A comparative study on surgical outcomes of trabeculectomy with and without anti-metabolites in juvenile open-angle glaucoma

Purpose: To compare the surgical outcomes of trabeculectomy with and without anti?metabolites in patients with juvenile open?angle glaucoma (JOAG). Methods: This retrospective comparative case series included 98 eyes of 66 patients with JOAG who underwent either trabeculectomy without anti?metabolites (group A, n = 53 eyes) or with anti?metabolites (group B, n = 45 eyes) with a minimum of 2 years follow?up. The main outcome measures were intra?ocular pressure (IOP), number of glaucoma medications, visual acuity, additional surgical interventions, surgical complications, and risk factors for failure. Surgical failure was defined as IOP >18 mmHg or failure to reduce IOP by <30% from the baseline value or IOP ?5 mmHg or re?operation for refractory glaucoma or a complication or loss of light perception vision. Results: The mean post?operative IOP reduced significantly from baseline at all post?operative visits until 6 months and thereafter. The cumulative probability of failure at 2 years was 28.7% in group A [95% confidence interval (CI) = 17.6–44.8%] and 29.1% in group B (95% CI = 17.1–46.7%) (P = 0.78). Surgical complications occurred in 18 eyes (34%) in group A and 19 eyes (42%) in group B. Re?operations for glaucoma or complications were performed in two eyes (3.8%) in group A and two eyes (4.4%) in group B. Cox?hazard regression model revealed male gender (HR = 0.29; P = 0.008), baseline high IOP (HR = 0.95; P = 0.002), and an increased number of pre?operative glaucoma medications (HR = 2.08; P = 0.010) as significant factors associated with failure. Conclusion: Our study results on trabeculectomy in JOAG revealed a success of 71% in both groups at 2 years follow?up. There was no significant difference in success or failure rates between the two groups. The risk factors for poor surgical outcome in JOAG were male gender, baseline high IOP, and an increased number of glaucoma medications

Evaluation of the agreement and reliability of Transpalpebral Tonometers compared with Goldmann Applanation Tonometer – A systematic Review and Meta-Analysis Protocol

In 2020, the global prevalence of glaucoma was estimated to be 76 million and it was projected to increase to 111.8 million by 2040. Accurate intraocular pressure (IOP) measurement is imperative in glaucoma management since it is the only modifiable risk factor. Numerous studies have compared the reliability of IOP measured using transpalpebral tonometers and Goldmann applanation tonometry (GAT). This systematic review and meta-analysis aims to update the existing literature with a reliability and agreement comparison of transpalpebral tonometers against the gold standard GAT for IOP measurement among individuals presenting for ophthalmic examinations. The data collection will be performed using a predefined search strategy through electronic databases. Prospective methods-comparison studies published between January 2000 and September 2022 will be included. Studies will be deemed eligible if they report empirical findings on the agreement between transpalpebral tonometry and Goldmann applanation tonometry. The standard deviation and limits of agreement between each study and their pooled estimate along with weights and percentage of error will be reported using a forest plot. Cochrane’s Q test and the I2 statistic will be used to assess heterogeneity, and the publication bias will be investigated using a funnel plot, Begg’s and Egger’s tests. The review results will provide additional evidence on the reliability of transpalpebral tonometers that, in turn, could possibly assist practitioners to make informed decision about using it as a screening or diagnostic device for clinical practice, outreach camps, or home-based screening. Institutional Ethics Committee registration number: RET202200390. PROSPERO Registration Number: CRD42022321693.

Augmented loop myopexy with concurrent intraocular lens implantation for myopic strabismus fixus

Purpose: To evaluate safety profile and surgical outcomes of loop myopexy with concurrent intra? ocular lens implantation in cases of myopic strabismus fixus (MSF). Methods: A retrospective chart review of patients who underwent loop myopexy with concurrent small incision cataract surgery with intra?ocular lens implantation between January 2017 and July 2021 for MSF at a tertiary eye care centre was undertaken. A minimum of 6 months of follow?up after surgery was required for inclusion. The main outcome measures were improvement in alignment postoperatively, improvement in extra?ocular motility postoperatively, intraoperative and postoperative complications and post?operative visual acuity. Results: 12 eyes of 7 patients (male (6): female (1)) underwent modified loop myopexy at a mean age of 46.86 years (range 32?65 years). 5 patients underwent bilateral loop myopexy with intra?ocular lens implantation whereas 2 patients underwent unilateral loop with intra?ocular lens implantation. All eyes underwent additional medial rectus (MR) recession with lateral rectus (LR) plication. At the last follow?up, mean esotropia improved to 16 prism dioptres (PD) (Range: 10?20 PD) from 80 PD (Range:60?90PD), P = 0.016; and success (deviation ?20PD) was achieved in 73% (95% CI 48 to 89%). Mean hypotropia at presentation was 10 PD (range 6?14 PD), which improved to 0 PD (range 0?9 PD), P = 0.063. Mean BCVA improved from 1.08 LogMar to 0.3 LogMar units. Conclusion: Loop myopexy combined with intra?ocular lens implantation is a safe and effective procedure in the management of patients who have Myopic Strabismus Fixus with visually significant cataract and improves both visual acuity and ocular alignment significantly.

Angiotensin Receptor-Neprilysin Inhibitor Therapy and Cardiac Remodeling in Heart Failure: Consensus Statement from India

Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), ?-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile. Therefore, the consensus discusses objectives and topics related to ARNI in the management of cardiac remodeling, and experts shared their views on the early timely intervention of effective dosage of ARNI to improve the diagnosis and enhance mortality and morbidity benefits in cardiac reverse remodeling (CRR).

Role of Iron Therapy in Heart Failure: A Consensus Statement from India

Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF. Intravenous (IV) ferric carboxymaltose (FCM) reduces the hospitalization risk due to HF worsening and improves functional capacity and quality of life (QOL) in HF patients. The current consensus document provides criteria, an expert opinion on the diagnosis of ID in HF, patient profiles for IV FCM, and correct administration and monitoring of such patients.

The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement

Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.

Short-term outcomes of micropulse transscleral cyclophotocoagulation as a primary versus additional therapy in eyes with uncontrolled glaucoma

Purpose: To study the safety and efficacy outcomes of Micropulse Transscleral Cyclophotocoagulation (MP?TSCPC) as a primary versus additional therapy in eyes with uncontrolled glaucoma. Methods: This was a prospective, interventional, comparative study. All patients with advanced and refractory glaucoma treated with MP?TSCPC from April 2020 to December 2020 were recruited in this study. Results: A total of 77 eyes of 77 patients were analyzed. Group A (n = 33), included patients with advanced glaucoma at high risk for invasive surgery, who underwent MP?TSCPC as the primary intervention, and group B (n = 44) included patients who had undergone previous surgical intervention and MP?TSCPC was used additionally to control the intraocular pressure (IOP). Mean IOP and mean number of antiglaucoma medications were 34.06 (13.9) mmHg and 3.64 (0.7), respectively, in group A and 35.61 (11.5) mmHg and 3.73 (0.9), respectively, in Group B. Postoperatively, the mean IOP and percentage of IOP reduction were significantly lower at 1, 3, and 6 months, that is, 20.78 (32%), 22.07 (30%), and 19.09 (37%), respectively, in group A and 23.68 (35%), 19.50 (44%), and 19.61 (42%), respectively, in group B, but there was no difference between the groups at all visits. Postoperative need for ocular hypotensive drugs did not differ in group A (P = 0.231); however, it was significantly lower in group B (P = 0.027). Group A had 87%, 77%, and 74% success rates at 1, 3, and 6 months, respectively, whereas group B had 91%, 86%, and 77% success rates at 1, 3, and 6 months, respectively. Postoperative complications and intervention did not reveal any statistical difference between the two groups. Conclusion: MP?TSCPC may be considered as a temporizing measure both as a primary or as an additional intervention to control the IOP in eyes with refractory and advanced glaucoma that have a high risk of vision?threatening complications with invasive surgery.

Wilms tumour in a two day old neonate: A rare and challenging case

Wilms tumor or nephroblastoma is the second most common renal tumor occurring in the neonatal age group next to congenital mesoblastic nephroma. The most common age group of presentation of Wilms tumor is between 3 and 4 years of age. Here, we report a case of right-sided Wilms tumor in a 2-day-old neonate. A term-born female baby presented on day 2 of birth with abdominal distension and physical examination revealed a large palpable mass in the right lumbar region crossing the midline. Imaging features were suggestive of a retroperitoneal mass of probable right renal origin. The patient was taken up for right radical nephroureterectomy and Per-operatively, there was anticipated tumor spillage. Post-operative histopathological examination was suggestive of a triphasic Wilms tumor with no anaplasia and favorable histology. The patient was diagnosed with Wilms tumor of the right kidney, COG stage III, SIOP (“International Society of Pediatric Oncology”) intermediate risk. Loss of heterozygosity testing for 1p and 16q was negative. She was started on chemotherapy with a DDA4 regimen. She completed whole abdominal radiotherapy and tolerated treatment well. The child is disease free and is under regular follow-up. This case of neonatal Wilms tumor was indeed a challenge to the pediatric surgeons and the oncologists but the final results were worth the challenge that was faced

Improved population coverage of the human papillomavirus vaccine after implementation of a school-based vaccination programme: the Singapore experience

INTRODUCTION@#Cervical cancer has a high disease burden in Singapore, and it is strongly associated with human papillomavirus (HPV) infections. Despite constant efforts to encourage vaccination, local HPV vaccine uptake remains low. Universal mass vaccination is a proven cost-effective method to reduce the cervical cancer disease burden. This paper reviews the newly implemented school-based HPV vaccination programme in Singapore and the factors that led to its success.@*METHODS@#Fully subsidised HPV vaccinations were offered to all Secondary 1 female students on an opt-in basis, starting as a rollout dose in 2019. One-time catchup vaccination was also offered to female students in Secondary 2-5. Eligible recipients were identified using enrolment data provided by Ministry of Education schools. A total of 19,144 students across 139 schools were offered the rollout dose, and 20,854 students across 140 schools were offered the catchup doses.@*RESULTS@#High vaccine uptake rates of 80.6%-87.3% were noted with the introduction of the school-based programme, translating to high vaccine coverage of 90.3%-93.4%. Only a small proportion of students (1.5%-1.9% per cohort) opted out. The rate of reported side effects, which were commonly known effects, was low at one in 1000. Among the students who reported side effects, those who received the second vaccine dose did so uneventfully.@*CONCLUSION@#High HPV vaccine coverage was achieved after implementation of the school-based immunisation programme. Timely assessment of knowledge lapses and targeted intervention, strong partnerships with stakeholders, constant on-site adaptation and positive social influence contributed to its success. This model can be applied to future school health programmes.

Homocysteine Levels and Clinical Outcomes in Schizophrenia—A Pilot Randomized Controlled Trial

Objectives: To find out the relation between homocysteine levels in peripheral blood and the effectiveness as well as the safety of haloperidol and olanzapine in schizophrenia treatment. Materials and Methods: A prospective randomized parallel-group open-label interventional clinical trial was conducted on 40 mild to moderate schizophrenia patients. To compare the efficacy of olanzapine and haloperidol Brief Psychiatric Rating Scale (BPRS) score was used. Homocysteine levels of peripheral blood and Abnormal Involuntary Movement Scale scores were evaluated. Results: BPRS score improved in both groups on day 14 and day 28. But significantly more with olanzapine (P value =.001). The olanzapine group showed a higher reduction (13.91±0.47 to 9.74±0.5) in homocysteine levels than the haloperidol group. Also, the BPRS scores negatively correlated (r = –0.66) to homocysteine levels. Conclusion: Therefore, our study shows that peripheral blood homocysteine levels can be used to predict and assess the treatment outcome in schizophrenia patients. Biomarker driven approach in schizophrenia will allow the patients to be treated promptly with the right drug. In this light, personalized treatment holds great potential in the future.

Short-term surgical outcomes of twin-site combined phaco-emulsification and mitomycin-C augmented trabeculectomy in pseudo-exfoliation glaucoma versus primary open-angle glaucoma

Purpose: To compare the short?term outcomes of combined phaco?emulsification with posterior chamber intra?ocular lens and mitomycin augmented trabeculectomy in patients with pseudo?exfoliation glaucoma (PXFG) versus primary open?angle glaucoma (POAG). Methods: A total of 144 eyes of 144 patients were enrolled in this prospective interventional comparative study, 72 each of which had PXFG and POAG, respectively. All patients underwent twin?site combined phaco?trabeculectomy at a tertiary eye center in India between December 2017 and December 2018 and were followed up for a period of 12 months. The main outcome measures were intra?ocular pressure (IOP), best corrected visual acuity (BCVA), total surgical time, rate of intra?operative and post?operative complications, and the number of ocular hypotensive medications needed. Success rates were determined via Kaplan–Meier survival analysis. Results: The mean age was 63.9 ± 7.9 years in the POAG group and 66.4 ± 6.8 years in the PXFG group (P ? 0.04). The baseline BCVA, IOP, and cup?disc ratio were comparable between two groups. Intra?operative complications and post?operative outcomes were comparable between the two groups. There was a significant drop in anti?glaucoma medications in both groups. Six patients, three (4.2%) in each group, were lost to follow?up after 6 months. Three patients (4.2%) in PXFG needed additional glaucoma intervention for controlling IOP, one patient needed a non?valved glaucoma drainage device, and two patients required diode cyclo?photocoagulation within the follow?up period. Conclusion: Patients with PXFG had a longer surgical time than POAG. Similar success and complication rates were observed following combined twin?site phaco?trabeculectomy in both POAG and PXFG at 1 year. Combined glaucoma surgery resulted in good IOP control, improvement in BCVA, and lower requirement of ocular hypotensives in both the groups.

Multi?Disciplinary Orthodontic Camouflage Treatment of a Severe Skeletal Class III Malocclusion with 1 Year Follow-Up – A Case Report

Rationale: Orthodontic camouflage serves its purpose in treating mild to moderate skeletal dysplasia and in conditions where the patient is reluctant to opt for orthognathic surgery or when it is contraindicated. Patient Concerns: A 22?year?old male was concerned about his irregular teeth. Diagnosis: Angle’s dentoalveolar class III malocclusion on class III skeletal on an average mandibular plane angle with anterior crossbite, deep bite, crowding in maxillary and mandibular anteriors, proclined maxillary anteriors and retroclined mandibular anteriors with reverse overjet and congenitally missing 12, 22, palatally impacted 13 and retained deciduous 63 and palatally placed 23. Treatment: Orthodontic camouflage with a multi?disciplinary approach. Outcome: Optimal functional and dentofacial aesthetics were achieved by 22 months. Take?Away Lesson: The limitations of camouflage must be kept in mind and explained to the patient. The biomechanics need to be customized and integrating different specialties helps maximize the treatment benefits.

Correlation of pattern of visual field loss by perimetry and anterior chamber angle parameters by anterior segment optical coherence tomography in primary angle-closure glaucoma

Purpose: To correlate and analyze the pattern of the visual field (VF) defects by perimetry and anterior chamber angle parameters by AS-OCT in primary angle-closure glaucoma (PACG) across varied severity levels on presentation to a tertiary eye care center. Methods: This was a cross-sectional study, which included 323 eyes of clinically diagnosed cases of PACG. Glaucoma severity was categorized according to mean deviation (MD) as mild (-6.00 dB or more), moderate (-6.01 to -12.00 dB), and severe (-12.01 to -30.00 dB). AS-OCT measured the nasal (N) and temporal (T) angle opening distance at 500 ?m (AOD 500) and 750 ?m (AOD 750), anterior chamber angle (ACA), lens vault (LV), and anterior chamber width (ACW). The VF severity was then correlated with the AS-OCT parameters using statistical analysis. Results: The mean age ± standard deviation (SD) of the patients included in the study was 56.03 ± 8.6 years, with a 1:1.2 gender ratio. The number of eyes with mild, moderate, and severe VFs were 140 (43.3%), 88 (27.24%), and 95 (29.41%), respectively. There was no statistically significant correlation in the mean anterior chamber angle parameters (AOD 500, AOD 750, ACA 500, ACA 750, LV, ACW, and axial length (AL)) among the groups. However, the correlation between AOD 500 and LV thickness was found to be significant (P = 0.0000) with a negative Spearman’s rank correlation coefficient (r = -0.3329). Conclusion: The ACA parameters obtained by AS-OCT along the horizontal axis after elimination of pupillary block by laser peripheral iridotomy do not correlate and cannot be used to assess the disease severity of PACG

Comparison of clinical and biometric characteristics between nanophthalmic children and age-matched controls

Purpose: To compare the clinical and biometric characteristics of children presenting with nanophthalmos (NO group) with that of age?matched controls (CO group). Methods: Electronic medical records of 40 children (<18 years of age) with diagnosis of nanophthalmos (NO), presented to a tertiary center in Tamil Nadu between January 2010 and December 2019, were reviewed and compared with 30 age?matched controls (CO) presenting for routine eye examination between October 2019 and December 2019. Clinical parameters compared were best?corrected visual acuity (BCVA), axial length (AxL), keratometry (K), anterior chamber depth (ACD), lens thickness (LT), retinochoroidal scleral thickness (RCS), corneal diameter, central corneal thickness (CCT), intraocular pressure (IOP), lens axial length factor (LAF), and lens thickness/anterior chamber depth ratio (LT/ACD). Results: Mean age of the NO group was 8.95 ± 4.0 years. Mean spherical equivalent (SE) in NO group was 10.87 ± 3.1 D and was inversely correlated to AxL (r = ?0.46, P value = 0.003). All biometric parameters (AxL, ACD, LT, RCS, LAF, and LT/ACD), except CCT were significantly different between NO and CO groups. NO group children had 52.5% visual impairment with BCVA ? 6/24 and 17.5% had esotropia. Common ocular associations in NO group were amblyopia (64.3%), primary angle?closure glaucoma (PACG) (17.8%), pigmentary retinopathy (14.3%), and retinal detachment (3.6%). Angle?closure disease was seen in 50% of NO group and 30% underwent laser peripheral iridotomy (LPI). There was a significant difference in SE, ACD, and LAF among NO children with AxL <17 mm or >17 mm. Multivariable regression analysis revealed a significant correlation of SE and ACD with AxL. Conclusion: Nanophthalmos in children often present as amblyopia with visual impairment and strabismus. NO group with AxL <17 mm, had angle?closure disease as a common association with significantly lower ACD, higher SE, and LAF. All morphometric characteristics, except CCT, were significantly different between NO and CO groups. Close monitoring with serial biometry in NO group is needed for the timely diagnosis and prompt intervention to avoid visual impairment, due to glaucoma

A report on a series of nanophthalmos with histopathology and immunohistochemistry analyses using light microscopy

We aimed to study the histopathological and immunohistochemistry features in clinically diagnosed cases of nanophthalmos using light microscopy. This was an observational comparative study. We enrolled four eyes of four consecutive patients with nanophthalmos and visually significant cataract, who underwent cataract surgery with prophylactic posterior sclerostomy. Histological analysis of the excised scleral tissue was done and compared with age-matched cadaver controls between January 2021 and October 2021. Hematoxylin and Eosin (H&E) stains were used for histological analysis, and was further supplemented with immunohistochemistry (IHC) and immunofluorescence (IF) analyses using a simple light microscope. The immunostained sections were analyzed using confocal microscope for the fibronectin expression level. The main outcome measure was demonstration of histological changes of sclera in nanophthalmic eyes undergoing cataract surgery. Light microscopic features of nanophthalmos revealed thick fibers with fraying and lightly stained cores, irregular serrated edges, and randomly interspersed fibroblasts compared to regular arrangement of collagen fibers seen in cadaver controls. Immunohistochemistry analysis with anti-fibronectin antibody showed strong positivity in clustered fibers in nanophthalmos, and less intense diffuse staining in cadaver tissue. Histoclinical correlation was observed in one nanophthalmic scleral tissue with axial length less than 17 mm showing severe disorganization with diffuse collagenization, loss of fibrillary architecture compared to another specimen with axial length more than 17 mm. Simple, cost-effective light microscopy using basic stains was effective in identifying the characteristic histopathological features in nanophthalmic eyes, and this was further highlighted by immunohistochemistry and immunofluorescence analyses.

Validating the physiological potential of zero monopodial compact cotton TCH 1819 culture by chemical manipulation

Cotton is the most important global cash crop which controls economy of many nations. Global sustainability of cotton yield is one of the major challenges for meeting impending threats under climate change. Though India is one among the leading countries in cotton production, the supply is not enough considering the increasing demand. Scientists across the Globe are indulged in developing new lines and cultures with capacity to produce more yields. In this context, here, we have made an attempt to study the growth, physiology, and yield traits of cotton culture - TCH 1819 before its release (now released in the name of CO 17) by different chemical treatments. Observation on the leaf gas exchange traits, leaf parenchymal cells distinguished the source sink relationship of the culture. Chemical manipulation by growth retardants reduced the gibberellins content and modified the foliage structure. By characterizing the physiological potential through manipulation by growth retardant (Mepiquat chloride (0.015 %)) increased the yield by 30%. The traits identified in this study are potential indicators in breeding programme before releasing the variety.

Mercury Embolism

Post-transplant diabetes mellitus (PTDM) is a common problem among solid organ transplant recipients contributing to morbidity and affecting patient as well as graft survival adversely. It can occur at any period following transplantation, but maximum incidence is observed in the first few months, with a second peak after a few years after transplantation. The pathogenesis is complex and poorly understood, however, it is associated with both dysfunctional beta-cells and insulin resistance. Both nonpharmacologic and antidiabetic therapies are important for adequate glycemic control. This point of view article provides a short review on PTDM in solid organ transplantation (SOT) recipients from a general physician’s perspective.

Dual Clinical Collaborator: A Pragmatic Role of nurses from developing countries

Collaboration is crucial in Professional nursing practice. Nurses act as a liaison between physicians and patients and their family members. Thus, it is vital to define the collaborative role of nurses in developing countries. The authors discuss pragmatic nurses' role by adopting the Dual Clinical Collaborator model to ensure offering the quality of care to their clients. Nursing is a healthcare profession that focuses on the care of individuals and their families to help them recover from illness and maintain optimal health and quality of life.(1) Health Care Professionals (HCPs) work together to provide quality health care and accomplish common goals. As healthcare delivery is becoming more complex, collaboration among healthcare workers and the patient can be a path to improve the quality of healthcare services. According to Walker and Avant's method, the conceptual definition of collaboration in nursing is an intra professional or interprofessional process by which nurses come together and form a team to solve patient care or healthcare system problem with members of the team respectfully sharing knowledge and resources.(2) Thus, collaboration is crucial in everyday professional nursing practice and should be considered a core value of nursing.(3)