Topographic distribution of retinal neovascularization in proliferative diabetic retinopathy using ultra-wide field angiography

Purpose: To analyze the topographic distribution of neovascularization (NV) and capillary nonperfusion (CNP) using ultra?wide field fluorescein angiography (UWFFA) in patients with proliferative diabetic retinopathy (PDR). Methods: This was a prospective, single?center, observational study in which all patients who presented between March 2019 and December 2020 and satisfied the inclusion criteria were recruited. In our study, patients with treatment?naïve PDR without any fibrovascular proliferation underwent UWFFA. The images were analyzed qualitatively for the topographic distribution of NV and the CNP area was quantified. The number of lesions picked by UWFFA was compared with 7 standard field (7SF) image using overlay of 7SF. The main outcome measure was characteristics of neovascularization, such as the number, location, and area of CNP, measured using UWFFA, which was considered with 95% confidence intervals (CI). Results: Two hundred and fifty?three eyes of 187 patients with a mean age of 56.03 ± 8 years were included. Mean neovascularization elsewhere (NVE) was 2.91 ± 3.43. Maximum NVEs were seen in the superotemporal (ST; 0.9 ± 1.13) quadrant, followed by the inferotemporal (IT; 0.7 ± 1.08), inferonasal (IN; 0.66 ± 1.02) and superonasal (SN; 0.66 ± 1.01) quadrants. Maximum CNP area was seen in the SN (13.75 ± 8.83 disc diameter square [DD2]) quadrant, followed by the IN (13.48 ± 8.59 DD2), IT (11.34 ± 8.37 DD2), and ST (11.3 ± 8.34 DD2) quadrants. Mean CNP area was maximum in patients with only neovascularization of disc (NVD; 64.99 ± 41.47 DD2), followed by both NVD and NVE (61.37 ± 35.61 DD2), and was minimum in patients with only NVE (36.44 ± 22.03 DD2). Eighty?one (32%) eyes out of 253 had NVE and 189 (75%) out of 253 had CNP area outside 7SF (overlay) of Early Treatment Diabetic Retinopathy Study (ETDRS). Conclusion: Diabetic NV lesions and CNP areas are distributed asymmetrically throughout the retina and are not restricted to the posterior pole. Compared to conventional 7SF imaging, UWFFA reveals significantly more retinal vascular pathology in patients with PDR.

A pilot non-randomized trial of smartphone-based anaglyph system for treatment of adult amblyopia through VR (Virtual Reality)

Purpose: To evaluate the effectiveness of amblyopia treatment through a smartphone?based anaglyph system by virtual reality (VR) in adult patients. Methods: A total of 10 subjects diagnosed with anisometropic amblyopia were enrolled during the study period. Best Corrected Visual Acuity (BCVA), stereoacuity, and contrast acuity were evaluated during three visits (at presentation, 3 months and 6 months) of smartphone?based anaglyph video run in the VR mode. All the amblyogenic factors including stereopsis, color vision, and contrast acuity were compared using Friedman two?way analysis of variance. Statistical significance was considered if P < 0.05. Results: Mean BCVA in amblyopic eye improved significantly from a logMAR value of 0.73 ± 0.64 before Virtual reality vision therapy (VRVT) to a post?training VRVT value of 0.48 ± 0.44 (P < 0.01). Mean stereoacuity changed from a value of 560.00 ± 301.58 before VRVT to a value of 263.00 ± 143.58 seconds of arc after training (VRVT) (P < 0.01). Mean accommodation changes from a value of 15.00 ± 7.40 before training or VRVT to value of 12.60 ± 6.10 cm after training (P < 0.01). Mean contrast acuity changes from a value of 1.21 ± 0.72 at presentation to a value of 1.52 ± 0.49 log unit after VRVT. Conclusion: A smartphone?based anaglyph system using VR vision therapy appears to be an effective treatment option for amblyopia in adults.

Prevention and management of childhood progressive myopia: National consensus guidelines

Myopia is a major public health problem worldwide, including India, with the global prevalence of myopia increasing rapidly over decades. The clinical and socioeconomic impact of myopia is also expected to rise with rising prevalence. Therefore, the focus has now been shifted to prevent the incidence and progression of myopia. However, there is lack of any standardized guidelines for myopia management. This document aims to generate a national-level expert consensus statement on the management of childhood myopia in the Indian scenario. The expert panel of pediatric ophthalmologists consisted of 63 members who met in a hybrid meeting. A list of topics deliberating discussion in the meeting was provided to the experts in advance and they were instructed to provide their opinions on the matter during the meet. The panel of experts then gave their views on each of the items presented, deliberated on different aspects of childhood myopia, and reached a consensus regarding the practice patterns in the Indian scenario. In case of opposing views or lack of a clear consensus, we undertook further discussion and evaluated literature to help arrive at a consensus. A written document is prepared based on recommendations explaining definition of myopia, refraction techniques, components and methods of workup, initiation of anti-myopia treatment, type and timing of interventions, follow-up schedule, and indications for revised or combination treatment. This article formulates evidence-based guidelines for progressing myopes and pre-myopes and also establishes uniformity in the management of childhood myopia in the country.

Non-pathologic components are associated with reduced visual acuity in myopes after spectacle correction

Purpose: To find the association between reduced best?corrected visual acuity and non?pathologic components after optical correction in individuals with low to high myopia. Methods: Myopic children under 16 years of age were reviewed using electronic medical records and the following data were extracted and recorded: participant’s age, gender, uncorrected visual acuity (UCVA), manifest refraction, and best corrected visual acuity (BCVA). Spherical equivalent and cylinder were classified into low, moderate, and high categories based on the magnitude range. Similarly, astigmatism was defined into with?the?rule, against?the?rule, and oblique based on the location of the steepest meridian. Reduced BCVA was defined when the decimal visual acuity was less than 0.66 (equivalent to Snellen’s acuity of 6/9 or 20/30). Logistic regression was performed to test the factors associated with reduced visual acuity after optical correction in the absence of myopic pathologic changes. Statistical significance was considered if P < 0.05. Results: Overall 44.9% (N = 242/538) of myopes had reduced best?corrected visual acuity (BCVA) and none of the patients had pathologic myopic lesions. Using logistic regression, we found that high spherical refraction (OR 27.98, 95% CI 14.43–54.25, P < 0.001) and moderate spherical refraction (OR 5.52, 95% CI 2.56–11.91, P < 0.001) were significantly associated with reduced best corrected visual acuity despite any pathological lesions. Additionally, oblique and ATR astigmatism were associated with reduced visual acuity in myopic children with (OR 2.05, 95% CI 0.77–5.42) and (OR 1.59, 95% CI 0.82–3.08). Conclusion: Higher magnitude of refractive error components causes reduced visual acuity in the absence of pathologic changes.

METFORMIN INDUCED ENCEPHALOPATHY IN PATIENT WITH END STAGE RENAL DISEASE

Glucose lowering biguanides were discovered in the 1920s. Due to the association of phenformin and buformin with lactic acidosis, they were withdrawn from the market, but metformin was continued to be used as there was lesser incidence of latic acidosis when compared to Phenformin and buformin , and in fact, it is considered as the first-line drug of choice for type 2 diabetes mellitus (DM) especially in those with normal renal function. It is contraindicated in patients suffering from chronic kidney disease, liver disease, renal failure as there is increase chance of lactic acidosis. It can also rarely induce encephalopathy through lactic acidosis, hypoglycemia, renal impairment, and liver failure. There are only few case reports of metformin encephalopathy in end-stage renal disease (ESRD). we report one such case in a patient with end-stage renal failure undergoing maintenance hemodialysis.

Iron profile of pregnant sickle cell anemia patients in Odisha, India

ABSTRACT Introduction: During pregnancy, the iron requirement increases to meet the optimal growth of the fetus and prevent iron deficiency anemia-related complications in the mother. However, in sickle cell disease (SCD) primarily due to repeated blood transfusions and hemolysis-induced recycling of iron, its supplementation during pregnancy remains questionable and may be harmful. Methods: Twenty-five pregnant women with homozygous SCD and 25 pregnant women with normal hemoglobin variants were included as cases and control, respectively. Pregnancy and sickle cell anemia (SCA) were diagnosed using standard protocols. The serum iron, serum ferritin, total iron-binding capacity (TIBC), percentage transferrin saturation and C-reactive protein were estimated, as per the manufacturer's protocol. The complete blood count was performed. The unpaired 't-test' was performed using the SPSS v23.0 and the principal component analysis (PCA) was performed using the online software MetaboAnalyst for statistical analysis. Main Results: The studied cases had significantly lower mean hemoglobin and higher mean corpuscular volume (MCV), compared to controls. The mean serum-iron, serum-ferritin and percentage transferrin-saturation in the cases were significantly higher than that of the controls, while the TIBC was lower in the cases (p < 0.0001). The mean level of serum iron, ferritin, percentage transferrin saturation and TIBC were 309.44 ± 122.40mcg/dl, 860.36 ± 624.64ng/ml, 42.6 ± 17.30% and 241.32 ± 96.30 mcg/dl, respectively, in the cases and 95.36 ± 41.90mcg/dl, 122.28 ± 49.70ng/ml, 15.83 ± 3.10% and 492.6 ± 149.40mcg/dl in the controls, respectively. Higher MCV, mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) with lower hemoglobin (Hb) were noted in the cases. The PCA revealed that the cases were more heterogeneous in terms of the variability of the iron status and hematological indices than the controls. Conclusion: The current study shows iron sufficiency in most cases of pregnancy with SCA and suggests that evaluation of iron status must be made before initiating iron prophylaxis in pregnant women with SCA, especially in regions having a high prevalence of sickle cell hemoglobinopathy.

Simplifying biometry in oil-filled eyes: A novel formula for axial length calculation in eyes with 1000 cSt silicone oil

Purpose: To derive a formula for accurate axial length (AL) assessment using routine ultrasound in silicone oil?filled eyes, where optical biometry is unavailable or not possible. Methods: This was a prospective, consecutive, nonrandomized study of 50 eyes of 50 patients conducted in a tertiary care hospital in North India. AL measurements were taken using both manual A?scan and IOL master, both in silicone oil?filled status and 3 weeks after silicone oil removal. A correction factor of 0.7 was used for AL adjustment in oil?filled eyes. The corrected AL (cAL) was compared with IOL master values in oil?filled eyes. Agreement analysis was carried out using Bland Altman plot. Linear regression analysis was done using uncorrected manual AL to find a new equation. Data was analyzed using Stata 14. A P value <0.05 was taken as significant. Results: The study included 40 males and 10 females, with an age range of 6–83 years (mean 41.9 years). The mean AL of the oil?filled eye as measured by manual A?scan was 31.76 mm ± 3.09 and by IOL master was 24.7 mm ± 1.74. Linear regression analysis was performed in randomly selected 35 eyes of the observed data to obtain a new equation: predicted AL (PAL) = 14 + 0.3 × manual AL. The mean difference between PAL and optically measured AL with silicone oil in situ was 0.98 ± 1.67. Conclusion: We propose a new formula for better prediction of the correct AL in silicone oil?filled eyes using ultrasound?based AL measurement.

Applicability of near-miss tools to address maternal mortality

In India, there is a mandate to increase institutional delivery, which has led to an overwhelming response in health-care delivery. The maternal mortality rate has been an essential yardstick, used by health-care planners to assess the quality of obstetric services. As of late, there has been a shift in focus to maternal near-misses (MNMs) as a more valuable indicator of maternal health than the maternal mortality rate. The aim of this research article was to compare various standardized tools to address MNM, namely, the World Health Organization MNM tool, The Government of India's facility-based MNM review tool, etc.

Basal Cell Adenocarcinoma - 2 Case Series of a Rare Entity

Introduction: Basal cell adenocarcinoma is a rare well recognized low grade malignant salivary gland tumor often resembles basal cell adenoma. the infiltrating growth pattern and likelihood of vascular and perineural involvement distinguishes basal cell adenocarcinoma with basal cell adenoma. Case presentation: Here we present histopathological and immune histochemical analysis of two such rare cases of basal cell adenocarcinoma and review of literature is discussed. Conclusion: Basal cell adeno carcinoma is a low grade malignancy and doesn’t metastasize. With only few hundreds of cases that has been reported in literature, basal cell adeno carcinoma should be included as differential diagnosis in salivary gland tumors in order not to miss the diagnosis

Point-of-Care Ultrasound in Neonatology in India: The Way Forward

The clinician-performed point-of-care ultrasound (POCUS) is a useful tool, and its scope includes bedside assessment of pulmonary (e.g., pneumothorax, pleural effusion), cardiac (e.g., pulmonary hypertension, ductus arteriosus), gastrointestinal (e.g., necrotising enterocolitis), and intracranial (e.g., intraventricular hemorrhage, cerebral blood flow velocities) pathologies, procedural guidance and rapid assessment of etiologies of acute clinical deterioration (e.g., pneumothorax, poor cardiac contractility, intraventricular hemorrhage). Despite its potential to improve patient care, a curriculum and a structured program for POCUS training is lacking in India. Homogenous approach to training and ongoing quality assurance is essential to optimize benefits of POCUS as an effective tool in clinical practice. The training needs, the legal and infrastructural barriers to successful implementation of POCUS, and strategies to implement the program at the national level are discussed.

Evaluation of optical coherence tomography angiography changes in nonarteritic anterior ischemic optic neuropathy

Purpose: To study the long?term microvasculature changes at the macula and the optic disk in eyes with nonarteritic anterior ischemic optic neuropathy (NAION). Methods: Patients with acute NAION of less than 6 weeks duration were included. Optical coherence tomography angiography (OCTA) of the macula and the optic disk was performed at baseline, 3 and 6 months and compared with the controls. Results: The mean age of 15 patients was 52.25 (±9.06) years. The whole image superficial peripapillary density (42.49 ± 5.28) was significantly low when compared to that of control eyes (46.36 ± 2.09); similarly, radial peripapillary capillary density (49.35 ± 5.64) was also significantly reduced when compared to controls (53.45 ± 1.96, P < 0.05). These parameters showed significant progressive decrease at 3 and 6 months (P < 0.05). At the macula, both superficial (41.83 ± 3.64) and deep macular vasculature densities (47.30 ± 2.04) were significantly reduced when compared to control eyes (52.15 ± 4.84 and 55.13 ± 1.81, respectively). The vascular density at the macula remained stable at 3? and 6?months period. Conclusion: The study shows that the microvasculature in case of NAION is significantly reduced both in peripapillary area and in macular area.

Application-of-the-proposed-sydney-system-in-reporting-of-the-lymph-node-cytopathology—a-retrospective-study

Introduction: Fine needle aspiration cytology (FNAC) is a widely accepted first line of investigation to diagnose the cause of lymphadenopathy. A standardized categorization and reporting system for lymph node cytology was proposed in 20th International Congress of Cytology at Sydney which consisted of 5 categories (L1, L2, L3, L4, L5) with management recommendations for each. Aims and Objective: To review the application of the Sydney system in achieving a uniform standardized approach for classifying and reporting lymph node cytology and to assess the risk of malignancy (ROM) for each category. : A 2 year single institute retrospective study. Clinical details were collectedMaterials and Methods from the patient records and cytology smears were reviewed by 2 cyto-pathologists as per the Sydney system. Histological correlation was done wherever possible. Statistical analysis was performed. 437 cases were re-Results: evaluated, with mean age of 39.66 years, slight male preponderance and cervical lymph node being the most common site. L2/Benign was the most common category with reactive lymphoid hyperplasia being the most common diagnosis and metastatic squamous cell carcinoma was the most common L5/malignant diagnosis. Histopathological correlation was available for 40 (9.1%) cases and the highest calculated risk of malignancy (ROM) was for L4 and L5 categories (100% each). The diagnostic accuracy of the proposed Sydney system in our study was 96.66%. TheConclusion: proposed Sydney system improves the diagnostic accuracy and standardizes the reporting of lymph node cyto- pathology. It improves the patient care by giving management recommendation to the clinicians.

Knowledge, attitude, and practice of childhood myopia among Indian optometrists: A questionnaire-based study

Purpose: To investigate the knowledge of myopia and its natural history including complications and clinical approaches for management adopted by optometrists across India. Methods: An online survey was distributed to Indian optometrists. A pre?validated questionnaire was adopted from previous literature. Respondents provided information about their demographics (gender, age, practice location, and modality), myopia knowledge, self?reported practice behaviors relating to childhood myopia, the information and evidence base used to guide their practice, and perceived extent of adult caregiver engagement in making management decisions for myopic children. Results: A total of 302 responses were collected from different regions of the country. Most respondents demonstrated knowledge of the association between high myopia and retinal breaks, retinal detachment and primary open?angle glaucoma. Optometrists used a range of techniques to diagnose childhood myopia, with a preference for non?cycloplegic refractive measures. The most common approaches to management were single?vision distance despite most optometrists identifying orthokeratology and low?dose (0.01%) topical atropine as two potentially more effective therapeutic interventions for controlling childhood myopia progression. Almost 90% of respondents considered increasing the time spent outdoors to be beneficial for reducing the rate of myopia progression. The main sources of information used to guide clinical practice were continuing education conferences, seminars, research articles, and workshops. Conclusion: Indian optometrists appear to be aware of emerging evidence and practices, but are not routinely adopting measures. Clinical guidelines, regulatory approval, and sufficient consultation time may be of value for assisting practitioners in making clinical decisions based on the current available research evidence

Development and Psychometric Validation of the Orthodontic Health Literacy Tool

Introduction: Over the past few years, there has been increasing emphasis on context?specific health literacy. However, no such context?specific psychometric tools are available with regard to oral health literacy. The aim of this study was to develop and validate an Orthodontic Health Literacy Tool (Orth?HLT). Materials and Methods: After development of initial item pool, the items were assessed for content validity. The final tool consisted of 22 items in the four domains of functional, communicative, critical orthodontic health literacy, and orthodontic knowledge. Orth?HLT was administered to a convenience sample of 642 subjects. The data were subjected to exploratory and confirmatory factor analyses using IBM SPSS Version 20.0 software and IBM SPSS Amos 26.0, respectively. Pearson’s correlation, independent samples t?test, and one?way analysis of variance were performed. Results: Orth?HLT demonstrated good face and content validity. The domain?specific internal consistency reliability values were optimal. Exploratory factor analysis on the items in all four domains resulted in a single factor solution. Four models were evaluated in the confirmatory factor analysis; the correlated factors model showed best model fit indices. Each domain of Orth?HLT showed moderate to strong positive correlation with Indian Oral Health Literacy Measure in Telugu indicating the convergent validity of the tool. Conclusion: Orth?HLT is the first context?specific oral health literacy tool and demonstrates strong psychometric properties, which could be used to evaluate orthodontic health literacy and articulate orthodontic health education materials in an informed manner.

Challenges of Second-hand Smoke: Are We Asking the Right Questions?

Second-hand tobacco smoke as defined by WHO is the smoke emitted by a smoker or released from a burnt cigarette or any tobacco product. It is highly prevalent all over the globe but its serious health implications are often neglected by the public and the scientific community alike. Second-hand smoke has everlasting impact on all the body’s major organs, especially among the vulnerable population of children, pregnant ladies, people with chronic diseases and senior citizens. Although India started its war against this menace earlier than other counties, all its efforts remain bootless as its approach and implementation have a wide range of lacunae. This review aims to give a big picture of second-hand smoke, highlighting its pathophysiological changes in the body, socioeconomic impact, various strategies, and the gap that prevents these strategies from finding a favorable result in India. It becomes all the more important to reduce its impact owing to the increase in prevalence among youth reducing their vitality, derailing the society and the nation. It is recommended that the health authorities approach this health problem with utmost seriousness as a laid-back approach could welcome this silent killer’s known and unknown repercussions

Non-traumatic esophageal perforation: A case report on Boerhaave’s syndrome

Boerhaave’s syndrome is a potentially fatal condition characterized by spontaneous perforation of a previously healthy esophagus, due to severe vomiting or straining. It often presents with non-specific symptoms such as fever, pain, and vomiting and hence may go undiagnosed. The Makler’s triad, consisting of vomiting, chest pain, and subcutaneous emphysema, may be seen in only 50% of cases. Delayed diagnosis may result in complications such as sepsis, mediastinitis, pneumothorax, and multi-organ dysfunction. In general, patients presenting later than 48 h are conservatively managed with esophageal stenting. Surgical repair is usually reserved for those patients who present within 24 h, or are managed conservatively and develop complications. Mortality rises from 0% if treated within 24 h to about 29% if delayed more than 48 h. We present a case of Boerhaave’s syndrome in a 35-year-old male who presented with spontaneous respiratory distress and hemodynamic instability, about 36 h after the onset of vigorous vomiting. The case was managed initially with endoscopic insertion of a self-expanding metallic stent, followed later by surgical closure of the esophageal perforation. The patient, however, developed post-operative septic complications and died after a week

Histomorphological-study-of-mucormycosis-in-covid19-patients-with-special-reference-to-rhinoorbital-region-in-a-tertiary-care-center

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 in Wuhan city, Hubei province, China. The patients with comorbid conditions like diabetes mellitus, lung disease are prone to a wide range of viral, bacterial and fungal infections. Aims And Objectives 1. To know the frequency of mucormycosis in Covid-19 patients. 2. To describe histomorphological pattern of mucormycosis and other fungal infections in Covid-19 patients. Materials And Methods: A prospective study was conducted from May 2021 to August 2021 for four month period with a sample size of 57 at a tertiary care hospital in south India. All the patients who were diagnosed with and or recovered from COVID-19 infection and came back with the fungal infection symptoms were subjected to surgical debridement were included in the study. All the demographic and clinical data were obtained from requests. In the presentResults: study we got 57 cases of covid-19 patient with suspected fungal infections.We examined the biopsy taken from different sites of rhinoorbital area with H&E and GMS stain. Out of 57 cases 36 cases were found to be having mucormycosis. Conclusion: Since Covid-19 is a risk for many opportunistic infections, its association with invasive fungal infection is dangerous and must be given serious consideration

Evaluation of retinal function and morphology in isoametropic amblyopia

Purpose: To observe the photoreceptor anomalies in cases of ametropic amblyopia. Methods: A prospective study with 25 isoametropic amblyopic children in the age group of 5–14 years and 25 age?matched controls was done. Examination included refraction, best?corrected visual acuity (BCVA), and color vision. Adaptive optics (AO) and multifocal electroretinogram (mf?ERG) were done to assess the anatomy and function of photoreceptors. The subgroup analysis of the improved and non?improved groups was done. Results: The mean cone density in cases and control in the superior, temporal, and nasal quadrants was respectively as follows (21640 ± 5713, 24040 ± 3386, P = 0.01) (19755 ± 6282, 21832 ± 2911, P = 0.03) (19897 ± 5418, 22171 ± 3660, P = 0.01) (20768 ± 4799, 22819 ± 3241, P = 0.01). The amplitude of N1 wave and P1 wave in cases was significantly low compared to the controls. Cases with subnormal color vision had reduced BCVA (0.55 ± 0.018) in comparison to the children with normal response (0.350 ± 0.014). Cone density was also significantly reduced in children with subnormal color vision. Sixteen out of 25 cases showed BCVA improvement with spectacles. Baseline cone density was found to be significantly higher in the improved group. There was no correlation between BCVA and AO parameters. Conclusion: Patients with ametropic amblyopia show subnormal photoreceptor properties than controls. Low cone density may be associated with defective color vision and poor prognosis in these cases

Clinicobacteriological profile and antibiotic susceptibility pattern of chronic dacryocystitis in adults

Background: Chronic dacryocystitis is a constant menace to delicate ocular structures. If left untreated, it can lead to sight as well as life-threatening complications. However, such complications may be prevented by timely intervention along with appropriate antibiotic prophylaxis. The objectives are to investigate the current bacterial community profile in adult patients with chronic dacryocystitis attending a referral eye care center in Odisha and to determine their drug susceptibility pattern to commonly used antimicrobial agents. Materials and Methods: An observational study was conducted on 70 adult patients with chronic dacryocystitis. The discharge from the punctum was collected by doing a regurgitation test or lacrimal passage irrigation and sent for microbiological analysis. Results: Out of 70 samples collected, 54 (77.1%) samples showed bacterial growth after 24–48 h of incubation. Among various isolates recovered, 68.5% were gram-positive and 27.8% were gram-negative organisms. Staphylococcus aureus was found to be the most common isolate among gram-positive, and Pseudomonas aeruginosa was most common among gram-negative organisms. Among all drugs used in the susceptibility test; amikacin, piperacilin + tazobactam, and netilmycin were found to be most sensitive and cefixime, and amoxycilin + clavulinic acid was found to be most resistant to gram-positive as well as for gram-negative organisms. Conclusion: Knowledge about the microbiological profile and the drug susceptibility pattern responsible for chronic dacryocystitis in a geographical area is important and should be kept in mind while treating these patients.

Stress and strategies in coping stress among the medical students of a south Indian city

Background: Stress is a personal experience brought on by complex interactions between a person and their environment, so it cannot be avoided. It typically happens when a person’s situational demand exceeds their available resources. Additionally, it has been noted that excessive stress can hurt self-esteem, academic performance, and both personal and professional development. This study sought to determine the stress level, different stressors, and coping mechanisms used by undergraduate medical students. Materials and Methods: A cross-sectional study was done among first to final-year medical undergraduate students between January and June 2022 at a tertiary care institution in South India. 450 students enrolled in the first year to last year were included in the study through the purposeful sampling method. The medical Student Stressor Questionnaire was used to assess the stress levels among the study participants. The coping strategies were considered using a brief coping orientation to problems experienced (COPE) inventory. Cluster analysis used the K-means method. Results: A total of 278 out of the 450 students completed the questionnaire and returned it, yielding an overall response rate of61.78%. Of which 175 (62.95%) women respondents made up the majority of the study participants. The mean age of the participants was 20.15 ± 2.8 years. 45.32% ( n = 126) of the study participants belonged to the first year of their study, whereas 23.02% ( n = 64) belonged to the second year of their research. Academic stress was the primary stressor. The predominant coping strategies used were problem-focused and emotion-focused coping with stress. Conclusion: A variety of stress management techniques should be offered to help the students in better handling of the demanding professional course.