bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dry eye disease and risk factors for corneal complications in chronic ocular graft-versus-host disease
Authors: Kate Anahita , Singh Swati , Das Anthony Vipin , Basu Sayan 
Published: April 2023

Purpose:
The current study was carried out to evaluate the clinical features and management outcomes of dry eye disease (DED) in chronic ocular GvHD following allogenic hematopoietic stem cell transplantation (HSCT).

Methods:
A retrospective review of consecutive patients diagnosed with chronic ocular GvHD between 2011 and 2020 was performed at a tertiary eye care network. Multi-variate regression analysis was carried out for identifying risk factors associated with progressive disease.

Results:
A total of 34 patients (68 eyes) with a median age of 33 years [inter-quartile range (IQR) 23–40.5] were studied. The most common indication for HSCT was acute lymphocytic leukemia (26%). Ocular GvHD developed at a median of 2 years (IQR 1–5.5 years) after HSCT. Aqueous tear deficiency was present in 71% of the eyes, of which 84% had a Schirmer value of <5 mm. The median visual acuity at presentation and that after a median follow-up of 6.9 months were comparable at 0.1 log minimum angle of resolution (logMAR) (P = 0.97). Topical immunosuppression was required in 88% of cases, and with this, improvement in corneal (53%, P = 0.003) and conjunctival staining scores (45%, P = 0.43) was noted. A progressive disease was present in 32% with persistent epithelial defects being the most common complication. Grade 2 conjunctival hyperemia [odds ratio (OR): 2.6; P = 0.01] and Schirmer’s value <5 mm (OR: 2.7; P = 0.03) were found to be associated with progressive disease.

Conclusion:
Aqueous deficient DED is the most common ocular manifestation of chronic ocular GvHD, and the risk of the disease progression is greater in eyes with conjunctival hyperemia and severe aqueous deficiency. Awareness among ophthalmologists of this entity is essential for its timely detection and optimal management.
A simple technique of meibography for morphological and functional evaluation of meibomian glands in dry eye conditions
Authors: Mounika Vala , Kamath Sumana J , Tejaswi Pagadala , Kamath Ajay R , Rodrigues Gladys R , Mendonca Teena Mariet 
Published: April 2023

Purpose:
Dry eye disease (DED) is because of a decrease in the tear film’s volume or a change in the composition of tears. Evaporative dry eye is the most common type, which is due to meibomian gland dysfunction (MGD). In this study, the morphology of meibomian glands was evaluated in all kinds of dry eyes to look for any loss of meibomian glands, assess the function of remaining glands, and investigate the relationship between anatomy, function, and severity of DED.

Methods:
A total of 300 patients were included in the study, with 150 eyes in the study group and 150 in the control group. Meibomian gland morphology was assessed by examining the tarsal plate after everting the eyelids. Tear film function was evaluated using tear film break-up time (TBUT) and Schirmer’s test (SCH I and II). Meibomian gland morphology was examined with a slit-lamp under magnification, a transilluminator using a small light emitting diode (LED) bulb, and non-contact meibography using an auto refracto-keratometer (ARK).

Results:
Females had a higher prevalence of dry eyes in our study. In all, 103 eyes (68.6%) in the study group had evaporative dry eye, making it the most prevalent type. Among the 150 controls, 104 controls with 69.3% had no dry eye symptoms, and in those with symptoms, the evaporative type was the most common, with a 28% prevalence.

Conclusion:
TBUT should be performed in all patients with detectable MG abnormality. Meibography has high specificity and sensitivity to diagnose MGD and in turn dry eyes and should be considered a routine screening modality.
Evaluation of dry eyes in children with vernal kerato-conjunctivitis using clinical tests and ocular surface analysis
Authors: Gupta Shalini , Rahman Mahmooda , Tibrewal Shailja , Gaur Abha , Ganesh Suma , Sangwan Virender Singh 
Published: April 2023

Purpose:
To evaluate dry eyes in children with vernal kerato-conjunctivitis (VKC) and correlate it with symptoms, clinical findings, and ocular surface analysis (OSA) parameters.

Methods:
Children with clinically diagnosed VKC underwent complete ophthalmological examination, Schirmer’s testing, modified ocular surface disease index (OSDI) scoring, Bonini grading, fluorescein tear-film break-up time (TBUT), VKC – Collaborative Longitudinal Evaluation of Keratoconus (CLEK) scoring, and OSA. Children with a TBUT of < 10 s were defined to have dry eyes. The above-mentioned parameters were compared between dry eye and non-dry eye VKC children.

Results:
The mean age of the 87 children included in the study was 9.1 ± 2.9 years. Dry eyes were seen in 60.9% [95% confidence interval (CI); 51% to 71%]. The mean TBUT was 13.4 ± 3.8 and 5.9 ± 1.9 s in non-dry and dry eye groups, respectively (P < 0.001). The mean value of Schirmer’s test was 25.9 ± 9.8 and 20.8 ± 8.6 mm in the non-dry and dry eye groups, respectively (P = 0.01). The two groups did not differ in their OSDI scores, Bonini grading, and CLEK scores. The OSA parameter of non-invasive break-up time (NIBUT) was 8.3 ± 3.2 s in non-dry eye group and 6.4 ± 2.9 s in dry eye group, P = 0.008. The lower lid Meibomian gland (MG) loss was 7.4% in non-dry eye group and 12.2% in dry eye group, P = 0.028. Other OSA parameters did not differ significantly among the two groups.

Conclusion:
Dry eyes are seen in two-thirds of pediatric VKC. Evaluation of dry eyes should be incorporated in their clinical evaluation. Among OSA parameters, NIBUT and lower lid MG loss are associated with dry eyes in pediatric VKC patients.
Type 1–type 2 interferon imbalance in dry eye disease
Authors: Panigrahi Trailokyanath , D’Souza Sharon , Suresh Babu Vishnu , Dickman Mor M , Nuijts Rudy M M A , Sethu Swaminathan , Shetty Rohit 
Published: April 2023

Purpose:
Dry eye disease (DED) is characterized by altered ocular surface proinflammatory and antiinflammatory factors. Interferons (IFNs) are a class of pleiotropic cytokines well known for their antimicrobial, inflammatory, and immunomodulatory roles. Hence, this study investigates the ocular surface expression of different types of IFNs in patients with DED.

Methods:
The cross-sectional, observational study included patients with DED and normal subjects. Conjunctival impression cytology (CIC) samples were obtained from the study subjects (controls, n = 7; DED, n = 8). The mRNA expression levels of type 1 IFN (IFNα, IFNβ), type 2 IFN (IFNγ), and type 3 IFN (IFNλ1, IFNλ2, IFNλ3) were measured by quantitative PCR (polymerase chain reaction) in CIC samples. IFNα and IFNγ expression under hyperosmotic stress was also studied in human corneal epithelial cells (HCECs) in vitro.

Results:
The mRNA expression levels of IFNα and IFNβ were significantly lower and that of IFNγ was significantly higher in DED patients compared to healthy controls. The mRNA levels of IFNα, IFNβ, and IFNλ were significantly lower compared to IFNγ in DED patients. An inverse association between tonicity-responsive enhancer-binding protein (TonEBP; hyperosmotic stress maker) and IFNα or IFNβ expression and a positive association between TonEBP and IFNγ expression was observed in CIC samples. The expression of IFNα was lower than IFNγ in HCECs undergoing hyperosmotic stress compared to HCECs without the stress.

Conclusion:
The presence of an imbalance between type 1 and type 2 IFNs in DED patients suggests newer pathogenic processes in DED, plausible ocular surface infection susceptibility in DED patients, and potential therapeutic targets in the management of DED.
A Tale of Two Brothers and the Incumbent Prerogative for a Social Ombudsman
Authors: Verma Rohit 
Published: April 2023

Abstract
Social support stipulates two imperative components: A structural component comprising network size and frequency of social interactions, and a functional component with emotional (such as receiving love and empathy) and instrumental (practical help such as monetary gifts or assistance between providing therapeutic care and social support. I present such a case where my role belonged to more of a social ombudsman for the care receivers mitigating their daily lifestyles rather than a clinician providing only pharmacological upkeep. This case taught me the perspective of devoting time to patients and their family members beyond the call for duty from being a mere prescription provider to be more of a social aid to the debilitated family unit.
Depression among Married Women in Assam: A Qualitative Study
Authors: Bora Debashree , Deuri Sonia Pereira , Saha Apurba 
Published: April 2023

Abstract

Background:
Women are at greater risk for depressive disorders than men. They are also known to be genetically and biologically vulnerable. Indian women mostly express their mental stress as somatic complaints and many other psychosocial factors influence as well as maintain the depressive symptoms. The psychosocial needs of women are often projected through the presentation of their depressive symptoms.

Aim:
The present study aimed to explore the psychosocial problems of married women diagnosed with depressive disorder.

Methods:
The study used a qualitative approach with exploratory research design. This study was carried out in the outpatient department of Lokopriya Gopinath Bordoloi Regional Institute of Mental Health in Tezpur (Assam). Purposive sampling was used and eight women were selected for the study. In-depth interviews were conducted to explore the psychosocial stressors, experiences, and illness narratives (idioms of distress) of these women. Among eight women who consented to participate in the study, six completed the study.

Results:
The salient findings of this study are that the women diagnosed with mild to moderate depressive disorders conveyed their mental health issues through various physical and emotional problems. Women expressed their problems primarily through somatic complaints, typically a variety of aches in different body parts, lethargy, excessive thinking, and decreased enthusiasm. Psychosocial factors centered around various social contexts and interpersonal issues, economic difficulties, marital difficulties and housing problems.

Conclusion:
The women’s narratives focuses predominantly on the socioeconomic and interpersonal difficulties as the underlying cause of their distressing symptoms is projective of psychosocial aberrations. Experiences expressed by women are located in their social world.
Effect of COVID-19 Lockdown on Intrafamilial Relationship in Urban Kakinada, Andhra Pradesh, India
Authors: Ganji Sravanthi , Babu G. Krishna , Prabha K. J. S. Surya , Babji K. 
Published: April 2023

Abstract

Background:
The COVID-19 pandemic has created public health crisis and economic instability globally. However, the pandemic and the nationwide lockdown have a significant impact on the psychosocial status, emotional state, relationships of individuals, family, and community. Families were facing challenges due to lockdown and will do their best to develop adaptive behavior for attaining self-stability. The present study helps to understand the effect of lockdown on family well-being and the shift of intrafamilial relationships during the lockdown.

Subjects and Methods:
A cross-sectional study was done in an urban area of Kakinada from April to June 2020. A convenient sample of 300 families was selected by systematic random method. One parent and one adolescent child from each family, a total of 600 study participants were included under the study. Data were collected using a semi-structured questionnaire, entered in Microsoft Excel and analyzed using IBM SPSS. The mean, frequencies, proportion, and Chi-square test were used to analyze data.

Results:
Adaptability has increased during lockdown by sharing of household work, from 3% before to 91.7%. 97.3% were happy spending time with family members. Communication and satisfaction have increased by a decrease in conflicts, from 19.7% to 7% during the lockdown. Only 3.08% of adults were facing either physical or verbal abuse.

Conclusions:
During the lockdown period, the family members spent quality time together acquired new skills, and conflicts among them were reduced. Domestic violence is low in this particular study area and familial bonding is high.
Comparison of NLR (neutrophil/lymphocyte ratio) and PLR (platelet/lymphocyte ratio) as inflammatory markers in 1st episode mania and bipolar mania: A preliminary study
Authors: Goyal Manish K. , Solanki Ram K. , Jain Akhilesh , Yadav Kuldeep S. 
Published: April 2023

ABSTRACT

Background:
There are various factors including inflammation that have been studied in bipolar disorder. NLR (Neutrophil to lymphocyte ratio) and PLR (platelet to lymphocyte ratio) are one of them. Various psychotropic drugs can affect the inflammatory state.

Aim:
This study was planned to find NLR and PLR in bipolar disorder (mania) and psychotropic drug naïve 1st episode mania.

Materials and Methods:
Total of 120 subjects were chosen including, 40 bipolar mania, 40 drugs naïve 1st episode mania, and 40 healthy controls. The severity of mania was assessed by the Young Mania Rating Scale. Blood samples were collected in the morning hours in order to get blood counts.

Results:
A significantly higher values of neutrophil counts and NLR, while the significant lower values of lymphocyte counts in both 1st episode and bipolar mania compared to healthy control were observed. The first episode mania group had significantly higher neutrophil counts and NLR in comparison to bipolar mania.

Conclusion:
Results suggest a possible inflammatory pathophysiology of mania. Psychotropic medicines may have an anti-inflammatory effect, signified by the fact that 1st episode mania group has a greater level of inflammation in comparison to bipolar mania.
Teachers’ perceptions of the impact of COVID-19 pandemic and virtual teaching on the physical and mental health of children in Kashmir: A qualitative study
Authors: Bashir Khalid , Kausar Zeenat , Khan S. Muhammad Salim , Qurieshi Mariya Amin , Haq Inaamul 
Published: April 2023

ABSTRACT

Background:
Children inherently want to remain engrossed in the activities as easily as possible within their ecological environment and academic curricular ambit. Covid-19 adversely affected our physical, social, and mental conditions and children were no exception.

Objectives:
To understand the experiences of teachers who have been doing virtual teaching to children during COVID-19; To understand the impact of virtual teaching and COVID-19 on physical and mental health of children.

Materials and Methods:
The qualitative study was conducted in the Kashmir valley and school teachers teaching students from class Ist to class 8th were involved in the study. Participants were selected purposefully based on the inclusion criteria. One-to-one in-depth interviews were conducted with sixteen (16) school teachers, using a preformed interview guide. Data analysis was performed using the thematic analysis method.

Results:
Data analysis yielded four overarching themes and twelve subthemes viz:- 1) Attitudes towards online sessions among teachers (2) factors affecting the physical and mental health of children (3) Effectiveness of online classes for individual lines of children’s mental development (4) External and internal factors impacting child development and pedagogy.

Conclusion:
The study result explicitly showed mental and physical health of children got considerably affected by online teaching during the Covid-19 pandemic. Online teaching especially to children is less yielding in terms of effective academic consequences. Nevertheless, blending online teaching with pedagogy can enhance certain multidimensional capabilities of the children.
A study of beliefs towards mental illness among teachers in Sikar city, Rajasthan
Authors: Kaur Navneet , Behere Nilam S. , Kulkarni Anjali S. 
Published: April 2023

ABSTRACT

Background:
Understanding the significance of adolescents’ mental health, school-based mental health interventions are being implemented with the help of teachers globally.

Aim:
Owing to the dearth of literature concerning the beliefs, and stigma among the teachers, the present study was conducted with an aim to study the mental health beliefs among teachers.

Methods:
This is a cross-sectional study conducted among randomly selected teachers teaching in government and private schools of Sikar city of Rajasthan. A general sociodemographic questionnaire, Beliefs Towards Mental Illness Scale, and a questionnaire about prior exposure to mental health issues was administered. Stata 15.0 was used for statistical analysis, and independent t-test and one-way analysis of variance test were applied to find out associations.

Results:
Majority of the participants were in age group of 31-40 years, married, and postgraduate. The mean Beliefs Towards Mental Illness Scale score of 147 teachers was 49.95 ± 17.34 of 105. Only 2% of the study participants have ever received training related to mental health issues. Teachers who had prior exposure to mental health issues, residing in semi-urban and urban areas showed more positive beliefs.

Conclusion:
Study participants have displayed negative beliefs toward mental health. This brings to light the important interventions like creating knowledge and awareness among the study population by conducting trainings. More research is needed to explore the mental health beliefs among the teachers.
Family intervention for expressed emotion in schizophrenia: Indian context
Authors: Shetty Kannappa V. , Math Suresh B. , Marimuthu Palaniappan , Rawat Vikram S. 
Published: April 2023

ABSTRACT

Background:
Expressed emotion (EE) being a part of the family environment could adversely affect the course and prognosis of schizophrenia.

Aim:
This study aimed to assess the effects of family intervention among the caregivers of persons with schizophrenia.

Methods and Materials:
The experimental research design was used for 80 caregivers of persons with schizophrenia. Sociodemographic interview schedule of caregivers, family emotional involvement and criticism scale, and mini international neuropsychiatric interview (MINI 6.0) were used for data collection. A standardized family intervention program involving 10 sessions was provided to caregivers. The intervention included six sessions of family psychoeducation, two sessions of communication training, one session of stress management, and one session on recap and referral services over a period of 2-3 months. The intervention used methods of social case and group work, social work principles, and therapeutic activities. The methodologies adopted a brainstorming technique, case vignettes, role plays, and video clippings concerning the topics of the day. Brief handout on intervention was given.

Results:
The RMANOVA score (F = 35.892; P =0.001) revealed that there was a significant reduction in EE of the caregivers of the intervention group who underwent the family intervention program in comparison with the control group.

Conclusion:
Family-based intervention was found to be effective for reducing EE in schizophrenia.
Comparison of Ultrasound Measured Gastric Volume in Term-Pregnant Patients Posted for Elective Cesarean Section with Nonpregnant Elective Surgery Patients---An Observational Study
Authors: Bellapukonda Snigdha , Podder Subrata , Kajal Kamal , Prasad G.R.V 
Published: April 2023

Background:
The pregnant patients undergoing anesthesia are at increased risk of aspiration due to decreased lower esophageal sphincter tone and mass effect of gravid uterus on gastric antrum. Ultrasound used as a noninvasive bedside imaging tool to measure gastric volume in term pregnant patients immediately before elective caesarian section (CS) may help in reducing aspiration induced morbidity and mortality.

Methods:
This observational prospective case--control study was conducted in 33 nonlaboring term pregnant patients immediately before elective CS and 30 nonpregnant patients immediately before elective surgeries, enrolled according to inclusion and exclusion criteria. A 2-5 MHz curvilinear probe was used to scan the participants in supine and right lateral decubitus (RLD) position in pre-recovery room. Visibility, qualitative grading (0,1, 2), anteroposterior (AP), and craniocaudal (CC) diameter, and cross-sectional area (CSA) of gastric antrum was measured. Gastric volume was derived from CSA using equations formulated by previous investigators.

Results:
Gastric antrum was visible in 27 (82%) of pregnant and 30 (100%) of nonpregnant patients in supine position (P = 0.014). In RLD position, 25 (75.7%) pregnant and 29 (96.7%) nonpregnant patients had antrum visible (P = 0.018). The qualitative grading was comparable (P = 0.064) in both the groups. In supine position, (P = 0.615), CSA in cm2 was 3.37 ± 1.31 and 3.54 ± 1.33, while in RLD position (P = 0.012), CSA was 3.98 ± 1.13 and 5.09 ± 1.85, in pregnant and nonpregnant patients, respectively.

Conclusion:
Gravid uterus sometimes impedes visualization of antrum by ultrasound in term pregnant patients immediately before elective CS and shows clinically similar gastric CSA when compared to nonpregnant patients, though statistically different in RLD position.

Trial registration number- NCT03380637
Effect of Intra-Abdominal Pressure on Maximum Level of Intrathecal Sensory Block: A Preliminary Randomized Controlled Trial
Authors: Jakhar Jubin , Gulabani Michell , Tyagi Asha , Sethi Ashok K. 
Published: April 2023

Objectives:
Increase in Intra-Abdominal Pressure (IAP) is commonly accepted as a cause for intrathecal dose sparing and consequently higher level of sensory block during pregnancy. There is however very little actual data evaluating the relationship. Thus, we aimed to evaluate association between IAP and maximum level of sensory block following intrathecal injection of hyperbaric bupivacaine as well as plain levobupivacaine for cesarean section.

Methods:
Preliminary randomized controlled blinded trial included females aged 18-40 years, scheduled for elective cesarean section under single-shot subarachnoid block. After randomization, they received either intrathecal hyperbaric bupivacaine (group H) or plain (isobaric) levobupivacaine (group P) in a dose of 12.5 mg (n = 40 each). IAP was measured before and after the spinal block, using the recommended intravesical technique. The maximum level of sensory block and the IAPs were measured in each patient.

Results:
There was no significant correlation of IAPprespinal with maximum level of sensory block for group H (P = 0.334; rs = -0.157) or group P (P = 0.637; rs = -0.078). Similarly, there was no significant correlation of the IAPpostspinal: group H (P = 0.370; rs = -0.145); and group P (P = 0.714; rs = -0.061). Both group H and group P had similar IAPprespinal (15.9 [14.3-18.2] and 15.3 [14.3-17.4] mmHg, respectively) (P = 0.474); as well as IAPpostspinal (15.2 [13.8-17.2] and 14.6 [13.4-16.0] mmH, g respectively) (P = 0.239). Among ancillary observations, duration of sensory block was significantly longer for group P versus group H (133.6 ± 24.2 and 103 ± 23.4 mins; P < 0.000). However, the maximum levels of sensory and motor block, respective times required to achieve them, as well as incidences of intraoperative hypotension and bradycardia were statistically similar between group H and group P (P > 0.05).

Conclusions:
The IAP was raised to the level of conventionally defined intra-abdominal hypertension (>12 mmHg) in patients scheduled for elective cesarean section. However, despite being increased, the IAPprespinal or IAPpostspinal did not show any significant association with the maximum level of sensory block (P > 0.05).