A study on correlation of computer vision syndrome and dry eye disease and knowledge regarding its associated factors amongst health professionals

Purpose: To know the magnitude and determinants of dry eye syndrome among health professionals and to study the correlation of computer vision syndrome with dry eye disease. Methods: In total, 501 participants took part in the study, which included history followed by baseline ocular examination, which included visual acuity using Snellen’s chart and anterior segment examination using a slit lamp. Later, a questionnaire was administered to health professionals to be filled out for analysis in the present study. Results: The symptoms reported occasionally were burning (35.5%), itching (34.5%), foreign body sensation 22.6%, and tearing (35.3%). The majority of participants used mobiles and laptops (56.1%) as a display. Also, 53.3% of participants have heard about dry eye syndrome, and the source of information was from friends and doctors in 17% of participants. One hundred twenty?one participants (24.2%) had taken the consultation for ocular symptoms. Eighty?six participants had mild, 29 participants had moderate, and 6 participants had severe dry eye disease, respectively. Conclusion: The pandemic effect, and the drastic shift of educational media from the classroom to the digital platform have increased the use of mobiles, laptops, or other digital pads for learning. This has increased the risk for health professionals.

The Challenges With The Standardization Of Ayurvedic Drugs

The use of Traditional medicinal products continues to grow rapidly across all over the world while the safety of these products has been raised. As the last century saw a predominance of communicable disorders this century can be considered as a century of Non communicable Diseases. The main issue here is people consuming traditional medicine along with contemporary with a preoccupied thought that these medicines are free from adverse effects. But all traditional systems are not like that. Ayurveda which is a complete and ancient system with the present aim of accomplishment of physical, mental, social and spiritual well being at a global front. Even though substitution, adulteration, improper focus on quality is pulling down the popularity of Ayurveda, hence purity and safety of Ayurvedic medicines along with strict Standardization is need of an hour.

Retinal Detachment as an Initial Presentation of Metastatic Breast Carcinoma – A Case Report

Ocular involvement in disseminated malignancies can present due to many reasons, most important being direct ocular infiltration by cancer cells. We present a case of choroidal metastatses. A 50-year-old female presented with sudden diminution of vision in the left associated with RAPD and deep episcleral congestion. Fundus examination revealed a solid retinal detachment and was confirmed by B-scan. Fine- needle aspiration cytology of the lymph node and retinal biopsy confirmed the features of adenocarcinoma breast. The past history confirmed the history of mastectomy and chemotherapy. She was later refereed for radiotherapy.

Mediclaim insurance challenges and solutions – Doctors supporting patients: A Medic LAWgic initiative

INTRODUCTION:Because patients covered by medical insurance are being denied legitimate claims, doctors are working shoulder to shoulder with them and have garnered significant experience in this matter. We, therefore, decided to a systematic survey under the Medic LAWgic banner and presented the data.METHODS:A short, 8-question multiple-choice survey was conducted online among doctor clinicians. Duplicate replies were removed. The remaining replies were evaluated, interpreted, and the data are being presented here.RESULTS:A total of 377 doctors responded. The majority (208, 55%) had faced problems with medical insurance claims in more than 10% of their patients. Almost half of them (48%) had outright rejection of the claims in more than 10% of their patients. Reduction in claim amounts was faced in more than 10% instances by 262 (70%). The five most common causes for refusal or rejection of claims included failure of patient to disclose pre-existing illness (234, 62%), other insurance policy terms related issues (157, 42%), oral medication (199, 53%), treatment without admission (155, 41%), and treatment with new modes of therapy (152, 40%). As many as 301/377 (80%) doctors had written letters to the insurance companies for supporting their patients’ claim. Such supporting letters from the treating doctors resulted in the claim being accepted or approved in 216 instances (57%).DISCUSSION:Mediclaim denial is a major and growing problem. People who need financial assistance the most are also the most vulnerable to denial. In the USA, such denial rates ranged from 1% to 45% of in-network claims in the year 2017. Unfortunately, <0.5% of patients appealed such claim denial. The insurance regulatory and development authority of India (IRDA) have issued guidelines that all claims need to be settled within 30 days and that insurance companies must fulfill their contractual commitment for genuine claims, even if timely intimation was not possible. Insurance companies are running a business for profit. Hence, even the most expensive plans will have a list of exclusions, in the fine print. Indian patients need to be proactive in following up when claims are rejected or reduced. Doctors are their pillar of support, whose advantage needs to be taken by them. IRDA and consumer courts are also looking after patients’ rights in this matter.CONCLUSION:Patients are increasingly facing challenge of medical insurance companies denying legitimate claims. Doctors help by writing to the insurance companies supporting their patients claim and such letters help in the majority of instances. Patients and their families need to follow up aggressively when their claims are not approved, rejected or reduced. They should also request the help of their doctors when facing such challenges.

Standard setting of objective structured practical examination by modified Angoff method: A pilot study.

Background.The undergraduate curriculum at our institution is divided system-wise into four blocks, each block ending with theory and objective structured practical examination (OSPE). The OSPE in Physiology consists of 12 stations, and a conventional minimum score to qualify is 50%. We aimed to incorporate standard setting using the modified Angoff method in OSPE to differentiate the competent from the non-competent student and to explore the possibility of introducing standard setting in Physiology OSPE at our institution. Methods. Experts rated the OSPE using the modified Angoff method to obtain the standard set cut-off in two of the four blocks. We assessed the OSPE marks of 110 first year medical students. Chi-square test was used to compare the number of students who scored less than standard set cut-off and conventional cut-off; correlation coefficient was used to assess the relation between OSPE and theory marks in both blocks. Feedback was obtained from the experts. Results. The standard set was 62% and 67% for blocks II and III, respectively. The use of standard set cut-off resulted in 16.3% (n=18) and 22.7% (n=25) students being declared unsuccessful in blocks II and III, respectively. Comparison between the number, who scored less than standard set and conventional cut-off was statistically significant (p=0.001). The correlation coefficient was 0.65 (p=0.003) and 0.52 (p<0.001) in blocks II and III, respectively. The experts welcomed the idea of standard setting. Conclusion. Standard setting helped in differentiating the competent from the non-competent student, indicating that standard setting enhances the quality of OSPE as an assessment tool. Natl Med J India 2016;29:160–2

Clinical, biochemical & cytomorphologic study on Hashimoto’s thyroiditis.

Background & objectives: Despite, the extensive salt iodization programmes implemented in India, the prevalence of goiter has not reduced much in our country. The most frequent cause of hypothyroidism and goiter in iodine sufficient areas is Hashimoto’s thyroiditis (HT). This study records the clinical presentation, biochemical status, ultrasonographic picture and cytological appearance of this disease in a coastal endemic zone for goiter. Methods: Case records of patients with cytological diagnosis of HT were studied in detail, with reference to their symptoms, presence of goiter, thyroid function status, antibody levels and ultrasound picture. Detailed cytological study was conducted in selected patients. Results: A total of 144 patients with cytological proven HT/lymphocytic thyroiditis were studied. Ninety per cent of the patients were females and most of them presented within five years of onset of symptoms. Sixty eight per cent patients had diffuse goiter, 69 per cent were clinically euthyroid and 46 per cent were biochemically mildly hypothyroid. Antibody levels were elevated in 92.3 per cent cases. In majority of patients the sonographic picture showed heterogeneous echotexture with increased vascularity. Cytological changes were characteristic. Interpretation & conclusions: our study showed predominance of females in the study population in 21-40 yr age group with diffuse goiter. We suggest that in an endemic zone for goiter, all women of the child bearing age should be screened for HT.

Retinopathy of Prematurity –Promising Newer Modalities of Treatment.

Retinopathy of prematurity (ROP) is a disorder of neonatal retinal vascularization. The incidence is increasing in developing countries like India in view of the rising numbers of preterm deliveries and improved neonatal care. Traditional modalities of treatment included cryotherapy and laser therapy, which were laborious and required special training. Hence, research is on way to find novel treatment modalities directed at various levels of pathogenesis for this blinding disease. We reviewed the published and unpublished literature on newer methods of ROP management. The pathogenesis of ROP has been studied with respect to the mediators of angiogenesis. Anti vascular endothelial growth factor (Anti-VEGF) therapy has been extensively studied and the studies have demonstrated its promising role early stages of ROP. The role of Insulin like growth factor (IGF), Granulocyte colony stimulating factor (GCSF), and June kinases (JNK) inhibitors are being studied by various researchers across the world. Gene therapy holds promise in the reversal of ROP changes.

Endobronchial metastasis from renal cell carcinoma: a case report.

A 46-year-old man had primary pulmonary symptoms of intermittent fever, cough and dyspnoea. Radiological investigations revealed a mass at right hilum with right upper lobe collapse. Bronchoscopy showed a luminal mass of which the biopsy showed a tumour with predominantly clear cell change. Subsequent investigations revealed primary renal adenocarcinoma. The differential diagnosis of clear cell lung tumour is discussed. This case of endobronchial metastasis from renal cell carcinoma is being presented because of its rarity.

Retrieval of a separated file using Masserann technique: a case report.

The separated instrument particularly a broken file leads to metallic obstruction, in the root canal and blocks thorough cleaning and shaping procedure. When attempts of bypassing such a fragment go in vain, it should be retrieved by mechanical devices. Masserann Kit is one such device for orthograde removal of intracanal metallic obstructions. This clinical case demonstrates usage of Masserann technique in successful retrieval of a separated file which was tightly binding in the apical 3rd root canal dentin of maxillary left lateral incisor.

Anatomical variation of maxillary sinus mimicking a periapical cyst: a case report.

Maxillary sinus can pose diagnostic dilemma radiographically because of its anatomical variation which can mimic a periapical pathosis. This case report deals with one such diagnostic problem, where a maxillary sinus was interpreted in an intraoral periapical radiograph as a periapical cyst. With the advances in imaging techniques, the use of an Ultrasound imaging together with application of Colour Power Doppler helped in revealing the contents of the radiolucent area and come up with an accurate diagnosis. Thus a thorough knowledge about the normal anatomy and its variations and proper diagnostic aids are essential in the diagnosis of periapical pathology.

Tilt table testing in the diagnostic evaluation of presyncope and syncope: a case-series report.

Tilt table testing has long been used as a standard tool in the diagnostic evaluation of syncope. However, differences of opinion exist with regard to its utility in the evaluation of patients with only presyncopal attacks. We present the results of drug-free, 70-degree head-up tilt table tests (maximum duration of 45 minutes), conducted between May 2002 and May 2003 in the Department of Physiology at JIPMER. This series consisted of both male and female patients (age 6-79 yr) with presyncope (n = 43), unexplained syncope (n = 43) and asymptomatic healthy volunteers without a history of syncope (n = 14). 28 out of 43 patients with unexplained syncope had a history of recurrent syncope while the remaining 15 had only 1 episode. 2 out of 43 patients (4.6%) with a history of only presyncopal attacks had a positive test (induction of intense presyncope and/or syncope accompanied by hypotension and/or a relative bradycardia). 21 out of 43 patients (49%) with a history of syncope had a positive test. 7 had vasodepressor syncope due to hypotension, 6 had cardioinhibitory syncope characterized by asystole and 10 had a mixed form of the vasovagal syndrome characterized by hypotension as well as bradycardia. 18 out of 28 patients (64%) with recurrent unexplained syncope had a positive test. All fourteen healthy volunteers had a negative test. We conclude that tilt table testing is useful in the diagnostic evaluation of patients with unexplained syncope, especially those with recurrent syncope, but not in the evaluation of patients with presyncope alone.

Prolonged release biodegradable vesicular carriers for rifampicin--formulation and kinetics of release.

An attempt has been made to design suitable liposome and niosome-encapsulated drug delivery system for rifampicin and evaluated the same in vitro and in vivo. A modified lipid layer hydration method was employed to prepare these vesicular carriers. The formulated systems were characterized in vitro for size distribution analysis, drug entrapment, drug release profiles and vesicular stability at different conditions of storage. In vivo drug kinetics was evaluated in normal, healthy albino rats for niosomal formulation upon subcutaneous injection and various pharmacokinetic parameters were determined. Niosomes and liposomes exhibited mean diameter of 9.73 and 11.87 microns with entrapment efficiencies of 30.5 and 34.2% respectively. Both the products exhibited sustained release characteristics in vitro with zero order drug release kinetics up to initial 10 hr. Stability evaluation indicated that both formulations were not significantly leaky over a period of one month. Niosomal formulation elevated plasma elimination half life and decreased elimination rate constants for rifampicin in vivo suggested that encapsulation retarded the removal of the drug from circulation compared to free drug due to slow drug release into systemic circulation. A five-fold increase in the area under plasma rifampicin concentration-time curve for niosomal rifampicin as compared to free drug indicated better bioavailability of encapsulated drug. It is evident from this study that niosomes and liposomes could be promising delivery systems for rifampicin with prolonged drug release profiles and reasonably good stability characteristics.

A comparative evaluation of apical linear dye penetration of Glass ionomer based sealers with conventional root canal sealers. An in vitro study.

This study was done to evaluate the clinical practicality of a new Water mixable Glass ionomer root canal sealer with conventional type 11a Glass ionomer cement, if used as a sealer, along with Zinc oxide Eugenol and Calcium Hydroxide containing sealers. Forty freshly extracted single rooted Maxillary incisors were selected for the study. Ten teeth were assigned for each sealer group. Access cavity was prepared, wording length determined, modified step-back preparation and obturation of the root canal done with lateral condensation technique. Assigned groups were Group 1--Type 11a Glass ionomer cement, Group 11--Mixed Tubliseal, Group 111--Mixed Sealapex, Group IV--Endion. Micro leakage Values were assessed by the amount of linear dye penetration in to the apical pulp space. Statistical analysis was done with one way analysis (ANOVA), using Fisher's 'F' test and students unpaired 't' test. Seal apex exhibited the least micro leakage value and found to be the best sealer among the four sealer groups.

Application of glass ionomer cements in restorative dentistry.

Dentistry was marked with radical changes in clinical restorative procedures. If the inherent characteristic of the ionomer cement was examined, it becomes very clear to the researcher as well as the dentist, that no other material has had an impact as comparable to glass ionomer cements on restorative dentistry. This scientific paper highlights the clinical applications of the cement in restorative dentistry. Glass ionomer cements are bioactive, by forming permanent adhesive bonds to dentin and enamel which enables them to prevent the development of secondary caries by providing an impermeable seal against the intrusion of oral fluids and other caries producing agents. The hydrophilic nature of the cement also makes them susceptible to the action of aqueous fluids before they are fully set, requiring that the freshly placed restoration be protected by varish, petroleum jelly or a low viscosity photo polymerizing bonding agent.

Modification of glass ionomer cements.

Glass Ionomer cement (the term was coined by B.E. Kent) has been described as a hybrid of silicate cements and zinc polycarboxylates. Scientific efforts were devoted to improving properties to make it a fully practical material for anterior and posterior restorations and secondarily properties were modified to extend its range of application. First half of 90's witnessed modifications that replace part or most of the original formulation with alternative filler particles or matrix setting reactions to make these materials more composite like. This article focuses on the various modifications of the basic Glass ionomer cement.

Acanthamoeba keratitis--a report of two cases.

Two cases of unilateral corneal ulcers caused by Acanthamoeba are reported. Neither of the patients had contact lenses at any time. The diagnosis was confirmed by Giemsa stain and cultures of the corneal scrapings.