bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intensive topical interferon therapy in uveitic macular edema
Authors: Kawali Ankush , Sanjay Srinivasan , Mohan Ashwin , Mahendradas Padmamalini , Shroff Sujani , Shetty Rohit 
Published: August 2022

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

Methods:
This is a prospective, interventional case study of eyes with UME. Commercially available injection IFN for subcutaneous use was reconstituted to form eye drops and a dose of 6 times/day for 2 weeks, 5 times/day for next 2 weeks, followed by 4, 3, 2, 1 taper per month was prescribed. Optical coherence tomography (OCT) and clinical examination was done at 0, 2, 4, 8 weeks, and further as required.

Results:
Nine eyes of 9 patients with UME were studied. Mean central macular thickness (CMT) at presentation was 522.2 mm (range: 408–803 mm). At 2-week, 1-month, and 2-month follow-up, mean CMT decreased to 451.6 mm (range: 322–524 mm), 375.8 mm (range: 287–480 mm), and 360.3 mm (range: 260–485 mm), respectively. Four eyes which showed inadequate response to previous topical IFN therapy (4 times/day) showed significant improvement with intensive therapy at 1 month follow-up. In 4 eyes, UME resolved completely with mean CMT 285.5 mm (range: 260–312 mm) at 7.5 weeks (range: 4–12 weeks). Study exit was seen in 2 cases due to inadequate response and relapse of uveitis. Mean follow up was 3.38 months (range: 1–5 months).

Conclusion:
Intensive topical IFN therapy can be an alternative therapeutic option in the treatment of UME. Study of intraocular penetration, combination with other drugs, and the efficacy of IFN separately for different uveitic entities may explore new avenues in treatment of UME.
To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes
Authors: Dhami Abhinav , Sharma Pragya , Dhami Nimrata B , Dhami Gobinder S 
Published: August 2022

Purpose:
To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes.

Methods:
This is a retrospective study analyzing medical records of consecutive patients with refractory macular hole (at least 1 prior surgery) and eyes with retinal detachment with coexisting macular holes (MH). Optical coherence tomography (OCT) of the macula was performed before and after surgery. The primary study outcome evaluated were the functional and anatomic macular hole closure, and secondary outcomes were improvement in visual acuity and restoration of the outer retinal bands, external limiting membrane, and ellipsoid zone in eyes with acquisition of autologous retinal transplant using Finesse Loop.

Results:
The study included eight eyes of eight patients; retinal autograft was performed in six (75.0%) and autologous retinal transplantation (ART) with rhegmatogenous retinal detachment (RRD) was performed in two (25.0%) eyes. The average MH basal diameter in the study was 1310.88 ± 138.63 µm. The successful hole closure rate was observed to be 75% (6 eyes) and 100% retinal reattachment was observed in ART with RRD. Statistically significant (P = 0.001) improvement was noted for preop and postop visual acuity gain for ART acquisition and postop macular hole closure. The restoration of the external limiting membrane (ELM) and ellipsoid zone (EZ) was observed in 37.5% (3 eyes) of patients.

Conclusion:
Finesse™ Flex Loop can be used to harvest retinal tissue and it provides good anatomical and functional outcomes for failed macular hole.
Steep increase in myopia among public school-going children in South India after COVID-19 home confinement
Authors: Saara Krishnamurthy , Swetha Saravanan , Subhiksha Rangavittal , Amirthaa Murali , Anuradha Narayanan 
Published: August 2022

Purpose:
Novel coronavirus has brought huge changes in lifestyle, especially among children. Reports indicate that the prevalence of refractive errors among children has increased due to home confinement. Hence, this study was done to understand the current status of refractive errors among children from public schools in southern India.

Methods:
This cross-sectional study was conducted as part of school eye screening conducted between September and October 2021. Children between 14 and 17 years of age from public schools underwent a three-phased comprehensive eye examination. Children identified with refractive errors and an equal proportion of children without any refractive errors underwent a survey on outdoor activities. Prevalence estimates and 95% confidence interval were calculated. Chi-square tests and regression analysis were used to understand the association between refractive error and other variables.

Results:
From the data of 3,850 (90.69%) children, the prevalence of vision impairment, refractive errors, and myopia in at least one eye was found to be 12.83% (n = 494), 21.51% (n = 828), and 19.53% (n = 752), respectively. The average myopic spherical equivalent error was found to be -2.17 ± 1.11D (range:-0.50 D to -14.00 D). Almost 96.82% of girls had less than 3 h of outdoor activities. Refractive errors were 7.42 and 2.77 times more (95% CI: 3.51-15.70), P < 0.001) among children who had outdoor activities less than 3 h per day and sleep less than 7 h per day.

Conclusion:
Comparing to previous studies from North Indian and South Indian public schools, this study reports a three- to six-fold rise in myopia post-home confinement among public school children from India.
Uncontrolled diabetes mellitus exacerbated by COVID-19–induced inflammation is the risk factor for COVID-19–associated rhino-orbito-cerebral mucormycosis: A matched pair case–control study
Authors: Karat Shubashree , Lobo Aaron C , Satish Deepthi , Devaraj Rincy , Manjooran Riya R , Nithyanandam Suneetha 
Published: August 2022

Purpose:
Amidst the ongoing coronavirus disease 2019 (COVID-19) pandemic, India experienced an epidemic of COVID-19–associated rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to describe the epidemiology and elucidate the risk factors for developing COVID-19–associated ROCM, comparing the risk factors among COVID-19 patients with and without ROCM.

Methods:
This case–control study included all COVID-19–associated ROCM patients treated at our hospital from May 1 to July 30, 2021. Controls included age- and sex-matched COVID-19 patients without ROCM, who were treated during the same time (exact matching, in 1:2 ratio). Matched pair analysis using conditional logistic regression was performed to examine the association of various risk factors with the development of ROCM in COVID-19 patients.

Results:
The study included 69 patients with COVID-19–associated ROCM and 138 age- and gender-matched controls. Epidemiologically, COVID-19–associated ROCM predominantly affected males (59/69, 85%), in their early 50s (mean 52 years), with 48% (33/69) of patients being from medical resource-constrained settings. On multivariate conditional logistic regression, elevated serum glycated hemoglobin (HbA1c) (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.03–1.78), blood glucose (OR = 1.008, 95% CI: 1.003–1.013), and C-reactive protein (CRP) (OR = 1.07, 95% CI: 1.02–1.17) were associated with increased odds of developing COVID-19–associated ROCM. Patients with undetected diabetes mellitus with increasing HbA1c (OR = 3.42, 95% CI: 1.30–9.02) and blood glucose (OR = 1.02, 95% CI: 1.005–1.03) (P = 0.02) had a higher probability of developing COVID-19–associated ROCM than patients with established DM.

Conclusion:
Uncontrolled DM evidenced by elevated HbA1c and blood glucose levels, exacerbated by COVID-19–induced proinflammatory state indicated by elevated CRP, is the principal independent risk factor for COVID-19–associated ROCM. Middle-aged males with undetected DM, from a resource-constraint setting, are particularly at risk.
Clinical and imaging characteristics of outer retinal folds in eyes with retinitis
Authors: Dhewale Saurabh , Kelgaonkar Anup , Khalsa Ashish , Padhy Srikanta Kumar , Behera Umesh Chandra , Padhi Tapas Ranjan , Basu Soumyava 
Published: August 2022

Purpose:
To describe clinical and imaging characteristics of the outer retinal folds (ORF) in cases of retinitis, retinochoroiditis, and chorioretinitis.

Methods:
Retrospective review of retinitis cases with presence of ORFs either at presentation or during follow up.

Results:
ORFs were seen adjacent to retinitis lesions in 16 eyes of 14 cases (retinitis post-febrile illness n = 10, toxoplasma retinochoroiditis n = 2, fungal chorioretinitis n = 2) either at presentation (n = 2) or during follow up (n = 14). Optical coherence tomography (OCT) appearance was outer retinal vertical stout lesions involving ellipsoid, external limiting membrane, and outer nuclear layer. All the cases had a presence of past or concurrent subretinal fluid and/or subretinal hyperreflective material when ORF was seen. ORF resolved with variable outer retinal atrophy over a mean period of 2.86 months.

Conclusion:
ORF is observed in cases of retinitis with subretinal fluid either at presentation or during resolution. It is not specific to any etiological disease. Differentiation of this sign from vertical outer retinal stripes in viral retinitis on OCT is important to avoid misinterpretation.
Innovation Urrets-Zavalia syndrome
Authors: Narang Priya , Narang Rhea 
Published: August 2022

Background:
Surgeons often notice unexplained dilation of the pupil following an uncomplicated intra-ocular surgery. No definite line of treatment has been proposed for managing Urrets-Zavalia syndrome (UZS). The authors have previously documented the results of surgical pupilloplasty and have outlined this modality of treatment for cases with UZS.

Purpose:
To highlight the aspect of development of UZS post-operatively in the eyes following an intra-ocular surgery.

Synopsis:
The video highlights the aspect of prevalence of the persistently dilated pupil that is non-responsive to topical miotics. Apart from associated glare, these cases often have raised intra-ocular pressure because of appositional closure of the anterior chamber angle. Surgical pupilloplasty pulls the iris tissue centrally, eventually releasing the mechanical blockage and often breakage of the peripheral anterior synechias as demonstrated by intra-operative gonioscopy and anterior segment optical coherence tomography.

Highlights:
Performing a surgical pupilloplasty can resolve the UZS, and timely intervention can also prevent the development of secondary glaucoma because of fallback of the iris tissue on the structures of the anterior chamber angle.

Online Video Link:

https://youtu.be/IF_w8dVk5_w

Key words: Dilated pupil, SFT, single-pass four-throw, surgical pupilloplasty, Urrets-Zavalia, UZS
Development of a Questionnaire on Awareness about Occupational Therapy among Health-Care Professionals
Authors: Bhardwaj Shivani , Sharma Raj Kumar , Sethuraman Lakshmanan , Dwivedi Amit 
Published: August 2022

Background:
Occupational therapists are recognized as essential members of the health-care team. Occupational therapy treatments are required to deliver better services and to promote a comprehensive service approach. Occupational therapy awareness is critical for providing high-quality care to all patients. There is, however, a paucity of studies aimed at determining occupational therapy awareness and knowledge. This study aimed to develop a questionnaire to assess health-care professionals' (HP's) awareness and knowledge of occupational therapy.

Objectives:
This study aimed to develop a reliable questionnaire to assess HP's awareness and knowledge about occupational therapy.

Study Design:
This study was based on a cross-sectional design.

Methods:
The questionnaire was created in three stages. Initially, the first stage was to do a literature review for item generation. The second stage was to circulate a draft of the questionnaire among experts for face validity, and stage three was to test the reliability of items.

Results:
The generated items underwent face validity by ten experts. After face validation, the final questionnaire consisting of two sections (awareness and knowledge about OT and advocacy) were circulated to fifty health-care professionals. A statistical analysis (Cronbach's alpha) was done to analyze internal consistency, which indicates α = 0.78.

Conclusion:
This study concludes that the questionnaire is reliable for exploring awareness and knowledge about occupational therapy.
Gender Differences in Quality of Life and Subjective Happiness in Indian Elderly
Authors: Moirangthem Sarju , Ojha Gita Jyoti 
Published: August 2022

Background:
As aging is associated with lower quality of life (QOL), it is important to determine overall QOL and its related factors among older adults. Studies have shown that gender plays an essential role in the perception of health across cultures. As very few studies has been conducted on gender disparity in the elderly in India. Thus, the study was conducted to assess the differences in QOL and subjective happiness between male and female community-dwelling elderly.

Objectives:
The study was conducted to assess the differences in QOL and subjective happiness between male and female community-dwelling elderly in India. Study

Design:
The study design involves a cross-sectional survey.

Methods:
The data were collected from community-dwelling elderly (>60 years of age) based on convenient sampling. QOL and subjective happiness were tested by World Health Organization QOL (WHOQOL)-BREF and the Subjective Happiness Questionnaire. Informed consent was taken before administering the study-specific questionnaire via mail, telephone, or in person. Only completed questionnaires were used. Data hence collected were analyzed.

Results:
The data were analyzed by descriptive analysis, whereas the differences between gender on QOL and happiness were computed using the t-test and Mann–Whitney test, respectively. Gender and educational qualification correlated with QOL measure WHOQOL (P = 0.05; 95% confidence interval [CI]: 0.014, 0.527). Furthermore, a positive correlation (P = 0.01; 95% CI: 0.994, 0.998) was found between WHOQOL-BREF and the Subjective Happiness Questionnaire. For the overall QOL and general health section in WHOQOL-BREF, males scored a mean ± standard deviation (SD) of 3.825 ± 0.71 and 3.275 ± 1.15, whereas females scored a mean ± SD of 3.875 ± 0.56 and 3.35 ± 1.21. For the four domains of WHOQOL-BREF except for domain 4 (t = 2.17; 95% CI: 26.13, 28.06), mean ± SD (27.10 ± 4.35), (P = 0.033), and Subjective Happiness questionnaire, the differences in the means of elderly males and females were nonsignificant on Mann–Whitney test.

Conclusion:
This study shows that gender-related factors influence specific areas of QOL, such as females scoring less in physical and psychological factors, whereas scoring better than males in social relationship and environment areas.
Reduction of Metal Artifacts Caused by Titanium Peduncular Screws in the Spine by Means of Monoenergetic Images and the Metal Artifact Reduction Software in Dual-Energy Computed Tomography
Authors: Ceccarelli Luca , Vara Giulio , Ponti Federico , Miceli Marco , Golfieri Rita , Facchini Giancarlo 
Published: August 2022

Objectives:
To evaluate the reduction of metal artifacts in patients with titanium peduncular screws in the spine using (1) conventional images (CI), (2) virtual monoenergetic reconstructions (VMRs), and (3) VMR + Metal Artifact Reduction Software (VMR + MARS), with dual-energy computed tomography (DECT).

Materials and Methods:
Twenty-four patients with titanium peduncular screws in the spine were studied using a 64-channel DECT. During the postprocessing phase, the CI, the VMRs from 100 to 140 keV, and the VMR at 140 keV + MARS were synthesized. All the images were considered, and a quantitative evaluation was performed measuring the attenuation values (in terms of Hounsfield Units) with region of interest, in correspondence with the most hyperdense and hypodense artifacts. All the values were then compared. A qualitative evaluation, in terms of image quality and extent of artifacts, was also performed by two radiologists.

Results:
In quantitative terms, the 140 keV + MARS reconstruction was able to significantly reduce both bright and dark metal artifacts, compared to CI and to VMRs. The VMR was capable of significantly reducing both dark and bright artifacts, compared to CI. In qualitative terms, the VMR at 140 keV proved to be the best, compared to CI and VMR + MARS images.

Conclusions:
The VMR + MARS image reduces metal artifacts from titanium peduncular screws more than VMRs alone and CI. Furthermore, the VMR can decrease metal artifacts from a quantitative and a qualitative point of view. Combining information from VMRs and VMR + MARS images could be the best way to solve the issue of metal artifacts on computed tomography images.
Determination of Dose Distributions by Monte-Carlo Simulation of 6 MV Photon Beam of Varian VitalBeam Accelerator Using Geant4 Multithreaded Code
Authors: Chiuyo Julius S. , Lugendo Innocent J. , Muhogora Wilbroad E. 
Published: August 2022

Background:
Accuracy of dose delivery in radiation therapy is a primary requirement for effective cancer treatment. In practice, dose delivery accuracy of ±5% is desired. To achieve this accuracy level, an accurate method for calculating the dose distributions in the tumor volume is required. Monte-Carlo method is one of the methods considered to be the most accurate for calculating dose distributions.

Materials and Methods:
G4 linac-MT code was used to simulate a 6 MV photon beam. The initial electron beam parameters were tuned to validate the beam modeling from depth doses and beam profile. The dose distributions measured in water phantom were compared to the calculated dose distributions based on gamma index criterion.

Results:
The beam tuning showed the initial electron energy, sigma and full width at half maximum of 6.2 MeV, 0.8 MeV, and 1.18 mm, respectively, best match the measured dose distributions. The gamma index tests showed the calculated depth doses and beam profile were generally comparable with measurements, passing the standard acceptance criterion of 2%/2 mm. The simulated photon beam was justified by the index of beam quality, which showed excellent agreement with measured doses with a discrepancy of 0.1%.

Conclusion:
The observed agreement confirm the accuracy of the simulated 6 MV photon beam. It can therefore be used as radiation source for calculating dose distributions and further investigations aimed at improving dose delivery and planning in cancer patients.
Biological Evaluation of Grid versus 3D Conformal Radiotherapy in Bulky Head and Neck Cancer
Authors: Alanizy Najah Abdulmuneem , Attalla Ehab Marouf , Abdelaal Ahmed Mosa , Yassen Mohamed Nabil , Shafaa Medhat Wahba 
Published: August 2022

Grid radiotherapy is one of the treatment techniques applied to treat patients with advanced bulky tumors.

Purpose:
This study aims to estimate the difference in biological and dosimetric parameters of the grid radiotherapy technique for the treatment of bulky head and neck (H and N) tumors and compare it with conventional conformal radiotherapy.

Subjects and Methods:
Three-dimensional conformal and grid radiotherapy were designed by the Monaco treatment planning system (TPS). Eight bulky tumors of (H and N) cases were selected, using a single fraction 15–20 Gy. Dose-volume histogram of the tumors and organs at risk (OARs) used to calculate the equivalent uniform dose (EUD) (Gy) by Matlab program. Furthermore, dosimetric parameters of the tumors from the TPS were compared for two techniques (grid radiotherapy and the conventional conformal radiotherapy).

Results:
Grid attained a lower EUD (Gy) in tumors and OARs as compared to conformal therapy, as Grid principle protects about half of the tumor area from the radiation leads to less coverage of the tumor. Also, where OARs in closed with tumors and the shielding by multi-leaf (1 cm) were more effective than other techniques, lead to a decrease of radiobiological values according to its definition by Niemierko. Radiobiological results showed significant differences between the two methods, and dosimetric data obtained by the TPS for tumours for two plans were P < 0.05.

Conclusions:
The grid plan achieves lower values of EUDs than the conformal technique for OARs. Hence, it achieves more sparing and fewer complications for these organs.
Flattening Filter-Free Volumetric-Modulated Arc Radiotherapy for Left-Sided Whole-Breast, Partial-Breast, and Postmastectomy Irradiations
Authors: Zhang Rui , Xie Yibo , DiTusa Chloe , Ohler Raymond , Heins David , Bourgeois Daniel , Guo Beibei 
Published: August 2022

Purpose:
Unflattened photon beams exhibit many benefits over traditional flattened beams for radiotherapy (RT), but comprehensive evaluations of dosimetric results and beam-on time using flattening filter-free (FFF) beams for all types of breast irradiations are still lacking. The purpose of this study was to investigate if FFF RT can maintain equal or better dose coverage than standard flattened-beam RT while reducing doses to organs at risk (OARs) and beam-on time for various types of breast cancer irradiations.

Methods and Materials:
FFF volumetric-modulated arc therapy (FFF-VMAT) and standard VMAT (STD-VMAT) treatment plans were created for 15 whole-breast irradiation (WBI) patients with 50 Gy/25 fractions, 13 partial-breast irradiation (PBI) patients with 38.5 Gy/10 fractions, and 9 postmastectomy irradiation (PMI) patients with 50 Gy/25 fractions. Planning target volume (PTV) coverage and dose to OARs were evaluated.

Results:
Both techniques produced clinically acceptable plans for all three types of irradiations. For WBI, FFF-VMAT plans exhibited similar PTV and OARs evaluation metrics as STD-VMAT. For PBI, FFF-VMAT plans showed significantly lower mean and maximum doses for ipsilateral and contralateral lungs, contralateral breast, and heart. For PMI, FFF-VMAT plans showed significantly lower mean dose and V5 for contralateral breast but significantly higher Dmean, Dmax, and V20 for ipsilateral lung and significantly higher Dmean, V22.5, and V30 for heart. FFF-VMAT techniques significantly reduced beam-on time than STD-VMAT for all cases.

Conclusion:
This work has shown that FFF beams are most beneficial for small-field irradiation such as PBI, and breast cancer patients could potentially benefit from the shortened beam-on time.
Significance of Dosimetric Parameters in Patients Undergoing Gamma Knife Radiosurgery for Vestibular Schwannoma
Authors: Jayaprakash Shobha , Pendse Anil M. , Deshpande Sudesh 
Published: August 2022

Vestibular schwannoma (VS) is a benign, encapsulated, and slow-growing tumor of the myelin-forming cells of the 8th cranial nerve. Gamma Knife radiosurgery (GKRS) has become a widely accepted primary treatment modality for small- to medium-sized VSs. In the case of VS, highly conformal, precisely focused radiation is delivered to the acoustic tumor in a single session under the direct supervision of a radiosurgery team

Aim:
This study aims to determine the significance of Conformity Index and Gradient Index (GI) in patients undergoing GKRS for VS, retrospectively, and re-assess the plans.

Materials and Methods:
A dosimetric study of 112 patients of VS (both operated and nonoperated) treated on Gamma Knife Perfexion unit at our hospital, over a 3-year period, was carried out retrospectively. The patients’ mean age at the time of GKRS was 48 years and the mean dose to the tumor margin was 13 Gy. The conformality of the treatment plan was determined by Conformity Index. GI determines fall off dose outside the target.

Results:
The dosimetric parameters such as Conformity Index and GI were calculated using the dose-volume histograms and the volume analysis tools available in the Leksell Gamma Plan using TMR 10 algorithm. The mean Paddick Conformity Index was found to be around 0.80 ± 0.085 and the mean GI was 2.67 ± 0.22.

Conclusions:
The dosimetric parameters can be used to evaluate the dose coverage and conformity and dose fall off outside the target.