bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epithelial ingrowth under LASIK flaps: tips and tricks for preventing recurrence!
Authors: Venugopal Anitha , Madkaikar Aditee , Ravindran Meenakshi 
Published: August 2023

Background:
LASIK for refractive error correction has become a universal surgery. Despite its popularity, the estimated prevalence of traumatic flap dislocations in post-LASIK patients is 3.9%, and it is sometimes associated with epithelial ingrowth. The prognosis in such cases depends on the rapid surgical revision of the flap with the removal of the EI and perioperative steps to prevent Epithelial ingrowth (EI) recurrence in the future.

Purpose:
The video aims to display the steps involved in revising the flap, removing EI, and tips to prevent its recurrence.

Synopsis:
A 33-year-old post-LASIK patient presented with decreased vision, photophobia, and glare during the COVID pandemic in the right eye for 2 months. The best-corrected visual acuity was reduced to 6/60. The anterior segment revealed traumatic flap dislocation along with macro fold temporally and epithelial ingrowth. She underwent a successful flap revision surgery with no recurrence of epithelial ingrowth postoperatively.

Highlights:
A successful revision of a 2-month-old traumatic folded flap was performed along with the complete removal of EI. It explains the step-by-step approach to avoid the recurrence of EI in each step of the surgical revision of the flap. The video is self-explanatory and guides novice surgeons too.

Video link:
https://youtu.be/JuOSjhrfw0g

Key words: Epithelial ingrowth, LASIK, traumatic flap dislocation
Long-term outcomes of therapeutic corneal transplants performed in a tertiary eye care hospital in South India
Authors: Christy Josephine S , Mathews Priya , Ravisankar Rashmita , Akpek Esen K 
Published: August 2023

Purpose:
This study aimed to review the demographics, clinical characteristics, and long-term outcomes of therapeutic penetrating keratoplasty (TPK) performed in a tertiary eye care hospital.

Methods:
Case records of 149 therapeutic transplants (135 patients) that were performed during the calendar year 2016 were retrospectively analyzed, and outcomes were measured until 3 years of follow-up. Information on demographics, presentation characteristics, keratoplasty indications, offending microbe, and secondary surgical interventions was studied. The final outcome was classified in terms of therapeutic, anatomical, and functional outcomes.

Results:
The median age of the recipients was 55 years with 61% men. The most common indications for TPK were perforated infectious ulcer (45.9%), nonhealing ulcers (29.9%), and graft infections (17.4%). Fungal etiology was noted in 61.2% and bacterial etiology in 17.4% of the eyes. Therapeutic success was achieved in 130 eyes (89%) at the end of 1 month. Anatomical success was achieved in 130 (98.5%) and 88 patients (86.3%) at the end of 1 and 6 months, respectively. At the 6-month time point, 78 patients (76.5%) attained functional success with vision better than light perception. Three-year follow-up data were available for 23.7% of recipients, of which only 12 patients (37.5%) retained a clear graft either after a primary therapeutic or secondary optical keratoplasty.

Conclusion:
Therapeutic keratoplasty is highly effective in eradicating infection and providing anatomical integrity. However, timely intervention can aid in achieving the best functional outcome.
Ten-year follow-up of corneal cross-linking and refractive surface ablation in patients with asymmetric corneal topography
Authors: Moscovici Bernardo Kaplan , Rodrigues Pablo Felipe , Dantas Marcos Paulo Suehiro , Okimoto Juliana Taemy , Naves Obidulho Sakassegawa , Taguchi Felipe Marques de Carvalho , Malta João Baptista Nigro Santiago , Campos Mauro 
Published: August 2023

Purpose:
Compare the safety and efficacy of wavefront-guided photorefractive keratotomy (PRK) 6 months after cross-linking (CXL) to wavefront-guided PRK alone for refractive correction in patients with bilateral asymmetric corneal topography.

Methods:
Prospective randomized clinical trial with 16 patients (32 eyes). CXL with subsequent PRK after 6 months in one eye, and PRK alone was performed in contralateral eyes. The follow-up was 10 years. We analyzed visual outcomes, Scheimpflug topography, and corneal haze evaluation.

Results:
Eyes in the PRK group showed better results than in the CXL + PRK group. Mean postoperative CDVA was 0.044 logmar (SD, 0.073) in the PRK group and 0.1 logmar (SD, 0.21) in the CXL + PRK group, the mean sphere was + 0.21 (SD, 0.6) D in the PRK group and 0.87 (SD, 2.3) D in the CXL + PRK group, and mean SE was −0.35 (SD, 0.65) D in the PRK group and 0.62 (SD, 2.32) D in the CXL + PRK group. In one patient, a steepening of 2.5 D and a thinning of 17 µm occurred in PRK alone group. Two patients in the CXL + PRK group presented corneal haze. The overall complication rate was 18,75% (haze and ectasia).

Conclusion:
Non-simultaneous CXL and PRK procedures yielded good refractive results, but worse than those obtained with PRK alone. Although one patient in the PRK group developed corneal ectasia, the CXL + PRK group had a higher loss of vision lines, indicating less safety.
Cataract surgery following penetrating keratoplasty in children
Authors: Janani Rajendran , Sneha Pandurangan 
Published: August 2023

Background:
Following penetrating keratoplasty, cataract surgery warrants certain modifications to ensure maximum survival of the graft.

Purpose:
To emphasize the intraoperative challenges and surgical manipulations to be followed.

Synopsis:
The surgeon makes a superior sclerocorneal tunnel avoiding the graft host junction. Dispersive viscoelastic is used. Continuous curvilinear capsulorhexis is done. Cataractous lens aspirated with a low flow rate. The intraocular lens is placed in the bag. Superior peripheral iridectomy and primary posterior capsulorhexis are done. The wound closed with two interrupted 10–0 nylon sutures. Graft host junction integrity is maintained.

Highlights:
Ensure 1. Good intraoperative corneal visibility, 2. Avoid graft host junction for main port incision 3. Generous dispersive viscoelastic use/soft shell technique to protect the corneal endothelium, 4. Avoid phaco energy in case of soft cataracts/low phaco energy and flow rates, 5. Phaco probe to be meticulously oriented away from corneal endothelium, 6. Primary posterior capsulorhexis to be done as in any pediatric cataract surgery, 7. Make sure of the graft host junction integrity at the end of the surgery, 8. Restrict to a single port whenever possible.

Video link:
https://youtu.be/tu4R5JangYs

Key words: Graft survival, pediatric cataract surgery, penetrating keratoplasty
Anti-fungal efficacy of combination of amphotericin B with colistin and gentamicin in McCarey-Kaufman corneal preservation medium
Authors: Kukutam Sushmasri , Chaurasia Sunita R , Joseph Joveeta , Roy Sanhita , Ramachandran Charanya , Kandibanda Srinivas 
Published: August 2023

Purpose:
To curtail the potential of donor corneal tissue disseminating fungi to the recipient’s eye, we evaluated the addition of amphotericin B to McCarey-Kaufman (M-K)—corneal storage medium supplemented with colistin.

Methods:
Amphotericin B was examined for its ability to inhibit the growth of Candida albicans and Aspergillus flavus using a microbroth dilution test and checkerboard assay in combination with only gentamicin and a combination of colistin, gentamicin, and amphotericin B. The safety on epithelium and endothelium was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay.

Results:
The minimal inhibitory concentration of gentamicin was found to be >256 μg/ml against both C. albicans and A. flavus, whereas that of amphotericin B was found to be in a range of 0.25–0.5 and 1–2 μg/ml for C. albicans and A. flavus, respectively. According to the checkerboard assay, 80% (4/5) of C. albicans isolates and 100% (5/5) of A. flavus isolates responded synergistically to the combination of amphotericin B and gentamicin, but only 20% (1/5) of C. albicans isolates showed an additive effect. None of the tested isolates displayed antagonism. The combined effect of the three drugs also did not display any antagonistic effect. Additionally, the MTT assay reveals no toxic effect of the antimicrobials used on corneal epithelial and endothelial cells.

Conclusion:

In vitro experiments demonstrate that amphotericin B is not toxic to either epithelium or endothelium and is a promising additive to the M-K medium supplemented with colistin.
Prevailing practice patterns in keratoconus among Indian ophthalmologists
Authors: Deshmukh Rashmi , Shrivastava Alok Kumar , Vaddavalli Pravin Krishna 
Published: August 2023

Objective:
The past few years have seen a rapid advancement in the management of keratoconus (KC). However, there is no prescribed standard of care for the management of KC. This study evaluated the prevailing practice patterns among Indian ophthalmologists in the diagnosis and treatment of KC via an online survey.

Methods:
This was a survey-based cross-sectional study in which a questionnaire (Supplement 1) was created. Questions pertaining to the practicing experience, setting of practice, and training background were asked in addition to the investigations done and decision making in KC management. Responses were collected via Survey Monkey (Survey Monkey, Palo Alto, California, USA) and statistical analysis performed using R software (4.1.3).

Results:
The survey was answered by 273 ophthalmologists. Pentacam was the most used topographer (195 users), followed by Orbscan (41 users), Sirius (34 users), and Galilei (3 users). The lowest limit of pachymetry for performing collagen crosslinking (CXL) was 400μ for most practitioners. More than half the respondents (50.55%) did not perform photorefractive keratectomy (PRK) or intracorneal ring segment (ICRS) implantation in a suitable patient. Accelerated 10-minute protocol (9 mW/cm2 for 10 minutes) was the most commonly (54.21%) used for CXL, followed by Dresden protocol (3 mW/cm2 for 30 minutes) (36.63%). When a patient was unsuitable for CXL, 55.31% surgeons advise contact lens (CL) trial, 35.16% surgeons advise keratoplasty, 26.74% surgeons perform stromal augmentation, and 7.69% surgeons advise spectacle correction. Corneal scar was the most common indication (49.45%) for performing keratoplasty.

Conclusion:
Topography remains the most used diagnostic modality for initial diagnosis. Optical coherence tomography and epithelial mapping are increasingly being used for early diagnosis of KC. Not all ophthalmologists were comfortable performing ICRS or PRK. When patients are unsuitable for CXL, CL trial remains the most frequently advised option followed by keratoplasty.
Removal and identification of a subconjunctival parasite by light and scanning electron microscopy
Authors: Jha Vikas Kumar , Verghese Amita , Basaiawmoit Priya , Janakiraman Narayanan , Raman Muthusamy , Biswas Jyotirmay 
Published: August 2023

Background:
Ophthalmic dirofilariasis is an uncommon zoonotic parasitic infection caused by species of Dirofilaria, a dog tapeworm that is transmitted to human by mosquitoes. Man is a dead-end host for the parasite. Ophthalmic involvement is rare and includes periorbital, subconjunctival, subtenon, and intra-ocular involvement. We report the removal of a subconjunctival worm and identification by light microscopy (LM) and scanning electron microscopy (SEM).

Purpose:
A 62-year-old female presented with complaints of redness, discharge, and foreign body sensation with difficulty in opening eyes in the left eye for the last 3 days. The patient is a non-vegetarian. On examination, her best corrected visual acuity in both eyes was 20/20. On slit lamp examination, there was a long, thin, round, coiled white subconjunctival live worm in the left eye superiorly. The rest of anterior segment evaluation, intra-ocular pressure, and fundus was normal in both eyes. The parasite was removed under local anesthesia from subconjunctival space [Video]. External surface morphology under LM revealed fine transverse cuticular striations with tapered cephalic and caudal ends. Uterus was long and coiled with indistinguishable masses inside. The finding was also confirmed by SEM.

Synopsis:
A subconjuctival parasite was removed and identified as Dirofilaria repens by characteristic LM and SEM findings.

Highlight:
Dirofilaria species may lodge in many tissues of human bodies including eye and adnexa. Dirofilaria is a natural parasite of carnivorous animals, mostly dogs, cats, and foxes.[1] The most common mode of transmission to human is usually by bite of mosquitoes like Culex and Aedes, which are considered as vectors, and it is often thought that parasitemia is because of accidental conduction.[1] Simple surgical removal of the worm is curative. After removal, the worm should be visualized directly under LM. All the internal structures of the transparent worm could be seen and compared with those under SEM.

Video Link:
https://youtu.be/XJb90ZHCX-I

Key words: Dirofilaria repens, light microscopy, scanning electron microscopy, subconjunctival dirofilariasis
Evaluation of vitamin D and vitamin D-binding protein levels and vitamin D receptor expression in basal cell carcinoma
Authors: Nagui Noha A. , Saleh Marwa A. , El-Daly Sherien M. , Khater Nohha H. , El Sharkawy Dina A. 
Published: August 2023

Background
Exposure to the sun is the main cause of basal cell carcinoma (BCC) development and also the main source of vitamin D in the body. Vitamin D has anticancer activities; however, its role in BCC is debatable.

Objective
To measure the level of plasma vitamin D, vitamin D-binding protein (VDBP), and vitamin D receptor (VDR) relative expression in BCC patients and healthy controls, in an attempt to evaluate their association with BCC development.

Patients and methods
Plasma vitamin D and VDBP as well as VDR relative expression levels were measured in 30 BCC patients and 30 healthy controls. VDR relative expression was also measured in nonlesional skin of patients and compared with that of lesional skin.

Results
Vitamin D, VDBP, and VDR expression levels were statistically significantly lower in BCC patients (16.8±9.65 ng/ml, 275.8±206.7 ng/ml, 0.49±0.35, respectively) than in controls (22.7±11.3 ng/ml, 429.7±248.1 ng/ml, 1.02±0.07, respectively) (P=0.027, 0.12, and 0.001, respectively). In addition, VDR relative expression was statistically significantly lower in BCC tissue than in nonlesional skin of patients (0.644±0.234) (P=0.001).

Conclusion
Decreased vitamin D, VDBP, and VDR expression levels may be associated with BCC, suggesting a possible role in the pathogenesis of the disease. Correction of vitamin D deficiency via supplementation or topical application of vitamin D analogs may have a role in the prevention or therapy of BCCs that should be evaluated.
Limitations of dermoscopy in detecting distal and lateral subungual onychomycosis among patients with severely dystrophic nail psoriasis
Authors: El-Komy Mohamed H.M. , Aboelmagd Sara H. , Khalil Haidy S. , Abdelrahman Reem M. , Bedair Nermeen I. 
Published: August 2023

Background
Onychomycosis among patients with nail psoriasis is being increasingly reported in the literature. When the two conditions coexist in the same nail, it is usually difficult to clinically detect the fungal nail affection.

Objective
To study the value of dermoscopy in detecting distal and lateral subungual onychomycosis among patients with nail psoriasis.

Patients and methods
Fifty psoriasis patients with nail changes were subjected to full history and clinical examination, including targeted Nail Psoriasis Severity Index calculation, dermoscopic examination and nail scrapping for fungal culture on Sabouraud dextrose agar, and dermatophyte (DM) test medium.

Results
Twelve (24%) of the 50 patients recruited showed a positive mycological growth on culture. Nondermatophyte molds and DM were isolated from 16 and 8% of patients, respectively. Nail psoriasis severity was not affected by fungal growth on culture and no significant relation could be detected between culture results and nail dermoscopic findings.

Conclusion
Specific dermoscopic signs of distal and lateral subungual onychomycosis do not appear to be evident in severely dystrophic psoriatic nails even when culture results show growth for DM and/or nondermatophyte molds.
Association between etiologic species with CD4 count and clinical features of oral candidiasis among HIV/AIDS patients
Authors: Murtiastutik Dwi , Prakoeswa Cita R.S. , Tantular Indah S. , Listiawan Muhammad Yulianto , Hidayati Afif N. , Ervianti Evy , Bintanjoyo Lunardi 
Published: August 2023

BackgroundOral candidiasis (OC) is an oral mucosal disorder due toCandidagenus. Its predisposing factor among patients with HIV/AIDS is mainly decreasing CD4 count. OC is commonly caused byCandidaalbicans.As CD4 decreases, the shift toC.non-albicanshas been observed.ObjectiveTo evaluate the association ofCandidaspecies with CD4 count and clinical features in HIV/AIDS patients with OC.Patients and methodsThis is a cross-sectional study. A total of 114 oral rinse solution samples from HIV/AIDS patients with OC were collected.Candidaspecies identification was done by culture in Chromagar followed by VITEK 2. The association ofCandidaspecies with CD4 count and clinical features was analyzed using Pearson'sχ2and Kruskal–Wallis tests.ResultsThere was growth of 149 isolates in culture from 114 patients.C. albicanswas found in 104 (69.7%) isolates.Candidanon-albicans were found in 45 (30.3%) isolates, namelyCandida kruseiin 22 (14.85%),Candida glabratain 12 (8.1%),Candida tropicalisin six (4.05%),Candida dubliniensisin two (1.3%),Candida parapsilosisin two (1.3%), andCandidalipolyticain one (0.7%) isolate.Candidaspecies was significantly associated with clinical types, episode types, pain on swallowing, CD4 count, and antiretroviral (ARV) use among all patients.ConclusionAmong HIV/AIDS patients with OC, growth ofC. albicansonly was more common in higher CD4 count, while mixed growth ofC. albicansandC.non-albicanswas more common in lower CD4 count. Clinical features associated with growth ofC. albicansonly were pseudomembranous type, recurrent OC, absence of pain on swallowing, and patients on ARV, whereas those associated with mixed growth ofC. albicansandC.non-albicanswere cheilitis type, first-episode OC, presence of pain on swallowing, and ARV-naive patients.
Mucocutaneous manifestations in patients with chronic kidney disease
Authors: Khatri Hitesh S. , Adhicari Pankaj , Parry Manzoor A. , Sharma Manjuri 
Published: August 2023

Background
Cutaneous manifestations in chronic kidney disease (CKD) can affect quality of life and can vary across regions, races, and nutritional status of patients.

Objective
To study the prevalence of mucocutaneous manifestations in patients with CKD and compare between dialysis and nondialysis patients.

Patients and methods
This was a cross-sectional study from North-East India. A total of 210 patients with CKD were included, with 61 patients in dialysis group and 149 in the nondialysis group. A comprehensive history, detailed examination, and all the relevant investigations were done.

Results
There was a male predominance in this study, and the mean age was 49.85±12.5 years. Diabetes mellitus (42.9%) was the most common cause of CKD. Cutaneous involvement was seen in 142 (67.61%) patients, with predominance in dialysis patients (60/61) (98.36%) as compared with nondialysis patients (80/149) (55.03%). Xerosis (58.09%) was the most common skin change seen in 122 patients, being more in the dialysis group as compared with the nondialysis group (73.8 vs. 51.7%; P=0.0034). This was followed by pallor (36.19%) of the skin and mucosa. Pruritus (35.23%) was seen in 74 patients, being more in dialysis patients. Cutaneous infections were seen in 57 patients. Absent lunula (14.26%) and half-and-half nail (12.85%) were the most common nail changes. Mucosal changes were seen in 28 (13.33%) patients. Hair changes were seen in 16.67% of patients, with predominant affection in dialysis patients.

Conclusion
Xerosis, pruritus, skin pallor, absent lunula, xerostomia, macroglossia, and infections were the most common mucocutaneous manifestations in this study. Xerosis, pruritus, absent lunula, and hair changes were more common in dialysis patients.
Assessment of perception and utility regarding flip classroom among MBBS students: A descriptive study
Authors: Khan S Muhammad S , Dkhar Sabira A , Quansar Ruqia 
Published: August 2023

Abstract

Purpose:
A flipped classroom is a type of blended learning technique. In modern times, the teaching techniques need to be improved and changed. The aim of the study was to assess the perception of students with regard to flipped classroom.

Materials and Methods:
The study was a descriptive cross-sectional study design. A total of 152 students participated in this study.

Results:
After watching the video and before the actual interaction, about 84.2% felt confident. About 56.6% of respondents thought flipped classrooms were superior to traditional classroom instruction. The flexibility of the “flipped classroom,” according to 44.1% of respondents, makes it the most useful feature. The aspect of flipped learning that 43.4% of students liked the most was learning about new ideas before class. A total of 98.2% thought they needed to be more accountable for their education.

Conclusion:
Although the flip classroom cannot completely replace the traditional classroom but when used in conjunction, it can help students learn more effectively. It has paved the path for improvements to teaching techniques and unquestionably produced a better manner of instruction.
Clinical profile and response to treatment in chronic hepatitis C and renal disease: A prospective study from North India
Authors: Ashraf Aadil , Wajeed Ahmad Yousuf , Khan Javed , Shah Altaf Hussain , Dar Hilal 
Published: August 2023

Abstract

BACKGROUND AND AIMS:
Successful treatment of hepatitis C virus (HCV) infection is associated with improved outcomes in different clinical domains. The treatment of HCV infection in high-risk groups like chronic kidney disease (CKD) is challenging. We conducted a study on the efficacy of the fixed-dose combination of sofosbuvir–velpatasvir in CKD patients.

MATERIALS AND METHODS:
The study was conducted in our hospital, Sher I Kashmir Institute of Medical Sciences Soura. Patients with HCV infection (detectable RNA levels) with an estimated glomerular filtration rate (eGFR) >15 mL/min were included in the study. All the patients were evaluated for liver disease. Patients with prior exposure to a direct-acting antiviral agent, portal vein thrombosis, or hepatocellular carcinoma were excluded from the study. All the patients received an open-label combination of sofosbuvir and velpatasvir (400/100 mg). The primary endpoint was to assess sustained virological response 12 (SVR12), and the secondary endpoint was to assess the side effect profile of the patients.

RESULTS:
A total of 33 patients were enrolled in the study, with 17 in Group A (GFR 15–30 mL/min/1.73 m2) and 16 in Group B (GFR >30 mL/min/1.73 m2). In total, 142 (87.6%) achieved viral clearance at 4 weeks of therapy. Sixteen out of 17 (94.1%) in Group A and 13 out of 16 (81.25%) in Group B achieved viral clearance at 4 weeks of therapy [early virological respsone (EVR)]. All patients in both groups achieved end-of-treatment response viral clearance, and the same number of patients maintained viral clearance 12 weeks after stopping the treatment (SVR12). In Group A, no significant improvement was seen in the mean level of any parameters pre and posttreatment. In Group B, there was an improvement in all the parameters except serum creatinine after the completion of treatment. However, the difference was significant between pre and posttreatment values of serum alanine transaminase (U/L) and liver stiffness measurement levels (P value of −0.04 and 0.01, respectively).

CONCLUSION:
We conclude that treatment with sofosbuvir–velpatasvir is a safe and effective treatment option in HCV infection in CKD.