LV Prasad Eye Institute EyeSmart electronic medical record-based analytics of big data: LEAD-Uveitis Report 1: Demographics and clinical features of uveitis in a multi-tier hospital based network in Southern India

Purpose: To describe the demographics and epidemiology of uveitis presenting to a multi?tier ophthalmology hospital network in Southern India. Methods: Cross?sectional hospital?based study of 19,352 patients with uveitis presenting between March 2012 and August 2018. Results: In total, 1,734,272 new patients were seen across the secondary and tertiary centers of our multi?tier ophthalmology hospital network during the study period. Among them, 25,353 eyes of 19,352 patients were diagnosed with uveitis and were included in the study. Uveitis constituted 1.11% of all cases. The majority of patients were male (60.33%) and had unilateral (68.09%) affliction. The most common age group was 21� years with 12,204 (63.06%) patients. The most common type of uveitis was anterior uveitis, which was seen in 7380 (38.14%) patients, followed by posterior uveitis in 5397 (23.89%) patients. Among the infectious causes, tuberculosis was the most common etiology (2551 patients, 13%) followed by toxoplasmosis (1147 patients, 6%). Conclusion: Uveitis constituted 1.11% of all cases presenting to our clinics. It was more common in the age group of 21� and was predominantly unilateral. Anterior uveitis was the most common subtype seen in 38%.

Evidence of dengue virus in eviscerated specimens of panophthalmitis secondary to dengue fever: A possible cause-effect phenomenon

Purpose: To report a retrospective series of three cases of infectious panophthalmitis post?dengue fever with ex vivo confirmation of dengue virus ribonucleic acid (RNA) in the tissues of the eye. Methods: Four eyes of three patients, who were diagnosed with panophthalmitis following dengue fever and who underwent evisceration, were included. All demographic and clinical data were recorded. The eviscerated samples were subjected to direct microscopy, culture for bacteria, fungi, and parasites, and molecular virology (dengue virus [DENV] NS1?specific reverse transcription loop?mediated isothermal amplification (RT?LAMP) assay). Results: The time from the development of dengue fever to the occurrence of ocular symptoms was 4.33 ± 1.15 (median 5) days. DENV NS1 RNA, suggestive of the presence of the dengue virus, was confirmed in all evisceration specimens (uveal tissue, cornea). All the patients recovered completely from dengue fever and on follow?up had healthy eviscerated sockets. Conclusion: Demonstration of the DENV RNA in the eviscerated specimens of panophthalmitis following dengue fever implicates the DENV in the pathophysiology of the ocular infection.

Dental Age Estimation In Children Using Willems Method And Its Correlation With Chronological Age: A Digital Orthopantomographic Study

Aim and Objective: To assess the developmental stages of seven mandibular left teeth for estimation of dental age (DA )in children aged 8-16 years of south Kerala origin and to evaluate the possible correlation between DA and chronological age (CA) using Willems method. Materials and methods: Digital OPGs of 60 subjects (30 males and 30 females) who fit the study criteria were obtained .Assessment of mandibular teeth (31-37) development was undertaken and DA was assessed using Willems method. Results and Conclusion: There was significant correlation between DA and CA in both males (r=0.847) and females (r=0.801).The overall mean differences between DA and CA was 0.5 ± 1.2 with a gender variability as 0.330 ± 1.045 for males and 0.603 ± 1.417 for females.

A novel smartphone ophthalmic imaging adapter: User feasibility studies in Hyderabad, India.

Aim of Study: To evaluate the ability of ancillary health staff to use a novel smartphone imaging adapter system (EyeGo, now known as Paxos Scope) to capture images of sufficient quality to exclude emergent eye findings. Secondary aims were to assess user and patient experiences during image acquisition, interuser reproducibility, and subjective image quality. Materials and Methods: The system captures images using a macro lens and an indirect ophthalmoscopy lens coupled with an iPhone 5S. We conducted a prospective cohort study of 229 consecutive patients presenting to L. V. Prasad Eye Institute, Hyderabad, India. Primary outcome measure was mean photographic quality (FOTO‑ED study 1–5 scale, 5 best). 210 patients and eight users completed surveys assessing comfort and ease of use. For 46 patients, two users imaged the same patient’s eyes sequentially. For 182 patients, photos taken with the EyeGo system were compared to images taken by existing clinic cameras: a BX 900 slit‑lamp with a Canon EOS 40D Digital Camera and an FF 450 plus Fundus Camera with VISUPAC™ Digital Imaging System. Images were graded post hoc by a reviewer blinded to diagnosis. Results: Nine users acquired 719 useable images and 253 videos of 229 patients. Mean image quality was ≥ 4.0/5.0 (able to exclude subtle findings) for all users. 8/8 users and 189/210 patients surveyed were comfortable with the EyeGo device on a 5‑point Likert scale. For 21 patients imaged with the anterior adapter by two users, a weighted κ of 0.597 (95% confidence interval: 0.389–0.806) indicated moderate reproducibility. High level of agreement between EyeGo and existing clinic cameras (92.6% anterior, 84.4% posterior) was found. Conclusion: The novel, ophthalmic imaging system is easily learned by ancillary eye care providers, well tolerated by patients, and captures high‑quality images of eye findings.

An unusual presentation of nonarteritic ischemic optic neuropathy with subretinal fluid treated with intravitreal bevacizumab.

A 62‑year‑old hypertensive male presented with acute nonarteritic ischemic optic neuropathy (NAION) with contiguous macular edema and subretinal fluid in the right eye. Presenting vision was 20/1000. The patient was treated with intravitreal bevacizumab 1.25 mg/0.05 ml. At 1 month follow‑up, the macular edema and the optic nerve head edema completely resolved with a good visual improvement up to 20/40. The visual improvement was maintained at the last follow‑up 6 months postinjection. Intravitreal bevacizumab may be a good option for acute NAION especially in an unusual presentation with macular edema and subretinal fluid.

Zero transmission of HIV: Till date’s only way leading towards its possible eradication.

Background: AIDS emerged as one of the most important public health issues of the late twentieth and early twenty-first centuries. The AIDS epidemic has prompted Wide-reaching changes in public health, clinical practice, and scientific research, and has had a great impact upon socities throughout the world. Aim: This article gave an insight into beak up of mode of transmission seen in our studied area of Gujarat, which highlighted in which area one should focus more at least to control the prevalence of HIV. Material and methods: In the present study 961 HIV sero-positive patients (T group) were screened with respiratory tract infections and more 300 HIV sero-positive patients but without respiratory tract infections (C2 group) had been inquired and collected their information about mode of transmission and other demographic characters like age, literacy, financial status, gender etc. Results: The highest patients had acquired HIV by hetro -sexual mode of transmission. In T group it was found to be in 773 (80.43%), while in C2 group it was seen among 257 (85.67%) HIV infected patients. But when both groups are merged which we consider TC2 group, this hetero-sexual mode of transmission was noted in 1030 (81.68%) HIV infected patients, followed by mother to child transmission (MTCT) which was found in 101 (10.51%) patients of T group while MTCT was seen in 29 (9.67%) HIV infected patients of C2 group. Conclusion: If anybody knows exact percentage of acquiring HIV in the particular area, one can work on this direction, to reduce that particularly mode mode of transmission seen in our studied area of Gujarat, which highlighted in which area one should focus more at least to control the prevalence of HIV. Material and methods: In the present study, 961 HIV sero-positive patients (T group) were screened with respiratory tract infections and more 300 HIV sero-positive patients but without respiratory tract infections (C2 group) had been inquired and collected their information about mode of transmission and other demographic like age, literacy, financial status, gender etc. Results: The highest patients had acquired HIV by hetero9-sexual mode of transmission. In T group it was found to be in 773 (80.43%), while in C2 group it was seen among 257 (85.67%) HIV infected patients. But when both groups are merged which we consider TC2 group, this hetero-sexual mode of transmission was noted in 1030 (81.68%) HIV infected patients, followed by mother to child transmission (MTCT) which was found in 101 (10.51%) patients of T group while MTCT was seen in 29 (9.67%) HIV infected patients of c2 group Conclusion: If anybody knows exact percentage of acquiring HIV in the particular area, one can work on this direction, to reduce that particular mode of transmission so that at least prevalence of HIV could certainly be decreased tremendously in that particular area, state, country and ultimately from globe. Minimum transmission of HIV can be achieved by widespread of ABC (Abstinence, behavioral change, condoms) policy and with additional maximum and quick implementation of TasP (Treatment as prevention), PrEP (Pre-exposure prophylaxis) and PEP (Post exposure prophylaxis) as and when required in the all ART Centres of our country.

Idiopathic multiple retinal pigment epithelial detachments - a case report

Retinal pigment epithelial detachment, often asymptomatic is a common retinal finding. Multiple serous retinal pigment epithelial detachment especially in a female is very uncommon. We describe a case of multiple retinal pigment epithelial detachments throughout the fundus in a 51-year old female otherwise asymptomatic. Indocyanine green angiography and fundus auto fluorescence showed abnormalities with a normal systemic work-up. This is the first report of an asymptomatic patient correlating angiogram with auto fluorescence in multiple serous retinal pigment epithelial detachments

Helicobacter pylori coinfection is a confounder, modulating mucosal inflammation in oral submucous fibrosis.

The oral cavity has been considered a potential reservoir for Helicobacter pylori (H pylori) , from where the organism causes recurrent gastric infections. Aim: With this case-control study we tried to evaluate the role of H pylori in the etiology of mucosal inflammation, a condition that compounds the morbid state associated with oral submucous fibrosis (OSF). Materials and Methods : Subjects ( n = 150) were selected following institutional regulations on sample collection and grouped into test cases and positive and negative controls based on the presence of mucosal fibrosis and inflammation. The negative controls had none of the clinical signs. All patients underwent an oral examination as well as tests to assess oral hygiene/periodontal disease status; a rapid urease test (RUT) of plaque samples was also done to estimate the H pylori bacterial load. We used univariate and mutivariate logistic regression for statistical analysis of the data and calculated the odds ratios to assess the risk posed by the different variables. Results : The RUT results differed significantly between the groups, reflecting the variations in the bacterial loads in each category. The test was positive in 52% in the positive controls (where nonspecific inflammation of oral mucosa was seen unassociated with fibrosis), in 46% of the test cases, and in 18% of the negative controls (healthy volunteers) (χ2 = 13.887; P < 0.01). A positive correlation was seen between the oral hygiene/periodontal disease indices and RUT reactivity in all the three groups. Conclusions: The contribution of the H pylori in dental plaque to mucosal inflammation and periodontal disease was significant. Logistic regression analysis showed gastrointestinal disease and poor oral hygiene as being the greatest risk factors for bacterial colonization, irrespective of the subject groups. A positive correlation exists between RUT reactivity and the frequency of mucosal inflammation.

Solitary intraosseous neurofibroma of mandible.

Solitary intraosseous neurofibroma is a rare benign non-odontogenic tumor. Although neurofibromas occur predominantly as a feature of neurofibromatosis affecting the soft tissue, a few cases of solitary intraosseous neurofibromas of the jaw have been reported. We herewith report a case of solitary intraosseous neurofibroma of mandible in a middle-aged woman with a discussion on its clinical, radiological, and histopathological presentation along with review of cases.