bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of ultrasound-guided paravertebral block versus erector spinae plane block for postoperative analgesia after percutaneous nephrolithotomy – A randomised, double-blind, controlled study
Authors: Khot Prajna Pandit , Desai Sameer N. , Bale Sushmitha P. , Aradhya Bhuvanesh N. 
Published: December 2023

Background and Aims:
Paravertebral block (PVB) is the regional anaesthesia of choice for percutaneous nephrolithotomy (PCNL). Erector spinae plane block (ESPB) is also effective for the same. This study aims to compare the analgesic efficacy and ease of performing PVB or ESPB for PCNL surgery.

Methods:
This study was conducted in 60 patients undergoing PCNL, who were randomised to Group P (n = 30; received ultrasound-guided [USG] PVB) and Group E (n = 30; received USG ESPB) after general anaesthesia. Blocks were administered at T10 level on the side of the surgery using 20 ml of 0.25% bupivacaine. The trachea was extubated at the end of surgery. The primary outcome was analgesia duration, and secondary outcomes were postoperative pain scores, analgesic consumption, ease of block performance, time taken to perform the block and complications between the two groups. Continuous variables were compared using an independent sample t-test, and categorical variables were analysed using Pearson’s Chi-square test.

Results:
Demographic variables were comparable in both groups. The mean (standard deviation [SD]) time of first rescue analgesia in Group P and Group E were 16.6 (20.4)(95% confidence interval [CI]: 9.02–20.32) h and 16.3 (21.8) (95% CI: 8.17–24.51) h, respectively (P = 0.95). The postoperative pain scores and number of doses of analgesics used were comparable between the groups (P > 0.05). The time taken to perform PVB was much longer compared to the time taken to perform ESPB (P = 0.01).

Conclusion:
USG PVB and ESPB were equally effective for postoperative analgesia for PCNL surgery.
Efficiency of face mask ventilation before and after neuromuscular blockade: A randomised, double-blind controlled study
Authors: Kumar Supriya , Hussain Mumtaz , Bharti Alok K. , Kumar Arvind 
Published: December 2023

Background and Aims:
The traditional practice of administrating neuromuscular blocking drugs (NMBDs) after checking face mask ventilation is challenged repeatedly. This study compared the efficiency of face mask ventilation before and after administrating an NMBD in a patient with a normal airway. The secondary outcome measured was the grade of mask ventilation and tracheal intubating conditions.

Methods:
After ethical approval, patients (n = 120) in the age group of 18–65 years scheduled for elective surgery under general anaesthesia were randomly assigned into two groups. Group 1 received an NMBD before checking face mask ventilation. Group 2 received an NMBD after checking face mask ventilation. Lungs were ventilated for 180 s, during which expiratory tidal volume (Vte) was recorded as the primary outcome. Hans’s grading for face mask ventilation was used to grade mask ventilation. The ease of intubation was assessed based on intubating conditions (ease of laryngoscopy, vocal cord movement, and limb movement). SPSS 20.0 software was used for statistical analysis.

Results:
For a total of 180 seconds of mask ventilation, the mean (standard deviation) Vte measured after apnoea was significantly higher in Group 1 versus Group 2 [471.9 (63.3) vs 434.8 (77.0) mL/breath, P = 0.004]. The intubating condition was either excellent or good in all patients.

Conclusion:
The administration of NMBDs resulted in a larger mask Vte and shorter intubation time.
Strategies for successful management of moderate and severe Mooren’s ulcer at a rural center during the COVID-19 pandemic: Lessons learnt
Authors: Peraka Raghav Preetam , Murthy Somasheila I , Rathi Varsha M 
Published: December 2023

Purpose:
This study aimed to report the strategies that evolved in managing Mooren’s ulcer (MU) at a resource-limited center in rural India during the coronavirus disease 2019 (COVID-19) pandemic.

Methods:
This study includes a retrospective analysis of clinically diagnosed MU cases from January 2021 to August 2021 wherein strategies for management were developed. The demographic profile, ulcer clinical features, treatment algorithms (medical and surgical), complications encountered, referral to a higher center, and compliance with medication and follow-up were studied.

Results:
The mean age of presentation was 68.1 years (range, 62–73 years), and 90% were men. The median best-corrected visual acuity (BCVA) was 1.26 logarithm of the Minimum Angle of Resolution (LogMAR) (interquartile range (IQR), 0.00–5 logMAR) in the affected eye on presentation, which improved to 0.69 logMAR (IQR, 0.00–3 logMAR) at resolution (P = 0.442). The first-line management was conjunctival resection and tissue adhesive application (90%). 70% of cases were unilateral, 50% of cases had less than 2 clock hours of involvement, and 50% had less than 50% stromal involvement. Confounding factors included infectious keratitis (2) and corneal perforation (3). The mean duration of follow-up was 96 (1–240) days. The average follow-up visits per patient were 8.8 (1–22). 90% of cases could be managed successfully at the secondary center level with two cases needing a tertiary care referral.

Conclusion:
MU can be managed effectively by following a systemic strategy of early diagnosis, surgical therapy, and rapid institution of systemic immunosuppression in a remote location-based secondary center. The strategies developed can be a guide for ophthalmologists at remote centers managing patients or who are unable to travel to tertiary institutes.
Systemic lupus erythematosus (SLE) associated uveitis in India – A case series
Authors: Magesan Kowsigan , Nangia Purna , Manoharan Anitha , Sitaula Ranju K , Srikantiah Chandrashekara , Biswas Jyotirmay 
Published: December 2023

Abstract

Purpose:
To report the uveitic manifestations of patients with systemic lupus erythematosus (SLE).

Methods:
This was a retrospective analysis of all SLE cases with ocular manifestations seen by a single ophthalmologist between 2015 and December 2021.

Results:
In total, seven patients with a median age of 40 (range 18–50) years were included in the study. Female (85.7%) predominance was noted. Ocular findings were bilateral in 71% (five patients) of cases. Majority (10 eyes, 83%) of the patients had retinal vasculitis as the common finding. Antinuclear antibodies were positive in all the patients. The vision improved in two (16.6%) eyes, was stable in eight (66%) eyes, and worsened in one (8%) eye. All the patients were treated with oral steroids along with immunosuppressive agents.

Conclusion:
Though SLE is rare cause of uveitis, it can be associated with significant ocular morbidity. Hence, early diagnosis and treatment can salvage vision in many cases.
Biomechanical properties of cornea and ocular aberrations in myopic eyes
Authors: Dhiman Rebika , Singh Divya , Vanathi Murugesan , Tandon Radhika , Mahalingam Karthikeyan 
Published: December 2023

Abstract

Purpose:
To study the correlation of corneal topography, corneal biomechanical properties, and ocular aberrations with the magnitude of refractive error in myopic eyes.

Methods:
All myopic patients attending the clinic for refractive surgery were recruited. Data recorded included visual acuity, axial length (AL), central corneal thickness (CCT), manifest refraction spherical equivalent (MRSE), topography (Pentacam – Oculus), corneal biomechanical factors [ocular response analyzer (ORA)], and optical aberrations (iTrace). They were further categorized into group 1 (suitable for femto-LASIK) and group 2 (unsuitable for femto-LASIK).

Results:
Sixty eyes (30 myopes) of mean age 22.78 ± 2.71 years were enrolled. A negative correlation of refractive error was noted with AL (ρ = −0.9; P < 0.001), total aberrations (ρ = 0.53; P < 0.001), and lower-order aberrations (LOA) (ρ = 0.54; P < 0.001). A strongly positive correlation was noted between CCT and corneal hysteresis (CH) (ρ = 0.63; P < 0.001), CCT and CRF (ρ = 0.56; P < 0.001), CH and corneal resistance factor (CRF) (ρ = 0.83; P < 0.001), and Goldmann equivalent intraocular pressure (IOPg) and corneal compensated intraocular pressure (IOPcc) (ρ = 0.78; P < 0.001). An increase in higher-order aberrations (HOAs) as well as lower-order aberrations (LOAs) was noted with increasing sim-K [HOA (r = 0.73, P = 0.001); LOA (r = 0.601, P = 0.014)] and increasing CRF [HOA (r = 0.5, P = 0.006); LOA (r = 0.732, P = 0.001)] in group 2. The amount of refractive error, axial length, central corneal thickness, and sim-K were significantly different in the two groups.

Conclusion:
Increasing degree of myopia is associated with an increase in axial length, total aberrations, and lower-order aberrations. Corneal biomechanical parameters have a strong correlation with each other. Lower corneal biomechanics are noted in high myopes as they have weaker and thinner corneas. Corneal biomechanics and ocular aberrations do not differ significantly between cases suitable for femto-LASIK and cases unsuitable for femto-LASIK.
Clinicodemographic profile, management, and treatment outcomes in advanced retinoblastoma at a tertiary care center in North India
Authors: Kumar Sonali Vinay , Kumar Vinay , Sati Alok , Mishra Sanjay Kumar , Khera Sanjeev , Mishra Atul , Mathur Ankit , Gopinath Manoj , Mohimen Aneesh , Malik Virender , Kumar Natasha V 
Published: December 2023

Purpose:
The study was undertaken to look into the clinicodemographic profile, management, and clinical outcomes of advanced retinoblastoma at a tertiary care center.

Methods:
A prospective cohort study was conducted from Jan 2019 to Dec 2022. Forty-two patients of intraocular advanced retinoblastoma were assessed. The treatment protocol was formulated based on size, extension of tumor, and laterality. Primary outcome measure was response to the treatment in terms of regression of tumor and seeds and no evidence of recurrence after 12 month in enucleated eyes. Secondary outcome measures were complications like implant exposure, metastasis, and death associated with each treatment modality.

Results:
The mean age of the study group was 13 months. The most common presentation was leukocoria with diminished vision. Most of the patients had group E retinoblastoma (n = 40, 95%) as per the International Classification of Retinoblastoma. In 12 patients with group E retinoblastoma, primary enucleation was performed and in six patients, secondary enucleation was done, in which initially, globe salvage treatment was tried. In 30 patients, globe salvage treatment was attempted and we could manage to save 23 eyes. The most common treatment modality was intra-arterial chemotherapy using a triple-drug regimen. One patient developed intracranial spread and died due to systemic metastasis during the follow-up period.

Conclusion:
The current study showed that globe salvage is possible in advanced retinoblastoma if appropriate therapy is instituted depending upon the extent of the tumor and availability of latest treatment modalities. Intra-arterial chemotherapy using triple drugs can be offered as a first-line therapy in advanced unilateral retinoblastoma as it has been found to be very effective in the present study.
Knowledge and awareness of clinical trials among trial participants in India: A multicentric questionnaire-based cross-sectional study
Authors: Pillai Gopal S , Sheeba C S , Barman Manabjyoti , Sen Alok , Sundaram Natarajan , Dickson Merin , Joyal Shamilin , Choudhury Manjisa , Joy Merlin M , Deepthi K G , Jangid Poonam , Dani Samrudhi 
Published: December 2023

Purpose:
The knowledge and attitude of participants toward clinical trials (CTs) are a key determinant in successful recruitment and retention. This study aimed to evaluate knowledge and awareness-attitude among the recruited CT participants about CTs.

Methods:
This was a cross-sectional face-to-face survey comprising CT participants involved in the past or currently a part of a CT during this study within the Indian Ophthalmology Clinical Trial Network (IOCTN). A previously validated questionnaire was used, and data regarding demographics, knowledge, and awareness-attitude about CTs were collected. The total awareness-attitude score was used to determine the knowledge and awareness of the participants.

Results:
A total of 121 subjects had participated in the study who were part of ongoing trials, of which only five participants had prior experience of CTs. The majority (90%) had knowledge about CTs, whereas only 7% had confirmed signing consent forms. The total awareness-attitude score significantly varied across locations (27% for the southern zone, 53% for the central zone, and 52% for the western zone), and this was negatively associated with education. The most negative attitude (38.6%) was observed regarding adequate information sharing among participants, whereas non-disruption of their routine family life (60.7%) and financial stability (67.6%) were the top most positive attitudes revealed during their participation. The participants’ pre- and post-participation attitude toward CTs revealed a positive attitude.

Conclusion:
The factors influencing a participant’s knowledge and attitudes toward CTs were revealed in the study. Furthermore, the need for awareness regarding benefits of CTs to the public, participant’s rights, and their voluntary power were the major highlights.
Artificial intelligence in glaucoma detection using color fundus photographs
Authors: Sidhu Zubin , Mansoori Tarannum 
Published: December 2023

Purpose:
To explore the potential of artificial intelligence (AI) for glaucoma detection using deep learning algorithm and evaluate its accuracy for image classification of glaucomatous optic neuropathy (GON) from color fundus photographs.

Methods:
A total of 1375 color fundus photographs, 735 normal optic nerve head and 640 GON, were uploaded on the AI software for training, validation, and testing using deep learning model, which is based on Residual Network (Res Net) 50V2. For initial training and validation, 400 fundus images (200 normal and 200 GON) were uploaded and for the final training and testing 975 (535 normal and 440 GON) were uploaded later. Accuracy, sensitivity, and specificity were used to evaluate the image classification performance of the algorithm. Also, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were calculated.

Results:
The model used in the study showed an image classification accuracy of 81.3%, sensitivity of 83%, and specificity of 80% for the detection of GON. The false-negative grading was 17% and false-positive grading was 20% for the image classification of GON. Coexistence of glaucoma in patients with high myopia, early glaucoma in a small disc, and software misclassification of GON were the reasons for false-negative results. Physiological large cupping in a large disc, myopic or titled disc, and software misclassification of normal optic disc were the reasons for false-positive results.

Conclusion:
The model employed in this study achieved a good accuracy, and hence has a good potential in detection of GON using color fundus photographs.
Ocular surface changes in primary open-angle glaucoma on anti-glaucoma medications versus treatment-naïve patients
Authors: Srivastava Krati , Bhatnagar Kavita R , Shakrawal Jyoti , Tandon Manjari , Jaisingh Kirti , Pandey Latika , Roy Falguni 
Published: December 2023

Purpose:
To examine the ocular surface disease in primary open-angle glaucoma (POAG) patients already on treatment versus POAG patients without treatment.

Methods:
A prospective cohort study was conducted on 120 eyes of 60 POAG patients: 60 treatment-naïve eyes (group I) and 60 eyes already on topical anti-glaucoma medications (AGMs) (group II). All patients had filled out the Ocular Surface Disease Index (OSDI) questionnaire and underwent a comprehensive glaucoma workup. Tear break-up time (TBUT) test, Schirmer’s test (type I), corneal sensitivity, anterior segment-optical coherence tomography (AS-OCT), and corneal and conjunctival staining were done at day 1, 1 month, 3 months, 6 months, and 12 months follow-up.

Results:
On presentation, TBUT, Schirmer’s test, tear meniscus height (TMH), and tear meniscus depth (TMD) were significantly higher in group I compared to group II. No significant difference was noted in OSDI score, corneal sensitivity, and tear meniscus area (TMA) between the groups on presentation. Both, lissamine green and rose bengal staining, had higher grades in group II compared to group I. Worsening of ocular surface disease was noted in both groups on follow-up. OSDI score, TBUT, Schirmer’s test, TMH, and TMD had better values in group I in comparison to group II on follow-up.

Conclusion:
The study has identified glaucoma patients on AGMs to be more affected by dry eye disease (DED) compared to treatment-naive glaucoma patients. We found statistically significant differences in values of TBUT, Schirmer tests, lissamine and rose bengal staining, and AS-OCT parameters at baseline and 3, 6, and 12 months follow-up. OSDI scores showed significant differences at 6 and 12 months of follow-up. We recommend consideration of evaluation and management of DED/ocular surface disease in glaucoma patients on topical AGMs, particularly multiple drugs and doses.
The influence of altitude on the differences between Goldmann tonometry and Pascal dynamic contour tonometry: An ecological meta-analysis
Authors: Albis-Donado Oscar , Ramirez-Neria Paulina , Rios-Acosta Nadia , Stalmans Ingeborg 
Published: December 2023

Purpose:
A meta-analysis found that including atmospheric pressure as altitude in generalized linear models reveals higher differences between Goldmann tonometry and Pascal dynamic contour tonometry at higher altitudes, with the difference increasing in thinner corneas. To examine the difference in intraocular pressure (IOP) measurements by using Goldman applanation tonometry (GAT) and dynamic contour tonometer (DCT) tonometry in published literature and determine the influence of central corneal thickness (CCT), age, and altitude on that difference.

Methods:
Articles that compare GAT and DCT were selected for an extensive literature review, and the location and altitude of the research centers were found online. CCT and age were analyzed as covariates, when available.

Results:
A total of 157 studies including 24,211 eyes of 20,214 patients were included in the study. The results showed that the difference between DCT and GAT was higher at higher altitudes above sea level and increased with thinner corneas. However, the results were different in eyes with corneal transplants, where altitude and CCT had less influence, and in those post-refractive surgery where age was found to influence the difference. Theoretical correction formulas using altitude, CCT, and age were derived from this meta-analysis, but their accuracy and usefulness in clinical practice need validation.

Conclusion:
The findings suggest that there is a higher risk of underestimating IOP when the Goldmann tonometer is used at a higher altitude, particularly in eyes with glaucoma, thinner corneas, or corneal refractive surgery. Further research is needed to validate the accuracy of the correction formulas derived from this meta-analysis in clinical practice.
Subconjunctival dexamethasone-assisted conjunctival autograft harvesting versus normal saline during pterygium surgery – A randomized clinical trial
Authors: Meena Ashok , Agrawal Ashish , Parmar Gautam , Gurnani Bharat 
Published: December 2023

Purpose:
To evaluate the effect of subconjunctival dexamethasone compared to normal saline on conjunctival autograft harvesting in patients undergoing pterygium surgery.

Methods:
Fifty-two eyes of 52 patients who underwent pterygium excision combined with autologous conjunctival graft (CAG) using releasable suture were included in this prospective interventional study. The patients were randomized into two groups of 26 patients each. Group A consisted of patients in whom CAG was harvested using subconjunctival 0.5 ml of 0.4% dexamethasone sodium phosphate and in group B patients, normal saline was used. The patients were assessed for postoperative pain, foreign body sensation, and watering as the subjective signs of inflammation and conjunctival inflammation and lid edema as the objective signs of inflammation at 12 and 24 h postsurgery.

Results:
The mean age of group A and B patients was 47.69 + 13.09 and 46.00 + 10.76 years, respectively. The male:female ratio was 1.6:1 in group A and 1.1:1 in group B. The mean surgical time in group A was 243.96 ± 52.13 s and in group B was 258.08 ± 43.99 s. Postoperative pain, foreign body sensation, and watering were significantly lower in group A patients than in group B patients at both 12 and 24 h postoperatively (group A: 4.65 ± 1.33, 4.88 ± 1.73, and 3.85 ± 1.43, respectively, at 12 h; 1.89 ± 1.03, 1.69 ± 1.09, and 1.69 ± 0.97, respectively, at 24 h and group B: 6.42 ± 0.95, 6.65 ± 0.98, and 6.27 ± 1.40, respectively, at 12 h; 3.27 ± 1.43, 3.12 ± 1.25, 2.58 ± 1.14, respectively, at 24 h) (P < 0.001). Conjunctival inflammation was significantly lower in group A at 12 h (P < 0.05) and 24 h (P < 0.05) after surgery compared to group B. Lid edema failed to show any significant (P = 0.17) difference with respect to severity in both the groups at 12 and 24 h (P = 0.699).

Conclusion:
Subconjunctival dexamethasone decreased patient discomfort following pterygium surgery. The dexamethasone group had reduced conjunctival inflammatory signs without any notable complications.
Screening for Hearing Impairment in High-Risk Neonates in a Rural Tertiary Care Center
Authors: Thomas Kiren , Datta Ginni 
Published: December 2023

Introduction:
Among the many congenital problems, loss of hearing is one of the most common treatable diseases. Hearing loss in early life can have deleterious effects on the child's psychosocial, scholastic, and social-emotional development.

Aims:
The aim of this study was to estimate the incidence of neonatal hearing loss in high-risk neonates admitted in a rural tertiary care center. To determine the risk factors predictive of hearing impairment in these neonates.

Materials and Methods:
About 200 high-risk neonates were included in the study. The first screening by otoacoustic emission (OAE) was conducted before the neonate's discharge from the hospital. If it failed, OAE was repeated after 4 weeks or at the first immunization visit. If it again failed, then Brainstem Evoked Response Audiometry (BERA) was conducted within no more than 3 months.

Statistical Analysis Used:
It was performed using IBM SPSS Statistics (IBM SPSS Version 28.0. Armonk, NY). The Chi-square test was used to calculate the P value. P < 0.05 was considered statistically significant.

Results:
In the initial screening, 49 out of 200 high-risk neonates had referred OAE. Out of 49, 20 failed in repeat OAE. Out of these 20 neonates, hearing loss was confirmed in 15 neonates (7.5%) by BERA. The risk factors most commonly associated with hearing loss in the present study were neonatal intensive care unit admission >24 h (7%), hyperbilirubinemia (3%), meningitis (3%), and ototoxic drugs (3%). In the neonates who had hearing loss (15), 93.33% were having more than one risk factor.

Conclusions:
Our study concludes that there is significant hearing impairment in high-risk neonates. Screening for hearing loss and early identification is needed to modulate the period of neural plasticity, preventing them to banish into a world of social isolation, and educational malaise. The health-care facilities in rural regions have limited settings. Hence, at least a targeted screening is recommended for early detection of hearing loss and rehabilitation.