bluuebunny/crossref_metadata_2025_split huggingface dataset:
An analysis of the clinical profile of patients with uveitis following COVID-19 infection
Authors: Ganesh Sudha K , Mohanan-Earatt Amanda 
Published: February 2022

Purpose:
To describe the clinical profile of patients presenting with uveitis following COVID-19 infection at a tertiary care eye hospital in South India.

Methods:
In this retrospective chart review, all consecutive cases presenting with an acute episode of intraocular inflammation and a history of COVID-19 infection diagnosed within the preceding 6 weeks, between March 2020 and September 2021, were included. Data retrieved and analyzed included age, sex, laterality of uveitis, and site of inflammation. The diagnosis was categorized based on the SUN working group classification criteria for uveitis. Details regarding clinical features, investigations, ophthalmic treatment given, response to treatment, ocular complications, and status at last visit were also accessed. Statistical analysis of demographical data was done using Microsoft Excel 2019.

Results:
Twenty-one eyes of 13 patients were included in this hospital-based retrospective observational study. The study included six male and seven female patients. The mean age was 38 ± 16.8 years. Eight patients had bilateral involvement. Seven patients were diagnosed with anterior uveitis, three with intermediate uveitis, one with posterior uveitis, and two with panuveitis. All patients responded well to treatment and were doing well at their last visit. Two patients had complications that necessitated surgical treatment, following which they recovered good visual outcomes.

Conclusion:
With prompt diagnosis and appropriate management, all the patients with uveitis post-COVID-19 infection recovered with good visual outcomes. Thus, ophthalmologists must be aware of the possible uveitic manifestations following even uneventful COVID-19 infection.
Evaluation of reinforced plication as an alternative to resection in exotropia
Authors: Daga Darshana , Pujari Amar , Sharma Pradeep , Phuljhele Swati , Saxena Rohit 
Published: February 2022

Purpose:
To evaluate the surgical efficacy of reinforced plication of the medial rectus muscle to resection as an effective muscle strengthening procedure in exotropia.

Methods:
This is a prospective randomized trial in patients with exotropia who underwent complete orthoptic evaluation followed by random assignment into two groups by using a computer-drawn random number table. Group 1 patients underwent standard resection with recession procedure, and group 2 patients underwent reinforced plication with recession procedure. Follow-up was performed at day 1, 1 week, 1 month, 3 months, and 6 months to assess the surgical efficacy.

Results:
A total of 80 patients were included in the study of which 39 were in group 1 and 41 in group 2. The mean age in group 1 was 23.48 ± 11.94 years and 23.29 ± 10.02 years in group 2. The mean preoperative deviation in group 1 for distance was 50.13 ± 11.95 PD and 50.12 ± 9.79 PD in group 2 (P = 0.499). In group 1 with a mean surgical dose of 5.27 mm medial rectus resection and 8.04 mm lateral rectus recession, a 7.11 ± 3.95 PD deviation was noted at the end of 6 months. Similarly, in group 2 with a mean surgical dose of 5.16 mm medial rectus plication and 8.16 mm lateral rectus recession, a 6.00 ± 2.46 PD deviation was noted at the end of 6 months. Between groups, ocular surface changes, inter-surgeon comparison, and exotropia subtypes did not reveal any significant differences.

Conclusion:
In our observation, the reinforced medial rectus muscle plication showed clinically comparable results as compared to the standard resection procedure at the end of 6 months. Therefore, this innovative modification can be considered as an alternative to standard resection.
Iridodialysis repair – A simplified approach
Authors: Shekhar Madhu , Prasad R Senthil , Anusha A 
Published: February 2022

Background:
Iris root is the thinnest and weakest portion of the iris stroma. It can detach easily due to blunt trauma or accidental engagement of the iris during intraocular surgery resulting in glare, photophobia and monocular diplopia. Multiple techniques described for iridodialysis repair such as hang back technique, stroke and dock technique and sewing machine technique are technically challenging.

Purpose:
To describe an simplified approach of iridodialysis repair using 9-0 prolene suture.

Synopsis:
We demonstrate the technique of iridodialysis repair using animation for better understanding. Scleral flap is made adjacent to the iridodialysis area and a paracentesis is made oppsite to the iridodialysis. One arm of the double armed straight needle with 9-0 prolene suture is passed through the paracentesis into the iris root and docked in the 26G needle which is passed underneath the scleral flap 1.5mm posterior to the limbus. Then the needle is pulled out underneath the scleral flap and the manoeuvre is repeated for the second arm as well. The sutures are secured with 5-6 knots under the scleral flap. Intra-operative surgical videos of two patients with traumatic cataract and iridodialysis following blunt trauma are shown. After stabilizing the detached iris using iris hooks, phacoemlsification is done with implantation of foldable acrylic IOL, followed by iridodialysis repair as described above. Both the patients were relieved of their pre-operative symtoms and had good visual recovery.

Highlights:
We describe a simplified approach of iridodialysis repair that can significantly reduce the patient’s troublesome symptoms such as glare and monocular double vision.

Online Video Link:

https://youtu.be/-axYnSfWSb0
Unfolding falciform folds and their consequences - To touch or not to touch
Authors: Boral Subhendu Kumar , Mitra Santanu 
Published: February 2022

Background:
Falciform folds are congenital tractional retinal folds due to strong contractile forces and hyperextensibility of retina resulting in temporal dragging of the macula and often associated with familial exudative vitreoretinopathy and retinal detachment (RD). Retinologists are reluctant to treat these entities in view of their poor visual recovery.

Purpose:
To describe a novel surgical technique to unfold the falciform folds.

Synopsis:
This video demonstrates innovative surgical techniques to remove both pre-retinal and sub-retinal adhesions and unfold these folds, managing its consequences and visual recovery. We describe cases of congenital falciform folds with poor visual acuity, where we did vitrectomy, membrane adhesion removal, peeling of the internal limiting membrane (ILM) the macula, mechanical stretching of the folded retina by Tanno scraper or Finesse flex loop, then sub-retinal injection of balanced salt solution (BSS) by 38 gauge sub-retinal needle o create multiple blebs around the folded retina and finally sulphur hexafluoride tamponade. Post-operative macular hole with RD can be a complication. When this falciform fold is complicated by RD, there is risk of intraoperative subretinal migration of infusion cannula and therefore the need for peripheral relaxing retinectomy for redundant retinal fold as well as silicone oil as endotamponade. Vision improved in all our patients after the surgery.

Highlights:
Both long-standing pre-retinal adhesions as well as sub-retinal adhesions are responsible for he tformation of congenital falciform folds. For pre-retinal adhesions, vitrectomy with removal of all the adhesions along with peeling of the sticky ILM and then mechanical stretching of folded retina by Tanno scraper or Finesse flex loop are necessary. To remove sub-retinal adhesions, sub-retinal injection of BSS is necessary to stretch the folded retina from behind, but it should be done away from the retina to avoid formation of macular hole.

Online Video Link:

https://youtu.be/9h8IE3abKIM
Isolated Unilateral Palatal Palsy Secondary to COVID-19 Infection in a Child
Authors: Valdoriya Dwarkesh , Botre Abhijeet , Udavant Prashant 
Published: February 2022

Background:
Unilateral acquired isolated palatal paralysis is a very rare entity seen in children. It usually occurs due to isolated involvement of the pharyngeal branch of the vagus nerve. The definite etiopathogenesis is still unclear, but postinfectious immune-associated cranial mono-neuropathy is frequently postulated as plausible cause. We report an Indian girl who presented with isolated right palatal palsy following a coronavirus disease 2019infection. To the best of our knowledge, this has never been described in the literature before.

Clinical Description:
A 7.5-year-old girl child presented with nasal twang of voice and nasal regurgitation of liquids mainly from the right side of her mouth for 7 days. There was no evidence of any other neurological or systemic involvement. There was no history suggestive of any of the common causes usually attributed to palataopharyngeal palsy. Examination revealed right palatal palsy with deviation of the uvula to the left confirming lower motor neuron weakness of the pharyngeal branch of the vagus nerve.

Management:
Routine investigations excluding usual etiological causes were normal. The severe acute respiratory syndrome–corona virus 2 (SARS-CoV-2) immunoglobulin G antibody test was positive. The final diagnosis was postinfectious immune-mediated demyelinating isolated right palatal palsy. The child responded dramatically to a short pulse of methylprednisolone for 3 days and did not display any sequelae on follow-up.

Conclusion:
In the setting of the current pandemic, we recommend including SARS-CoV-2 serology in the routine workup of children presenting with isolated palatal palsy.
Fetus in Fetu
Authors: Kazia Athiya Perveen , Mathews Shirbin Joe , Vasu Priya Poickattusseril , Krishnadas Sajitha 
Published: February 2022

Background:
Fetus in fetu (FIF) is a rare congenital anomaly in which a parasitic fetus is trapped inside the body of its twin. The incidence is 1 in 500,000 births. Initially, considered as a mature teratoma, it was later identified as a separate entity due to the presence of an axial skeleton and organized limbs.

Clinical Description:
A 48-day-old girl presented with an antenatally detected calcified intra-abdominal mass. She had a palpable retroperitoneal mass measuring 6 cm × 4 cm at the left lumbar area. Sonology showed a heteroechoic cystic mass in the left lumbar region. Serum markers were normal except for a slightly elevated serum lactate dehydrogenase. Contrast-enhanced computerized tomography of the abdomen showed a well-defined cystic lesion measuring 7.6 cm × 6.5 cm × 5.9 cm with enhancing septae, multiple calcific foci, teeth, and bones in the left suprarenal region displacing the left kidney.

Management:
Laparotomy showed a cystic appearing mass with solid components within. Cystic structure was the amniotic covering and solid component turned out to be the FIF with a face, limbs, and umbilical cord. No adjacent infiltration was seen. Pathology confirmed the finding of FIF with an identifiable vertebral column, umbilical cord, pelvis and lower limb bones, skin, and retinal and brain tissue. The infant has been under follow-up for a year and is thriving.

Conclusion:
FIF is a rare condition of infancy which can be diagnosed preoperatively by radiological examination, treated by complete excision, and confirmed by gross and histopathology. Differentiation of FIF from teratoma is mandatory as the latter can be malignant.
An Unusual Cause of Acute Encephalopathy
Authors: Jain Prashant , Prasad Ashish , Sharma Rachna , Vasudevan Vibin 
Published: February 2022

Background:
Blood D-lactate levels increase in short bowel syndrome (SBS) and may lead to neurological manifestations.

Clinical Description:
A 5-year-old boy, postoperative case of SBS, presented with loose stools, generalized weakness, and lethargy for 2 days. The child had undergone significant intestinal resection in the past. On examination, he had some dehydration, and was drowsy, but arousable. Remaining examination was normal. Metabolic abnormalities detected included metabolic acidosis (pH of 7.1, HCO3 7 mmol/L), high anion gap (20 mmol/l), and normal lactate levels (2 mmol/L). Other baseline investigations were normal. He was treated as a case of acute gastroenteritis with some dehydration and metabolic acidosis and improved. He was discharged after 5 days. After 2 months, he was readmitted with drowsiness and unsteady gait. This time there was no diarrhea or dehydration. Investigations again revealed severe metabolic acidosis, high anion gap, and normal lactate levels.

Management:
We considered SBS induced D-lactate encephalopathy but were unable to prove it by assay due to unavailability of tests. The child was kept nil per orally and given bicarbonate infusion, on which he showed dramatic improvement. He was also given a low carbohydrate diet and oral metronidazole. The family was counseled at discharge 5 days later regarding dietary modifications and microsupplementation. The patient had 6 admissions for D-lactic encephalopathy over 4 years that coincided with dietary lapse.

Conclusion:
D-lactate acidosis is an underrecognized condition and its diagnosis and management is challenging. A high index of suspicion should be kept in patients with history of intestinal resection presenting with acute encephalopathy and unexplained metabolic acidosis.
Using Innovative Narrative Therapies with Children who Witness Intimate Partner Violence
Authors: Malhi Prahbhjot , Bharti Bhavneet 
Published: February 2022

Background:
Intimate partner violence (IPV) is a form of abuse in which one partner causes physical, psychological, or sexual harm to the other, in the relationship. Exposure of children to this kind of domestic abuse is quite common in India, though not openly discussed. The management of children who present with functional somatic symptoms (suspected to be psychogenic in nature) is extremely challenging, especially since the history of IPV is not easily forthcoming. This case series highlights the evocative power of trauma-creative narrative interventions, such as poetry writing and story-telling, that help children express their fears and distress in a safe environment. This in conjunction with other modalities of management helps in their healing.

Clinical Description:
We present three children presenting with various functional somatic symptoms belonging to dysfunctional families. Comprehensive in-depth interviews, psychological assessment, and kinetic family drawings helped us assess each case, elicit the history of IPV, and understand the nature of the individualized fears and distress being experienced.

Management and Outcome:
The primary interventions used were creative narrative interventions such as asking the children to draw, write poems, and/or tell stories about their family and the situations they were experiencing. This helped them express their feelings of helplessness and latent anger arising from witnessing these violent events. Facing their fears in a safe environment resulted in successful resolution of somatic symptoms of all the three over time. This healing was reflected in the change in expressions via the art, poems, and written/oral narrations. Other strategies like provision of psychoeducation, highlighting the connection between symptoms and the underlying trauma, referral for marital counselling, and improving social support were also used.

Conclusions:
Pediatricians should have a high index of suspicion of the possibility of psychosomatic conditions when their patients display inexplicable manifestations that do not fit into any recognizable clinical phenotype, either by description or after investigation. These children and adolescents should be referred for a psychological evaluation and further eclectic management. The use of creative narrative therapies in conjunction with other modalities can lead to successful resolution of functional somatic symptoms.
Autosegmentation of lung computed tomography datasets using deep learning U-Net architecture
Authors: Mehta Akash , Lehman Margot , Ramachandran Prabhakar 
Published: February 2022

ABSTRACT

Aim:
Current radiotherapy treatment techniques require a large amount of imaging data for treatment planning which demand significant clinician’s time to segment target volume and organs at risk (OARs). In this study, we propose to use U-net-based architecture to segment OARs commonly encountered in lung cancer radiotherapy.

Materials and Methods:
Four U-Net OAR models were generated and trained on 20 lung cancer patients’ computed tomography (CT) datasets, with each trained for 100 epochs. The model was tested for each OAR, including the right lung, left lung, heart, and spinal cord. Dice similarity coefficient (DSC) and Hausdorff distance (HD) were used to assess the agreement between the predicted contour and ground truth.

Results:
The highest of the average DSC among the test patients for the left lung and the right lung was 0.96 ± 0.03 and 0.94 ± 0.06, respectively, and 0.88 ± 0.04 for heart, and 0.76 ± 0.07 for the spinal cord. The HD for these corresponding DSCs was 3.51 ± 0.85, 4.06 ± 1.12, 4.09 ± 0.85, and 2.76 ± 0.52 mm for left lung, right lung, heart, and spinal cord, respectively.

Conclusion:
The autosegmented regions predicted by right and left lung models matched well with the manual contours. However, in a few cases, the heart model struggled to outline the boundary precisely. The spinal cord model had the lowest DSC, which may be due to its small size. This is an ongoing study aimed to assist radiation oncologists in segmenting the OARs with minimal effort.
Taxane-induced acute interstitial pneumonitis in patients with breast cancer and outcome of taxane rechallenge
Authors: Anoop T M , Joseph Rona , Unnikrishnan P , Thomas Flowerlit , Venugopal M 
Published: February 2022

Background:
Although rare, taxane-induced interstitial pneumonitis is a well-recognized toxicity following chemotherapy. Data on taxane rechallenge in patients who developed taxane-induced interstitial pneumonitis following chemotherapy are limited. Here, we share our experience of acute interstitial pneumonitis following taxane chemotherapy for breast cancer and its clinical outcome following steroids and subsequent rechallenge with taxanes in selected patients without residual lung abnormalities on imaging following steroid treatment.

Objectives:
To study the taxane-induced acute interstitial pneumonitis in patients with breast cancer receiving chemotherapy and outcome of taxane rechallenge in these patients.

Materials and Methods:
Patients with breast cancer who developed taxane-induced acute interstitial pneumonitis following chemotherapy either with paclitaxel or docetaxel were included.

Results:
Among 1240 patients with breast cancer, who received chemotherapy with either docetaxel or paclitaxel, 41 patients developed taxane-induced acute interstitial lung disease (ILD) during the study period. The interstitial pneumonitis was more seen with docetaxel. Among paclitaxel regimens, weekly schedules showed more cases of ILD than 2 weekly paclitaxel. After steroid pulse/maintenance treatment, complete resolution of lung abnormalities was seen in 76%, but residual interstitial pattern on imaging was noted in 24% of patients. Taxane rechallenge was done in 20 (49%) patients. Agents used were paclitaxel, nab-paclitaxel, or docetaxel. All rechallenged patients received short-course oral steroids for one week following taxane rechallenge as a safety measure. Rechallenge was not done in 51% either due to patient unwillingness for rechallenge (27%) or patient with residual interstitial pattern on imaging (24%). None of the patients experienced any recurrence of pneumonitis or any mortality following taxane rechallenge.

Conclusion:
Acute interstitial pneumonitis is a well-known toxicity following taxanes in breast cancer and taxane rechallenge is an option in those patients without any residual pneumonitis following steroid pulse/maintenance. We also advise short-course oral steroids for 1 week following taxane rechallenge as a safety measure. We strongly do not recommend rechallenge in patients with residual lung abnormalities after steroids.
Long-term oxygen therapy prescription in India: Evaluation of compliance, factors affecting compliance, indications, and survival
Authors: Patro Mahismita , Gothi Dipti , Anand Shweta , Agarwal Mohit 
Published: February 2022

Introduction:
The international data shows that long-term oxygen therapy (LTOT) compliance is insufficient and variable. We conducted the first study from India on LTOT compliance, factors affecting compliance, indications, and survival through oxygen concentrator.

Materials and Methods:
Our organization from Delhi had given 378 oxygen concentrators over the last 5 years. We evaluated 120 patients randomly for participating in the study. Compliance was defined as the use of LTOT for at least 15 h/day.

Results:
Ninety-seven patients were included in the final analysis after exclusion criteria. The compliance to LTOT was seen in 45.36% (44/97). The commonest cause of noncompliance was lack of instructions (49.06%) followed by electricity issues, social stigma, and workplace constraints. A higher PaCO2 was associated with significantly lower compliance (PaCO2 53.18 vs. 44.98 mmHg, P = 0.036). Interstitial lung disease was associated with significantly higher compliance. Oxygen prescription was titrated with arterial blood gas analysis in only 4.12%. The indications for LTOT were chronic obstructive pulmonary disease (49.48%), posttuberculous obstructive airway disease (20.6%), and interstitial lung disease (12.37%). We found a significant reduction in the mean number of exacerbations/year from 3.91 to 1.93 (P < 0.0001). 61.86% of the patients were surviving on LTOT with a median survival time of 12 months.

Conclusion:
The adherence to LTOT in Indian patients is suboptimal mainly due to lack of instruction and is associated with a higher PaCO2. The practice of titration needs to be followed. The development of a national registry to monitor LTOT should be the long-term target.