Number Variation (CNV) study of enhancer hs1431 in populations of Central European and South Siberian ancestry. Central European samples included 97 Poles, while South Siberian samples included 78 Buryats and 27 Tuvinians. CNVs were detected by real-time PCR, using ViiA™ 7 Real-Time PCR System (Applied Biosystems). We revealed significant differences in CNV of hs1431 enhancer between Polish and Buryat population (p=0.0378), but not between Central European and South Siberian population (p=0.1225). Our results suggest that an increase in copy number variation of hs1431 enhancer is associated with biogeographic ancestry. However, this result needs extending and replicating in larger cohorts. This is the first study revealing the presence of copy number variation of enhancer hs1431 in humans.
Sudden death during methadone replacement therapy – case report and literature review
Authors: Skowronek Rafał , Krzystanek Marek
Published: December 2022

Metadon to pochodna difenylopropylaminy, wiążąca się z receptorami opioidowymi, która znalazła zastosowanie w programach leczenia zespołu abstynencji u osób uzależnionych od opioidów oraz w programach substytucyjnych. Celem pracy jest opis przypadku nagłego zgonu osadzonego w trakcie terapii substytucyjnej metadonem z praktyki opiniodawczej autorów oraz przegląd literatury. 41-letni mężczyzna obciążony wieloletnim wywiadem nadużywania substancji psychoaktywnych, zwłaszcza heroiny, odbywający karę pozbawienia wolności, po konsultacji w poradni leczenia uzależnień rozpoczął terapię zastępczą metadonem. W kolejnych dniach przyjął dwie dawki leku (po 50 mg). W nocy podczas obchodu stwierdzono zgon osadzonego. Badania toksykologiczne krwi wykazały obecność metadonu w stężeniu terapeutycznym 816 ng/ml. Obecnie uważa się, że nawet terapeutyczne stężenie metadonu zwiększa ryzyko nagłej śmierci sercowej, zwłaszcza u osób predysponowanych (np. obciążonych patologią strukturalną mięśnia sercowego, zaburzeniami rytmu pracy serca, z hipokaliemią, niewydolnością wątroby).

Sudden death during methadone replacement therapy – case report and literature review

Methadone is a diphenylpropylamine derivative that binds to opioid receptors and has been used in drug abstinence and substitution treatment programs. The aim of the study is to describe a case of sudden death of a prisoner during methadone substitution therapy from the authors’ medico-legal consulting practice and to review the literature. A 41-year-old male with a long history of abuse of psychoactive substances, especially heroin, serving a prison sentence, after consultation in the addiction treatment clinic, started methadone substitution therapy. In the following days he took two doses of the drug (50 mg each). The prisoner was pronounced dead during the night. Blood toxicology tests showed the presence of methadone at the therapeutic concentration of 816 ng/ml. Currently, it is believed that even the therapeutic concentration of methadone increases the risk of sudden cardiac death, especially in predisposed patients (e.g. with structural pathologies of the myocardium, cardiac arrhythmias, hypokalemia, and liver failure).
Notes on the decidability of addition and the Frobenius map for polynomials and rational functions
Authors: Chompitaki Dimitra , Kamarianakis Manos , Pheidas Thanases
Published: December 2022

Let pbe a prime number, Fp a finite field with pelements, Fan algebraic extension of Fp and z a variable. We consider the structure of addition and the Frobenius map (i.e., x →xp) in the polynomial rings F[z] and in fields F(z) of rational functions. We prove that any question about F[z] in the structure of addition and Frobenius map may be effectively reduced to questions about the similar structure of the field F. Furthermore, we provide an example which shows that a fact which is true for addition and the Frobenius map in the polynomial rings F[z] fails to be true in F(z). As a consequence, certain methods used to prove model completeness for polynomials do not suffice to prove model completeness for similar structures for fields of rational functions F(z), a problem that remains open even for F= Fp.
Appleiness of the Apple or the Dualism in Deleuzian Sensation
Authors: Lipiński Kamil
Published: December 2022

This article addresses the figural dimension of Gilles Deleuze’s thought in terms of the twofold relation of forces aligned with the dualism of figures emerging in the visual image. The drive towards the differentiation of haptic figures provides an insight into the anti-representative approach to figurative clichéof painting to reveal the crucial tropes of figural presence and the profound understanding of Deleuzian decentration by addressing the inner context of his writings and external writings commenting on his thought. In this essay, I review Deleuze’s argument, his use and critique of Riegl, the central place of what he calls hapticity in this vision, and consider his attempt to illustrate what this “sensation”might be.
Toksyczne przedmieścia. Radioaktywne dziedzictwo St. Louis w soczewce projektów Allany Ross
Authors: Krzosek-Hołody Magdalena
Published: December 2022

The article follows the radioactive history of St. Louis featured in the works of the artist and activist Allana Ross. Her artistic practice presents an interesting, interdisciplinary approach to the social and environmental problems connected to the radioactive contamination of the city. The aforementioned contamination (apart from the workers directly involved in the processing of the uranium ore) affected mainly the lower middle-class families living in the outskirts.

From the early 1940s until the late 1960s St. Louis based chemical company Mallinckrodt was the major manufacturer of uranium utilized in the Manhattan Project and later on in the development of the American national atomic energy programme. As the result of the negligence of many social and political actors, the radioactive waste produced by Mallinckrodt spread over the city’s suburbs contaminating air, soil and water. These facts, however, were not publicly known for many years. Just recently they received the publicity that they demanded. Even though the radioactive contamination of St. Louis dates back to the 1940s, the affected areas had not been taken care of till the late 1980s, when the city was included into FUSRAP and Superfund programmes, which were established by the U.S. government to “clean the radioactive mess”left recklessly in the American landscape some decades ago.

The author of the article adopts the notion of negative heritage introduced by Lynn Meskell (2002) to interpret the significance of the radioactive contamination of the region and contextualize the works of Ross. The artist herself understands her projects, which may as well fall into the recently established category of artivism, as adaptive strategies for the slowly approaching environmental catastrophe. In a more general sense Ross calls out not only for the redefinition of St. Louis negative radioactive heritage, but also for the new culture of nature and new modes of human –environment relations.
Ogrody – pomniki antropocenu
Authors: Salwa Mateusz
Published: December 2022

The aim of the article is to analyse the metaphor of the garden as a metaphor which allows one to give an account of the conditions of the Earth subject to human actions and –more importantly –to sketch a utopian project of going beyond the Anthropocene. A new understanding of the garden modifies the traditional view of it as a paradise, where a harmony between humans and nature reigns. Today, gardens are often approached as places of cooperation, negotiation as well as of tensions and conflicts among human beings and other-than-human beings, that is as places where numerous relationships create a human and other-than-human community. The analyses will start with an interpretation of Alan Sonfist’s Time Landscape (1978–), a public park in Manhattan that was conceived of as a reconstruction of the local precolonial landscape and at the same time as its monument. Sonfist’s work is a good illustration of how the metaphor of the garden is nowadays interpreted and –I contend –it may be also seen as a monument of the Anthropocene.