A cross sectional study on nomophobia among medical students in Tirupati, Andhra Pradesh

Background: Medical students are using more applications of smartphones in their course besides the primary purpose of communication. The excessive usage of smartphone has given rise to a condition known as “nomophobia”. The objectives of the study are to estimate the prevalence of nomophobia and to evaluate the determinants of nomophobia among participants. Methods: A cross-sectional study was conducted from July to August 2022 among 320 undergraduate medical students of Sri Venkateswara Medical College, Tirupati. NMP-Q questionnaire used as a tool for data collection. Ethical clearance was obtained from the Institutional Ethical Committee and informed consent was taken from the participant. Collected data was coded and entered into a Microsoft excel and analysed using statistical package for the social sciences (SPSS) software version 21.0. Results: Prevalence of nomophobia among study subjects was found to be 100% (320); of which 59% showed moderate nomophobia followed by mild (35%) and severe nomophobia (6%). Nearly 60% of the students are using smart phone for communication, 56% for entertainment and 46% for study purpose. Conclusions: All participants were suffering from nomophobia with different grades of severity. It was significantly associated with age, year of study, number of apps used, average time spent with mobile and messages sent per day. Most of them were using smart phone for communication, entertainment and study purpose.

Cytokine gene polymorphism (interleukin-1β +3954, Interleukin-6 [−597/−174] and tumor necrosis factor-α −308) in chronic periodontitis with and without type 2 diabetes mellitus.

Background: Pro-inflammatory cytokine gene polymorphisms are potential candidates for susceptibility for both type 2 diabetes mellitus (DM) and chronic periodontitis (CHP). This study explored the association of interleukin‑1 beta (IL‑1 β) +3954, interleukin‑6 (IL‑6) −597/−174 and tumor necrosis factor‑alpha (TNF‑α) −308 single nucleotide polymorphisms in CHP with and without type 2 DM in Malayalam speaking subjects of Dravidian ethnicity. Materials and Methods: This case control study consisted of 51 chronic periodontitis with type 2 diabetes mellitus (CHPDM) and 51 CHP patients as cases and 51 healthy subjects as controls. Polymorphisms were identified by polymerase chain reaction amplification followed by restriction enzyme digestion and gel electrophoresis. Results: IL‑1 β (+3954) TT genotype and T allele were significantly associated with CHPDM group when compared with CHP (P = 0.001), whereas CC genotype and allele C was higher in CHP subjects (P = 0.001). For IL‑6 (−597) frequency of genotype GA/AA (P = 0.04) and allele A (P = 0.01) was lower in CHPDM group, and for TNF‑α −308 the frequency of genotype GA (P = 0.01) and allele A (P = 0.01) was higher in CHP subjects when compared with controls. Conclusions: In Malayalam speaking Dravidian population, IL‑6 (−597) genotype GA/AA and allele A appears to be protective for CHP with type 2 DM. Allele C of IL‑1 β +3954 and allele A of TNF‑α −308 appears to be risk factors for CHP individuals.

Successful transportation of human corneal endothelial tissues without cool preservation in varying Indian tropical climatic conditions and in vitro cell expansion using a novel polymer.

Background: Though the transplantation of human corneal endothelial tissue (CET) separated from cadaver cornea is in practice, its transportation has not been reported. We report the successful transportation of CET in varying Indian climatic conditions without cool preservation and the in vitro expansion of Human Corneal Endothelial Precursor Cells (HCEPCs) using a novel Thermo‑reversible gelation polymer (TGP). Materials and Methods: CET from cadaver corneas (n = 67), unsuitable for transplantation, were used. In phase I, CET was transported in Basal Culture Medium (Group I) and TGP (Group II) and in Phase II, in TGP cocktail alone, from three hospitals 250‑2500 km away, to a central laboratory. The transportation time ranged from 6 h to 72 h and the outdoor temperature between 20°C and 41°C. On arrival, CET were processed, cells were expanded upto 30 days in basal culture medium (Group A) and TGP scaffold (Group B). Cell viability and morphology were documented and Reverse transcription polymerase chain reaction (RT‑PCR) characterization undertaken. Results: In Phase I, TGP yielded more viable cells (0.11 × 106 cells) than Group I (0.04 × 106 cells). In Phase II, the average cell count was 5.44 × 104 cells. During expansion, viability of HCEPCs spheres in TGP was maintained for a longer duration. The cells from both the groups tested positive for B‑3 tubulin and negative for cytokeratins K3 and K12, thereby proving them to be HCEPCs. Conclusion: TGP preserves the CET during transportation without cool preservation and supports in vitro expansion, with a higher yield of HCEPCs, similar to that reported in clinical studies.

Collagen cross linking: Current perspectives.

Keratoconus is a common ectatic disorder occurring in more than 1 in 1,000 individuals. The condition typically starts in adolescence and early adulthood. It is a disease with an uncertain cause and its progression is unpredictable, but in extreme cases, vision deteriorates and can require corneal transplant surgery. Corneal collagen cross-linking (CCL) with riboflavin (C3R) is a recent treatment option that can enhance the rigidity of the cornea and prevent disease progression. Since its inception, the procedure has evolved with newer instrumentation, surgical techniques, and is also now performed for expanded indications other than keratoconus. With increasing experience, newer guidelines regarding optimization of patient selection, the spectrum of complications and their management, and combination procedures are being described. This article in conjunction with the others in this issue, will try and explore the uses of collagen cross-linking (CXL) in its current form.

Absence of kin discrimination in cannibalistic Anuran tadpoles of the frog Hoplobatrachus tigerinus (Daudin).

Kin discrimination was tested in the cannibalistic H. tigerinus tadpoles to know whether cannibalism is selectively directed towards non-kin members or it is indiscriminate. The association choice tests were conducted using satiated as well as starved subjects with the assumption that they will associate near non-sibs rather than near sibs with the intention of preferentially cannibalizing them. However, test tadpoles, fed or starved showed a random association choice with sibs and non-sibs, as in the end-bias stimulus blank tests. Therefore it is suggested that cannibalistic H. tigerinus tadpoles do not discriminate sibs from non-sibs and cannibalize on both rather indiscriminately.

Diagnostic categories of patients admitted into the prison ward of Institute of Mental Health,Hyderabad during the period 2009-2010

Background Criminal behavior is said to have an association with some psychiatric illnesses, esp. Schizophrenia.There is a modest significant relationship between schizophrenia and violence & crime which persists even aftercontrolling demographic and socio-economic variables.Aims To find out what diagnostic categories of psychiatric illnesses are prevalent in the patients admitted to prisonward of Institute of Mental Health, Hyderabad.Methods Retrospective analysis of records of prison ward patients was done.Results One in five of the patients admitted to prison ward had Schizophrenia mostly of paranoid type. Majority ofpatients were readmissions, because of poor compliance.Conclusions There is a dire need to strengthen prison mental health services.

Ultrasonographic evaluation of inflammatory swellings of buccal space.

Objectives : The main objective of the study was a) to differentiate cellulitis and abscess in buccal space region, b) to study the ultrasonographic anatomy of cheek region and c) to investigate the use of ultrasound in the diagnosis of inflammatory swellings of cheek region. Patients and Methods : The study consisted of 25 patients with unilateral buccal space inflammatory swellings of odontogenic origin. The contra lateral side was used as control. Toshiba ultrasonographic device with a linear array transducer (5-8 MHz) was used. The areas of interest were scanned under both transverse and longitudinal sections and were interpreted by a single observer. The clinical diagnosis of cellulitis or abscess was confirmed by the absence or presence of pus respectively both sonographically and by aspiration. Also various anatomical structures present in buccal space were studied. Results : Clinically 23(92%) were diagnosed as buccal space abscess and 2 (8%) were cellulitis. Ultrasonographically and therapeutically 24 (96%) were buccal space abscess and 1 (4%) was cellulits. The sensitivity of clinical criteria over ultrasonographic diagnosis was 96% with a specificity of 100%. Also the cheek thickness in males and females varied from 8.2 to 17.1mm with a mean of 11.6mm±2.1 (SD) and 8.2 mm to 14.2 mm with a mean of 11±1.8 (SD). The subcutaneous tissue appeared moderately echogenic, buccinator - highly echogenic, deep adipose tissue - less echogenic and parotid duct was appreciated as a thin hyperechogenic band crossing the buccinator muscle. Buccal space, masticator space and parotid space were appreciated. Conclusion : This study supports the ultrasonographic method of imaging of orofacial inflammatory swellings with high sensitivity and specificity. This imaging modality can also help in aspiration of pus in different spaces. We have described the ultrasonographic anatomy of the above mentioned spaces which can help a beginner in this field.

Association preference and mechanism of kin recognition in tadpoles of the toad Bufo melanostictus.

In experiments with specially designed choice tanks, tadpoles of Bufo melanostictus spend signifi cantly greater amounts of time near kin than near non-kin. However, in the absence of kin members, they prefer to spend more time near non-kin rather than stay away in isolation in the opposite blank zone with no company. This implies that association of toad tadpoles with their kin is due to attraction rather than repulsion from non-kin. Experiments designed to elucidate the sensory basis of kin recognition showed that toad tadpoles recognize their kin based on chemical cues rather than visual cues. They can also discriminate between homospecifi c non-kin and heterospecifi c (Sphaerotheca breviceps) tadpoles since the tadpoles spent signifi cantly greater amounts of time near the former than near the latter. These fi ndings suggest that where kin members are unavailable, selection may have favoured living with non-kin so as to derive benefi ts from group living and that a phenotype-matching mechanism may operate for both kin and species discrimination in B. melanostictus.

Calculating graft size and position in rotational corneal autografting: a simplified approach.

In eyes with eccentric corneal opacities partially involving the pupillary area, using a rotational corneal autograft, can help restore vision without the immunological complications associated with allografts. In this report, we describe a simple intraoperative method for determining trephine size and placement for rotational corneal autografting. This surgical approach helps in the planning and execution of rotational corneal autografting, to obtain good outcomes.

Updates on the surgical management of paediatric cataract with primary intraocular lens implantation

With the advent of modern surgical techniques, paediatric cataract has become much more manageable. Intraocular lens (IOL) implantation is the standard of care for patients over the age of 2 years. The use of IOL in young infants is still controversial. In addition, there are still unresolved issues, such as the minimum age at which IOL can be safely implanted, IOL power selection and IOL power calculation. The current trends in the management of the above challenges are discussed. Although numerous reports on the prevention and management of posterior capsule opacification have been published, there are ongoing intensive debates and research. Long-term postoperative complications like glaucoma and rhegmatogenous retinal detachment are problems that cannot be overemphasised and these issues are also reviewed.

Bilateral epithelial defects after laser in situ keratomileusis. Clinical features, management and outcome.

PURPOSE: To describe the preoperative characteristics, intraoperative details, management, and postoperative in patients with bilateral epithelial defects after laser in situ keratomileusis (LASIK). METHODS: Retrospective non-comparative case series. RESULTS: Six patients with bilateral epithelial defects after LASIK were part of a cohort of 605 patients undergoing bilateral LASIK at our center from December 2001 to April 2003. The mean age of the patients (5M:1F) was 28.5 +/- 7.9 years, and the average pretreatment myopic spherical equivalent (SE) refraction was 7.3 +/- 0.7 D (-4, -12.25D). An epithelial flap was present in 6 eyes and an epithelial defect with a mean diameter of 3 mm (2mm, 6mm) was seen in 6 eyes. In four patients the epithelial disturbance was bilaterally similar. All defects occurred in the inferior cornea and the epithelial flaps had the hinge positioned superiorly. None of the patients had ocular or systemic risk factors that could have resulted in this complication. A bandage contact lens was used in 6 eyes. At last follow-up of 5.5 +/- 9.5 months (0.25, 21 months), unaided visual acuity was 6/9 or better in 10 eyes. Best spectacle-corrected visual acuity (BSCVA) was maintained in 8 eyes, while 4 eyes lost one line of BSCVA. Recurrent corneal erosions were not reported in the follow-up period. CONCLUSIONS: These patients represent a hitherto unrecognised group of individuals who appear to have a subclinical weakness of adhesion of the corneal epithelium to the underlying structures, which is not evident on clinical examination. This results in bilateral epithelial disturbances after LASIK. Appropriate management results in satisfactory clinical outcomes. Other options for treatment of the fellow eye of such patients include the use of a different microkeratome, release of suction during the reverse pass of the Hansatome microkeratome, and photorefractive keratectomy if the refractive error is low.

Electrocardiographic localization of the occlusion site in left anterior descending coronary artery in acute anterior myocardial infarction.

BACKGROUND: The site of occlusion of left anterior descending coronary artery is important in acute anterior myocardial infarction because, proximal occlusion is associated with less favorable outcome and prognosis. The present study attempted to evaluate the electrocardiographic correlate of the location of the site of the left anterior descending coronary artery occlusion with respect to first septal perforator and/or the first diagonal branch. METHODS AND RESULTS: The study included 50 patients with a first acute anterior myocardial infarction. The electrocardiogram with the most pronounced ST segment deviation before the start of reperfusion therapy was evaluated and correlated with the left anterior descending occlusion site as determined by coronary angiography. ST segment elevation in lead aVR, ST segment depression in lead V5 and ST segment elevation in V1>2.5 mm strongly predicted left anterior descending occlusion proximal to first septal, whereas abnormal Q wave in V4-6 was associated with occlusion distal to first septal. Abnormal Q wave in lead aVL was associated with occlusion proximal to first diagonal, whereas ST depression in lead aVL was suggestive of occlusion distal to first diagonal branch. For both first septal and first diagonal, ST segment depression > or =1 mm in inferior leads strongly predicted proximal left anterior descending artery occlusion, whereas absence of ST segment depression in inferior leads predicted occlusion distal to first septal and first diagonal. All the patients were followed during their in-hospital stay (median of 7 days), during which four patients in the proximal to first septal and first diagonal group and one patient in the distal to first septal and first diagonal group died (p < or = 0.001). CONCLUSIONS: In acute myocardial infarction electrocardiogram is useful to predict the left anterior descending occlusion site in relation to its major side branches and such localization has prognostic significance.

Foraging behaviour in tadpoles of the bronze frog Rana temporalis: experimental evidence for the ideal free distribution.

The ability of bronze frog Rana temporalis tadpoles (pure or mixed parental lines) to assess the profitability of food habitats and distribute themselves accordingly was tested experimentally using a rectangular choice tank with a non- continuous input design. Food (boiled spinach) was placed at two opposite ends of the choice tank in a desired ratio (1 : 1, 1 : 2 or 1 : 4) to create habitat A and B. The tadpoles in Gosner stage 28-33, pre-starved for 24 h, were introduced in an open ended mesh cylinder placed in the center of the choice tank, held for 4 min (for acclimation) and then released to allow free movement and habitat selection. The number of tadpoles foraging at each habitat was recorded at 10, 15, 20, 25 and 30 min time intervals. The actual suitability, Si (the food available in a habitat after colonization of tadpoles) of each habitat was obtained from the equation Si = Bi - fi (di) where Bi is basic suitability (amount of food provided at each habitat before release of tadpoles), fi is the rate of depletion of food (lowering effect) with introduction of each tadpole, and di is the density of tadpoles in habitat i. The expected number of tadpoles at each habitat was derived from the actual suitability. With no food in the choice tank, movement of the tadpoles in the test arena was random indicating no bias towards any end of the choice tank or the procedure. In tests with a 1 : 1 food ratio, the observed ratio of tadpoles (11.71 : 12.28) was comparable with the expected 12 : 12 ratio. The observed number of tadpoles in the habitats with a 1 : 2 food ratio was 8.71 : 15.29 and 7.87 : 16.13 for pure and mixed parental lines respectively. In both cases, the observed ratios were close to the expected values (7 : 17). Likewise, in experiments with a 1 : 4 food ratio, the observed number of tadpoles in the two habitats (10.78 : 37.22) did not differ significantly from the expected ratio of 7 : 41. In all tests, the number of R. temporalis tadpoles matched ideally with habitat profitability (undermatching index K approximate, equals 1). The study shows that tadpoles of the bronze frog exhibit an ideal free distribution while foraging regardless of whether they are siblings or non-siblings in a group, which correlates well with their group living strategy in nature

Limbal stem cell transplantation.

The past two decades have witnessed remarkable progress in limbal stem cell transplantation. In addition to harvesting stem cells from a cadaver or a live related donor, it is now possible to cultivate limbal stem cells in vitro and then transplant them onto the recipient bed. A clear understanding of the basic disease pathology and a correct assessment of the extent of stem cell deficiency are essential. A holistic approach towards management of limbal stem cell deficiency is needed. This also includes management of the underlying systemic disease, ocular adnexal pathology and dry eye. Conjunctival limbal autografts from the healthy contralateral eye are performed for unilateral cases. In bilateral cases, tissue may be harvested from a cadaver or a living related donor; prolonged immunosuppression is needed to avoid allograft rejection in such cases. This review describes the surgical techniques, postoperative treatment regimes (including immunosuppression for allografts), the complications and their management. The short and long-term outcomes of the various modalities reported in the literature are also described.

Ophthalmic photography using a digital camera.

PURPOSE: To report the application of a digital camera for ophthalmic photography in routine clinical use. METHODS: A digital camera (Nikon Coolpix 995) was used both for external macrophotography of the eye and ocular adnexa, and slitlamp photography of the anterior segment of the eye. RESULTS: We were able to take external macrophotographs under high magnification of the eye and ocular adnexa. Slitlamp photography could be performed under diffuse, slit beam, and retroillumination. The structures of the angle, the optic disc and surrounding retina could be photographed using appropriate lenses. The attachment to the operating microscope allowed intraoperative photography. It could also be attached to the laboratory microscope to capture images of various histopathology and microbiology slides. CONCLUSIONS: A digital camera is a versatile instrument for ophthalmic photography. It is easy to use in routine clinical practice and provides good quality photographs.

Interface keratitis due to Mycobacterium fortuitum following laser in situ keratomileusis.

A case of unilateral interface keratitis due to Mycobacterium fortuitum following simultaneous bilateral LASIK procedure for low myopia is reported. Excimer phototherapeutic keratectomy was performed to the stromal bed to reduce the infective load. Intensive topical therapy with topical amikacin and ciprofloxacin resulted in resolution of the keratitis.

Complications of laser-in-situ-keratomileusis.

Laser-in-situ-keratomileusis (LASIK) has become a popular technique of refractive surgery because of lower postoperative discomfort, early visual rehabilitation and decreased postoperative haze. Compared to photorefractive keratectomy (PRK), LASIK involves an additional procedure of creating a corneal flap. This may result in complications related to the flap, interface and underlying stromal bed. The common flap-related complications include thin flap, button holing, free caps, flap dislocation and flap striae. The interface complications of diffuse lamellar keratitis, epithelial ingrowth and microbial keratitis are potentially sight threatening. Compared to PRK, there is less inflammation and faster healing after LASIK, but there is a longer period of sensory denervation leading to the complication of dry eyes. The refractive complications include undercorrection, regression, irregular astigmatism, decentration and visual aberrations. Honest and unbiased reporting is important to understand the aetiology and redefine the management.