Study 3: Anterior segment optical coherence tomography-guided surgical approach in slipped medial rectus muscle

Purpose: To discuss the novel swept?source anterior segment optical coherence tomography (SS?ASOCT)?guided surgical approach in slipped medial rectus muscles. Methods: Prospectively (between February 2020 and July 2022), six patients with a clinical suspicion of slipped medial rectus muscle were recruited. After complete ophthalmic and orthoptic evaluation, the missing medial rectus muscle is screened using Anterior Segment Optical Coherence Tomography (ASOCT). In presence of a traceable muscle, its morphology, depth, and distance from a fixed anatomical landmarks were noted; in its absence, the status of other recti was noted. Intraoperatively, the features were confirmed and the intended intervention was performed. Results: The mean age of six patients was 25.66 ± 9.72 years, two with surgical trauma and four with penetrating trauma (66.66%). In five patients, the ASOCT traced the slipped medial rectus muscle successfully (83.33%); intraoperatively, the same was confirmed (within 1–2 millimeters) with favorable outcomes. ASOCT made a significant contribution in all subjects by reducing the number of interventions and muscle surgeries. Conclusions: In eyes with slipped medial rectus muscle, especially those which are within a finite distance from the angle can be traced using ASOCT. This approach impacts the outcomes in many ways

Anthropometry of deep-set eyes with respect to difficulty in docking during femtosecond laser procedures

Purpose: To identify the facial anthropometric parameters that predict the difficulty during femtosecond (FS) laser. Methods: This was a single?center observational study was conducted on participants between the ages 18 and 30 years who were planned for FS?LASIK (femtosecond laser?assisted laser in situ keratomileusis) or SMILE (small incision lenticule extraction) at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. The front and side?facing images of the participants were analyzed using Image J software to measure different anthropometric parameters. The nasal bridge index, facial convexity, and other parameters were measured. The difficulty faced by the surgeon during docking was recorded for each subject. The data were analyzed on Stata 14. Results: A total of 97 subjects were included. The mean age was 24 (±7) years. Twenty?three (23.71%) subjects were females while the rest were males. Difficulty in docking was seen in 1 (4.34%) female and 14 (19%) males. The mean nasal bridge index was 92.58 (±4.01) in subjects with deep?set eyes and 89.72 (±4.30) in normal subjects. The mean total facial convexity was 129.28 (±4.24) in deep?set eyes, and 140.23 (±4.74) in normal subjects. Conclusion: Total facial convexity appeared as the most important feature, with the value being less than 133° in most subjects with unfavorable facial anthropometry

An Appraisal of Behavioural and Non-Behavioural Factors Influencing the Male Infertility: Narrative Approach

Male infertility implies a man can't begin a pregnancy with his female accomplice. Male infertility can have many causes. You may not make sufficient sperm or sound sperm. You might have a hereditary issue like cystic fibrosis. You might have a blockage in your genital plot. According to the latest WHO statistics, approximately 50– 80 million people worldwide suffer from infertility, and male factors are responsible for approximately 20– 30% of all infertility cases. The diagnosis of infertility in men is mainly based on semen analysis. the incidence of male infertility has increased worldwide. Infertility is characterized as the failure of couples to have a child following one year of customary unprotected intercourse, influencing 10 to 15% of couples. It is necessary to study the factors that influence male infertility in each area/region for better management. This paper represents various factors based on behavioral and non-behavioral conditions prompting for male infertility augmentation rapidly.

Intra-operative aberrometry versus conventional biometry for intraocular lens power calculation: A prospective observational study from a tertiary referral center

Purpose: To evaluate the per operative intra?ocular lens (IOL) power calculation using intra?operative aberrometry (ORA) and its comparison with conventional methods. Methods: Patients with cataract planned for phacoemulsification by a single surgeon under topical anesthesia were enrolled in this prospective observational study in this prospective observational study. All patients underwent pre?operative biometry (Manual SRK?II and IOLMaster® 500) to determine the intra?ocular lens (IOL) power. Intra?operative aberrometry using ORA was also performed; however, IOL was inserted according to IOLMaster® (SRK/T). Spherical equivalent (SE) was recorded on post?operative days 1, 7, and 30. Patients were divided into three groups based on axial lengths for analysis. Comparative analysis was performed for the calculated IOL powers and prediction errors of ORA with conventional methods. Adjusted IOL power to calculate the emmetropic IOL using the LiHue formula was also determined and was compared with existing methods. A P-value less than 0.05 was considered statistically significant. Results: A total of 115 eyes from 113 patients were included, with a median age of 54.90 ± 14.3 years. The mean axial length was found to be 23.94 ± 2.3 mm. There was good agreement (87%) between ORA and IOLMaster® for calculated IOL powers with a mean difference of 0.047 ± 0.5D between the two (P = 0.33). A positive correlation was found between IOL power calculated using ORA, IOLMaster®, SRK?II, and adjusted IOL. Conclusion: The use of intra?operative aberrometry (ORA) to calculate IOL power in patients undergoing uncomplicated phacoemulsification is non?inferior relative to standard pre?operative measurement and planning.

Histopathological finding of vesiculobullous lesions of skin in relation to their clinical presentation: Prospective study from a tertiary care center

Background: Vesiculobullous disorders (VBDs) are extant with diverse clinical manifestations. Vesicles and bullae are fluid-filled cavities present within or beneath the epidermis. They are autoimmune blistering disorders in which autoantibodies are directed against target antigens present in the epidermis and dermo-epidermal junction. Objective: Evaluation of the various clinicodemographic profile of patients with a pattern of distribution (subtypes) of VBDs of the skin and assess the association between clinical aspects and histological changes in vesiculobullous lesions of the skin. Materials and Methods: The study material constituted 93 cases of VBDs out of 936 skin biopsies reported over two and a half years (January 2016 to June 2018) from the tertiary care center. A detailed history of the patients was taken, and a complete physical and dermatological examination with findings including clinical diagnosis was recorded. Histopathological examination (incisional/excisional/punch biopsy) was done in each case. The clinico-demographic evaluation was done and the results were correlated with histopathological findings. Results: Vesiculobullous lesions constituted 10.06% of all skin biopsies. The majority of cases were of pemphigus vulgaris (PV) 30 (32.25%) followed by 16 (17.2%) of bullous pemphigoid. In 83 cases (89.24%) histopathology findings were consistent with clinical diagnosis. Out of 34 cases that were diagnosed clinically as PV , the histopathological study proved 30 cases (88.23%) as PV. Conclusion: Vesiculobullous lesions of the skin are a heterogeneous group of disorders. It is essential to differentiate each pattern of subtype based on clinical examination and histopathological findings. Histopathological diagnosis with clinical correlation plays a major role in arriving at the diagnosis.

North India Childhood Cataract Study - The real scenario and causes of surgical delay of pediatric cataract

Purpose: The study sought to describe the clinical presentation pattern of pediatric cataracts and factors leading to delay in surgery at a tertiary care center in North India. Methods: A cross?sectional, interview?based study was conducted from January 2020 to October 2020, that included pediatric patients <12 years, with unilateral or bilateral congenital or developmental cataract. A pre?validated questionnaire was used to record data. The parameters recorded were age at first symptoms, age at diagnosis of cataract, age at surgery, laterality of cataract, first symptom, first family member noticing the abnormality, the morphology of cataract, association of perinatal complications, family history, systemic diseases, and cause (s) of delay in surgery. Results: A total of 89 patients were included. The mean age of subjects was 4.75(±3.51) years. A white pupil was the most common symptom (64.04%) and appeared in infancy in 30.3% of cases. Parents first detected the problem in 60.67%, and the pediatrician was the first medical contact in 11.23% of cases. The median (IQR) delay period between diagnosis of cataract and cataract surgery was 4 (3–6) months, the major causes were long GA waiting (30.33%), and delay due to systemic ill health (14.61%). Conclusion: Parental education on cataract detection is recommended to help in the timely detection and hence, improved outcomes of pediatric cataract surgery. Pediatricians, consulted for any systemic illness, have the role of the second most important contact in the detection of pediatric cataract.

Twitter sentiment analysis for COVID-19 associated mucormycosis

Purpose: COVID?19?associated mucormycosis (CAM) was a serious public health problem during the second wave of COVID?19 in India. We planned to analyze public perceptions by sentiment analysis of Twitter data regarding CAM. Methods: In this observational study, the application programming interface (API) provided by the Twitter platform was used for extracting real?time conversations by using keywords related to mucormycosis (colloquially known as “black fungus”), from May 3 to August 29, 2021. Lexicon?based sentiment analysis of the tweets was done using the Vader sentiment analysis tool. To identify the overall sentiment of a user on any given topic, an algorithm to label a user “k” based on their sentiments was used. Results: A total of 4,01,037 tweets were collected between May 3 and August 29, 2021, and the peak frequency of 1,60,000 tweets was observed from May 17 to May 23, 2021. Positive sentiment tweets constituted a larger share as compared to negative sentiment tweets, with weekly variations. A temporal analysis of the demand for utilities showed that the demand was high in the initial period but decreased with time, which was associated with the availability of resources. Conclusion: Sentiment analysis using Twitter data revealed that social media platforms are gaining popularity to express one’s emotions during the ongoing COVID?19 pandemic. In our study, time?based assessment of tweets showed a reduction over time in the frequency of negative sentiment tweets. The polarization in the retweet network of users, based on sentiment polarity, showed that the users were well connected, highlighting the fact that such issues bond our society rather than segregating it.

A clinicoepidemiological profile of lung cancers in India – Results from the National Cancer Registry Programme

Background & objectives: Lung cancer is a significant public health concern in low- and middle-income countries such as India. The present article describes the epidemiology, and clinical profile of lung cancer in India, based on recent data from the National Cancer Registry Programme (NCRP). Methods: The latest data on lung cancer from the NCRP were collated from 28 population-based cancer registries and 58 hospital-based cancer registries across a five-year (2012-2016) reporting period. Results: The highest age-adjusted incidence rate and mortality (AAMR) was found amongst males and females in the Aizawl district of Mizoram. A significant increase in the annual per cent change of lung cancer incidence was observed in metropolitan cities from 1982 to 2016. About one-third of the cases (36.5%) in males and females (31.7%) were recorded in the age group of 55-64 yr. Adenocarcinoma accounted for about a third (34.3%) of the morphological type in males and half (52.7% ) amongst females. Out of 22,645 recorded lung cancer cases, close to half (44.8%) of the patients presented with distant spread, while over one-third (35.3%) had loco-regional spread of disease at the time of diagnosis. Interpretation & conclusions: Our estimates suggest that the number of cases is expected to rise sharply to 81,219 cases amongst males and 30,109 in females in 2025. The rising incidence and delayed diagnosis of lung cancer in India are grave concerns. The findings of the present study call for scaling up and intensification of lung cancer-specific preventive, early diagnosis and control measures.

The Epidemiology of Intensive Care Unit Readmissions and Proposed Discharge Protocol for a Tertiary Care Hospital

Background: Intensive Care Unit (ICU) readmissions during the same hospitalization are associated with increased hospital stays, morbidity and mortality. Whereas mortality rates in patients admitted to the ICU for the first time may range from 10 to 20% depending on various factors, readmission mortality rates can be up to 50 to 70%. Factors leading to readmission in ICU in Indian Armed Forces Hospitals have not been well studied till date. Methods: This was a record based cross sectional descriptive study conducted at the ICU of a tertiary care Armed Forces hospital. Demographic and clinical data of ICU patients were analysed. ICU admission and discharge data for the duration of last three years were acquired from admission and discharge registers and Hospital Informatics system (HIS) software. The primary outcome was readmission rates to ICU during the same hospitalization. Secondary outcomes included diagnosis at time of index admission (first time admission) to ICU and at readmission, multiple readmissions to ICU and mortality rates in readmitted patients. Results: There were 3021 admissions to the ICU during the study period. 422 patients succumbed to illness during initial admission resulting in a mortality rate of 14%. 198 patients were readmitted to the ICU. The readmission rate to the ICU was 7.8%. The mortality rate in readmitted patients was 31% as compared to the ICU mortality rate of 14%. The triggering factors for readmission were usually respiratory or cardiac decompensations. Conclusion: Readmission to ICU occurred in about 7.8 % of all ICU patients in our study. ICU readmissions increase the risk of adverse outcomes. Objective measures in the form of a discharge protocol incorporating the stability and work index for transfer (SWIFT Score) may help minimizing readmission to ICU. Such protocols must be in place while shifting any patients from ICU so as to improve outcomes in patients of tertiary care hospitals.

Temporomandibular joint dysfunction and physiotherapy: direction through a case report

Temporomandibular joint (TMJ) dislocation is an uncommon but debilitating condition of the facial skeleton. The condition may be acute or chronic. Acute TMJ dislocation is common in clinical practice and has been managed easily with manual reduction. Chronic recurrent TMJ dislocation is a challenging situation to manage. In this article, we discuss a case referred by the department of oral medicine for conservative management of the recurrent dislocating TMJ. This case was managed conservatively using physical therapy as the first line of management. At the end of the intervention the patient was pain free and had achieved normal function of the TMJ

Conventional versus invagination stripping varicose veins: which is better?

Background: Varicose veins are dilated, tortuous veins. It is an extremely common condition causing substantial morbidity. Prevalence of varicose veins ranges between 5% to 30% in adult population. Surgery is preferred over conservative treatment in symptomatic primary varicosis of the great saphenous vein (GSV). This study aims to compare the efficacy of GSV stripping by invagination technique in comparison to the conventional method in terms of time taken to strip the vein, the length of vein stripped, post-operative pain, area of bruising and intra-operative blood loss.Methods: The study was conducted in Dr. D. Y. Patil Medical College, Hospital and Research Centre located in Pimpri, Pune between July 2017 to September 2019.It is a prospective comparative Study. Subjects were randomly divided into 2 groups alternately where group A and B were operated by conventional and invagination techniques respectively and their outcomes were compared.Results: The mean age of the cases in Group A (conventional stripping) was 52 years and in group B (Invagination stripping) was 53 years. Blood loss was significantly more in conventional stripping compared to invagination stripping (p<0.001). The post-operative (after 1 week) mean VAS of the cases in Group A was 3.1 and 2.3 respectively while in group B it was 2.9 and 2.1 respectively. Time taken to get back to activity was significantly more in conventional stripping compared to invagination stripping (p<0.001).Conclusions: From this study we concluded that Invagination stripping is a suitable alternative to time honoured conventional varicose vein stripping with added advantage of less blood loss, less postoperative pain and shorter time span to get back to work.

Effect of Intravenous Dexmedetomidine on Spinal Anaesthesia with Hyperbaric Bupivacine.

Background: Spinal anaesthesia is one of thecommonest anaesthetic techniques for infra-umbilicalsurgeries. Administration of dexmedetomidine forsedation during spinal anaesthesia is found to prolongthe duration of block. Aim and Objectives: To evaluating the effect of intravenous dexmedetomidine onblock characteristic of spinal anaesthesia withhyperbaric bupivacaine. Material and Methods: Atotalof 120 patients scheduled for various elective surgeriesunder spinal anaesthesia with hyperbaric bupivacainewere included in the study. The patients were dividedinto two groups of each containing 60 subjects. GroupD received 1µg/kg bolus dexmedetomidine over 10minutes immediately after spinal anaesthesia followedby 0.5µg/kg/hr infusion till the end of surgery andGroup S received similar amount of saline. Datacollected include onset of sensory and motor blockade,time for two segmental regression of block, duration ofanalgesia and sedation score were noted. Results:Onset of sensory block was faster in group D(2.38±1.48 min) as compared to Group S (3.03±0.22min). Onset of motor block was significantly faster inGroup D (6.97±0.93 min) as compared to Group S(8.01±0.85 min). Time required for two segmentregression was prolonged in Group D (122.67±7.15min) as compared to Group S (65.76±4.71 min). Totalduration of analgesia was also prolonged in group D(4.29 ±1.04 hr) compared to Group S (2.24±0.29 hr).Conclusion: Intravenous administration of dexmedetomidine prolongs the duration of sensory and motorblockade with arousable sedation.

Long-Term Testosterone Therapy in Type 2 Diabetes Is Associated with Decreasing Waist Circumference and Improving Erectile Function

Assessment of risk scoring of non-communicable diseases among doctors in a medical college of Navi Mumbai: a cross sectional study

Background: Doctors are supposed to lead healthier lifestyles and are usually assumed to have lower morbidity and mortality rates than general population due to their medical knowledge. However, recently a study conducted by the research cell of Indian Medical Association (IMA) concluded that doctors die younger and mostly due to cardiovascular diseases.Methods: A cross sectional study was conducted among 100 doctors in a medical college for duration of 3 months. Questionnaires were distributed, they were personally interviewed and required clinical examination was done. Data obtained was tabulated in MS Excel and analyzed using SPSS software. Risk of cardiovascular diseases, diabetes, stroke and obesity was estimated and its association with various determinants was seen.Results: Odds of having central obesity increases 10 times with BMI ≥25 kg/m2 as compared to <25 kg/m2. With risk ratio of 1.96, doctors are twice at risk of having BMI ≥25 as compared to general population. Number of people with higher risk of CVD increased after 45 years of age. People with at least one NCD outnumbered the people without any NCD, in the age group of 45-54 years and above. Insufficient physical activity is prevalent among 37% in this age group.Conclusions: This study gives an idea on impact of medical profession on lifestyle, outlook and attitude towards personal health among professional doctors. Initiatives must be taken to identify the causes of professional stress among doctors and measures must be taken to prevent them.

Microbiome data science

Best practices from open data science are spreading across research fields, providing new opportunities for research andeducation. Open data science emphasizes the view that digitalization is enabling new forms of resource sharing, collaboration and outreach. This has the potential to improve the overall transparency and efficiency of research. Microbiomebioinformatics is a rapidly developing area that can greatly benefit from this progress. The concept of microbiome datascience refers to the application of best practices from open data science to microbiome bioinformatics. The increasingavailability of open data and new opportunities to collaborate online are greatly facilitating the development of this field. Amicrobiome data science ecosystem combines experimental research data with open data processing and analysis andreproducible tutorials that can also serve as an educational resource. Here, we provide an overview of the current status ofmicrobiome data science from a community developer perspective and propose directions for future development of thefield.

A study to assess the prevalence of iodine deficiency disorders in Betul district, Madhya Pradesh, India

Background: Iodine deficiency disorders (IDD) constitute the single largest cause of preventable neurological damage worldwide. Majority of consequences of IDD are invisible and irreversible but at the same time these are preventable. The study was conducted to assess the prevalence of goiter in school children aged 6-12 years, to estimate the urinary iodine excretion and to assess the level of iodine concentration in salt samples obtained from households of selected school children.Methods: Population proportionate to size sampling. Sample size was 90 primary school-going children of age 6-12 years in each selected village, total 2700 from 30 villages/wards in Betul district, Madhya Pradesh, India.Results: The prevalence of goiter among the 6-12 years children was found to be 32.06%. Females had higher prevalence compared to males. Of the 540 salt samples, 370 (68.4%) had iodine concentration ?15 ppm at household level.Conclusions: IDD is a mild public health problem in Betul district.

A study to assess the assess the food safety knowledge and hygienic practices among food handlers

Background: Improper food production, handling, and preparation techniques have direct influence on health. A food borne disease is a disease usually either infectious or toxic in nature, caused by agents that enter the body through ingestion of food. The objective of the present study was to assess the food safety knowledge and hygienic practices among food handlers and to assess the improvement in knowledge and hygienic practices after educational intervention.Methods: This was a longitudinal educational interventional study, carried out during October to December 2017 among 50 randomly selected food handlers in and around Gandhi Medical College campus, where the study subjects were interviewed by using a questionnaire in local language regarding their knowledge and practices of food handling, and were then later educated on proper food handling practices by lecture and demonstration method followed by a post intervention interview after a gap of 2 weeks.Results: Out of 50 food handlers, 62% had knowledge of the food borne diseases and it raises up to 100% post intervention. During pre-intervention, only 78% of the participants used to wash their hands before preparing meal and after intervention 92% were washing their hands before preparing meal.Conclusions: Food safety knowledge and hygienic practices among food handlers improved by 73% after the educational intervention. Maximum improvement was seen in the use of gloves, caps and hand washing practices.

Appraisal of surveillance of human rabies and animal bites in seven states of India

Background: The key to understanding the burden of animal bites and rabies lies in accurate and timely data with the help of proper surveillance system across the country. Such a surveillance system needs to be evaluated also for a programmatic purpose. Objectives: The present study was conducted to appraise the surveillance system of human rabies and animal bites in seven states of India and also to describe the characteristics of human rabies cases in the states. Methods: The record-based study was conducted from July to December 2017. The survey team collected information about the surveillance status of human rabies from the infectious diseases hospitals and animal bites from integrated disease surveillance programme (IDSP) offices of the respective states for 2012�16. At the national level, also number of animal exposures and the human rabies cases were collected from the Central Bureau of Health Intelligence and IDSP and compared for concordance. Results: There was a gross underreporting of human rabies from the states to Government of India, and there was no concordance in the reports of animal bites between the IDSP offices of the states and NCDC, New Delhi, India. There was a gradual decline in the reported cases of human rabies from the states during the 5-year period of 2012�16, attributable to improvement in the overall rabies postexposure prophylaxis services. The documentation of information of the human rabies cases was poor in the infectious disease hospitals. Conclusion: The surveillance system on human rabies and animal bites in India has to be improved under the national rabies control program to eliminate rabies by the year 2030.