An ophthalmology professionalism survey tool: Outcomes from a multi-center study in Central India

Purpose: To describe a professionalism survey tool and its use to assess knowledge of medical professionalism in ophthalmology training programs in Central India. Settings and Design: Multi?center survey study. Methods: A validated 33?question, scenario?based survey addressing professionalism attributes was administered at five centers in central India. The attributes tested included “personal characteristics,” “physician–patient relationships,” “workplace practice and relationships,” and “socially responsible behaviors.” A mean attribute score (%) was calculated and compared to “gold standard” responses by a group of expert senior ophthalmologists (100% agreement for responses). Results: A total of 225 participants completed the survey; 124 residents, 47 fellows, and 54 consultants (98.4% response rate). The total mean attribute score was 80.7 ± 9.1 (min 16.67, max 100). There was variation in the mean attribute score by professionalism attribute (P < 0.001), and a trend toward higher mean attribute scores for consultants compared to trainees across all attribute groups. The scores for “personal characteristics” (93 ± 9.7) and “physician?patient relationship” (82 ± 15.8) were the highest, whereas scores for “socially responsible behaviors” (73.9 ± 18.6) and “workplace practices” were low (72 ± 13). Conclusions: There is a generally high level of professionalism knowledge among ophthalmologists in central India. The results suggest that experience does impact knowledge of professionalism. Potential for improvement in professionalism exists in around "workplace practices", and around "socially responsible behaviors". These findings may serve as a valuable discussion starter and teaching tool to enhance professionalism in ophthalmology training programs.

Pars plana Aurolab aqueous drainage implantation for refractory glaucoma: Outcome of a new modified technique

Purpose: To report the outcomes of pars plana insertion of Aurolab aqueous drainage implant (AADI) in adults with refractory glaucoma by the novel technique of making scleral tunnel instead of patch graft to cover the tube to prevent its migration. Methods: A retrospective study was done between April 2016 and April 2018 on patients with ?12 months of follow?up. The main outcome measure was a surgical failure at 12 months. The failure was defined as intraocular pressure (IOP) >18 mmHg or IOP ?5 mmHg on two consecutive follow?up visits after 3 months, reoperation for glaucoma, loss of light perception vision, or implant explantation. Alternate definitions of failure including IOP >21 and IOP >15 mmHg were also considered. Results: The study included 32 eyes of 32 patients. The mean age was 46.2 ± 17.5 years. The most common etiology is traumatic glaucoma (12 eyes, 37.5%). The mean preoperative IOP and anti?glaucoma medications were 43.3 ± 10.3 and 3.4 ± 0.5 mmHg, respectively; both the parameters at the final follow?up were reduced to 15.2 ± 8.1 and 1.6 ± 0.5 mmHg. The Kaplan–Meier survival estimates demonstrated that the cumulative probability of failure was 15.6% (95% CI; 6.8–33.5%) at 3 months, 18.7% (95% CI; 8.9–37.0%) at 6 months, and 25.0% (95% CI; 13.4–43.8%) at 12 months. Conclusion: Pars plana AADI implantation with a newer modification technique is a useful procedure in reducing IOP and the number of anti?glaucoma medications in the eyes with refractory glaucoma. The visual acuity may be stabilized with the concurrent treatment of posterior segment pathology

Wrist Deformity in Children and Adolescents with b-thalassemia on Oral Iron Chelation Therapy

Objective: To describe a novel wrist deformity in β-thalassemia major patients, and theirradiographic and magnetic resonance imaging findings. Methods: 30 patients withβ-thalassemia major who were noticed to have ulnar deviation at wrist joint were evaluated forprevious history of medications, serum ferritin levels, presence of pain and swelling at thewrist joint, and the duration of iron chelation therapy. Radiographs of wrist and limitedmagnetic resonance imaging (MRI) sequences were obtained in 30 and 15 patients,respectively. Results: Radiographs revealed varying severity of distal ulnar shortening, distalradial slanting and presence of soft tissue distal to the ulna. MRI showed similar deformitiesalong with abnormal marrow signal at distal ulnar ends; in 8 patients, a soft tissue distal to thedistal end of ulna was noted.Conclusion: Varying severity of radiological abnormalities,predominantly affecting the distal ulna, are present in children and adolescents with β-thalassemia receiving oral chelation therapy

To Study The Comparison Of Scaphoid Nonunion Treated By Vascularised Bone Graft From Distal End Of Radius With That Of Non Vascularised Bone Graft From Iliac Crest In A Medical College Hospital Setup

Aprospective randomised study comparing radiographic results of 10 patients treated for scaphoid nonunion using a vascularised bone graft from the dorsum of distal radius (group I), relative to 10 patients treated by means of non vascularised bone graft from the iliac crest(group II). Bone union was achieved in 7 of 10 patients group I and 4 of 10 group II patients. Functional results were good to excellent in 7 of the patients in group I and 6 in group II. Our study conclude that vascularised bone grafting yields superior results in scaphoid nonunion.

Prevalence of tobacco usage and its effect on the periodontal health parameters in the mining employees and the general population - A comparative study

Objective: Comparison of the prevalence of usage of tobacco products and its effect on the periodontal health parameters of the mining laborers and the general population of Udaipur city, India. Materials and methods: the cross sectional study was performed on the sample of 980 adults including 500 mining employees and 480 subjects from the general population. The presence or absence of the tobacco products usage was noted. The ADA type III examination using the community periodontal probe was done. The data obtained was subjected to chi-square and Cramer' v statistical analysis. Results: 79.40% of the mining-employees and 61.67% of the general population used different tobacco products, the difference noted was statistically significant (p=0.000). The most common periodontal condition amongst the mining employees and the general population was the presence of calculus (39% and 35.63% respectively) followed by the 4-5mm periodontal probing depth (29.20% and 26.04% respectively). The difference spotted was significant (p=0.018). There was statistically significant difference between the tobacco users and non- users for the different periodontal conditions (p=0.000). Conclusion: the tobacco product usage was high in mining employees group. There was a positive correlation between the usage of tobacco products and the periodontal health parameters (AU)

Attitudes of Saudi Arabian undergraduate medical students towards health research

Objectives: This study aimed to evaluate attitudes, perceptions and perceived barriers towards health research among Saudi Arabian undergraduate medical students

Methods: This cross-sectional study took place between August and October 2014 and included 520 students from five medical schools across Saudi Arabia. An anonymous online survey with 21 close-ended questions was designed to assess students' attitudes towards research, contribution to research-related activities, awareness of the importance of research, perception of available resources/opportunities for research, appreciation of medical students' research contributions and perceived barriers to research. Responses were scored on a 5-point Likert scale

Results: A total of 401 students participated in the study [response rate: 77.1%]. Of these, 278 [69.3%] were female. A positive attitude towards research was reported by 43.9% of the students. No statistically significant differences were observed between genders with regards to attitudes towards and available resources for research [P = 0.500 and 0.200, respectively]. Clinical students had a significantly more positive attitude towards research compared to preclinical students [P = 0.007]. Only 26.4% of the respondents believed that they had adequate resources/opportunities for research. According to the students, perceived barriers to undertaking research included time constraints [n = 200; 49.9%], lack of research mentors [n = 95; 23.7%], lack of formal research methodology training [n = 170; 42.4%] and difficulties in conducting literature searches [n = 145; 36.2%]

Conclusion: Less than half of the surveyed Saudi Arabian medical students had a positive attitude towards health research. Medical education policies should aim to counteract the barriers identified in this study

Finite element study on modification of bracket base and its effects on bond strength

OBJECTIVE: This article aims to analyze the difference in stresses generated in the bracket-cement-tooth system by means of a peel load in single and double-mesh bracket bases using a three-dimensional finite element computer model. MATERIAL AND METHODS: A three-dimensional finite element model of the bracket-cement-tooth system was constructed and consisted of 40,536 bonds and 49,201 finite elements using a commercial mesh generating programmer (ANSYS 7.0). Both single and double-mesh bracket bases were modified by varying the diameter from 100-400 µm progressively, and the spacing between the mesh wires was kept at 300 µm for each diameter of wire. A peel load was applied on the model to study the stresses generated in different layers. RESULTS: In case of double-mesh bracket base, there was reduction in stress generation at the enamel in comparison to single-mesh bracket base. There was no difference in stress generated at the bracket layer between single and double-mesh bracket bases. At the impregnated wire mesh (IWM), layer stresses increased as the wire diameter of the mesh increased. CONCLUSION: Results show that bracket design modification can improve bonding abilities and simultaneously reduce enamel damage while debonding. These facts may be used in bringing about the new innovative bracket designs for clinical use. .

OBJETIVO: o objetivo do presente artigo é analisar a diferença entre as tensões geradas na interface braquete-cemento-dente por meio do teste peel load em bases de braquete de malha simples e dupla e do método de elementos finitos tridimensional. MÉTODOS: foi construído um modelo de elementos finitos do sistema composto pela interface braquete-cemento-dente. Esse modelo consistiu de 40.536 nós e 49.201 elementos finitos. A análise foi feita com a ajuda do programa ANSYS 7.0. Tanto a base de braquete de malha única quanto a de malha dupla sofreram modificações no diâmetro, que variou de 100 a 400µm, progressivamente. O espaço entre os fios das malhas foi mantido a 300µm para o diâmetro de cada fio. O teste peel load foi aplicado ao modelo para investigar as tensões geradas nas diferentes camadas. RESULTADOS: quando comparadas às bases de braquetes de malha simples, as bases de braquetes de malha dupla geraram menos tensão no esmalte dentário. Não foram detectadas diferenças entre as tensões geradas na superfície dos braquetes com bases de malha simples e dupla. Na malha de fios impregnados (MFI), houve um aumento na tensão com o aumento do diâmetro dos fios que compõem a malha. CONCLUSÃO: os resultados revelam que as modificações no desenho do braquete podem aumentar a colagem e, ao mesmo tempo, minimizar os danos causados no esmalte durante o processo de descolagem. Esses fatos podem ser utilizados no desenvolvimento de desenhos de braquetes inovadores, destinados à utilização clínica. .

Predicting mortality after congenital heart surgeries: Evaluation of the Aristotle and Risk Adjustement in Congenital Heart surgery-1 risk prediction scoring systems: A retrospective single center analysis of 1150 patients.

Aims and Objectives: To validate Aristotle basic complexity and Aristotle comprehensive complexity (ABC and ACC) and risk adjustment in congenital heart surgery‑1 (RACHS‑1) prediction models for in hospital mortality after surgery for congenital heart disease in a single surgical unit. Materials and Methods: Patients younger than 18 years, who had undergone surgery for congenital heart diseases from July 2007 to July 2013 were enrolled. Scoring for ABC and ACC scoring and assigning to RACHS‑1 categories were done retrospectively from retrieved case files. Discriminative power of scoring systems was assessed with area under curve (AUC) of receiver operating curves (ROC). Calibration (test for goodness of fit of the model) was measured with Hosmer‑Lemeshow modification of χ2 test. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were applied to assess reclassification. Results: A total of 1150 cases were assessed with an all‑cause in‑hospital mortality rate of 7.91%. When modeled for multivariate regression analysis, the ABC (χ2 = 8.24, P = 0.08), ACC (χ2 = 4.17, P = 0.57) and RACHS‑1 (χ2 = 2.13, P = 0.14) scores showed good overall performance. The AUC was 0.677 with 95% confidence interval (CI) of 0.61-0.73 for ABC score, 0.704 (95% CI: 0.64-0.76) for ACC score and for RACHS‑1 it was 0.607 (95%CI: 0.55-0.66). ACC had an improved predictability in comparison to RACHS‑1 and ABC on analysis with NRI and IDI. Conclusions: ACC predicted mortality better than ABC and RCAHS‑1 models. A national database will help in developing predictive models unique to our populations, till then, ACC scoring model can be used to analyze individual performances and compare with other institutes.

Ocular malignant tumors. Review of the tumor registry at a tertiary eye hospital in central Saudi Arabia

To present the epidemiologic profile and magnitude of ocular malignant tumors [MT] representative of the Saudi population from the Tumor Registry [TR] at King Khaled Eye Specialist Hospital [KKESH]. This study evaluated the demographic information, clinical features including tumor laterality, ocular tissue of origin, and diagnosis of patients from the TR registry between 1983 and 2012 at KKESH, Riyadh, Kingdom of Saudi Arabia. The incidence of MT among Saudi adults [>/= 15 years old], and children [<15 years old] was estimated. The TR recorded 4,146 neoplasms [2,509 [60.5%] benign tumors, and 1,637 [39.5%] MT]. The incidence of MT in children was 3.6 per million/year [M/Y], and 2.4/M/Y for adults. Retinoblastoma [Rb] [n=763, 91%] was the most common ocular malignancy in children. In adults, the most common MT was squamous cell carcinoma [SCC] [n=363, 45.8%], basal cell carcinoma [BCC] [n=186, 23%], uvealmelanoma [n=94, 11.9%], sebaceous gland carcinoma [n=54, 6.8%], lymphomas [orbital, adnexal] [n=46, 5.8%], and others [n=53, 6.8%]. The Rb [7.7/M/Y in <5 years old Saudi children] was less frequent than that reported in some Gulf countries, but higher than that reported from the West. The SCC was less frequent in countries with comparable sun exposure than in other continents, but the incidence remained unchanged over 3 decades. There was a significant increase in BCC between 1983-1992 and 2003-2012. The rates of all cancers remained stable over 3 decades except BCC, which showed a significant rise

Development of a web-based glaucoma registry at King Khaled eye specialist hospital, Saudi Arabia: a cost-effective methodology

In this brief communication, we present the steps used to establish a web-based congenital glaucoma registry at our institution. The contents of a case report form [CRF] were developed by a group of glaucoma subspecialists. Information Technology [IT] specialists used Lime Survey softwareTM to create an electronic CRF. A MY Structured Query Language [MySQL] server was used as a database with a virtual machine operating system. Two ophthalmologists and 2 IT specialists worked for 7 hours, and a biostatistician and a data registrar worked for 24 hours each to establish the electronic CRF. Using the CRF which was transferred to the Lime survey tool, and the MYSQL server application, data could be directly stored in spreadsheet programs that included Microsoft Excel, SPSS, and R-Language and queried in real-time. In a pilot test, clinical data from 80 patients with congenital glaucoma were entered into the registry and successful descriptive analysis and data entry validation was performed. A web-based disease registry was established in a short period of time in a cost-efficient manner using available resources and a team-based approach.

Combined true and pseudoexfoliation in a Saudi patient with co-existing cataract and glaucoma

True exfoliation and pseudoexfoliation of the anterior lens capsule are different conditions, their coexistence is rare. We report a case with clinical findings of unilateral combined true exfoliation and pseudoexfoliation in a Saudi Bedouin that was confirmed his-tologically. We suggest that high levels of infrared radiation in the desert may have contributed to the capsular delamination

Pigmented hypopyon in association with monocytogenes endophthalmitis: an interesting case report following refractive surgery procedure with literature review

Listeria monocytogenes is an aerobic, motile, gram positive bacillus recognized as an intercellular pathogen in human where it most frequently affects neonates, pregnant women, elderly patients, and immunosuppressed individuals as well as healthy persons. Ocular listeriosis is rare, most frequently in the form of conjunctivitis, but has been also shown to cause rarely endophthalmitis with pigmented hypopyon and elevated intraocular pressure such as in our case. We are reporting one immunocompetent patient presenting with dark hypopyon following laser refractive procedure. His clinical findings, investigations, and further management are all described with relevant literature review of similar cases. Diagnosis of ocular listeriosis was confirmed by positive culture of anterior chamber [AC] aspirate with identification of the above organism. His visual outcome was satisfactory with good preserved vision. We believe that his ocular infection was exogenous and that ophthalmologists should be aware of the causative organisms of colored hypopyon to avoid delayed diagnosis

Transcriptome analysis of Anopheles stephensi embryo using expressed sequence tags.

Germ band retraction (GBR) stage is one of the important stages during insect development. It is associated with an extensive epithelial morphogenesis and may also be pivotal in generation of morphological diversity in insects. Despite its importance, only a handful of studies report the transcriptome repertoire of this stage in insects. Here, we report generation, annotation and analysis of ESTs from the embryonic stage (16–22 h post fertilization) of laboratoryreared Anopheles stephensi mosquitoes. A total of 1002 contigs were obtained upon clustering of 1140 high-quality ESTs, which demonstrates an astonishingly low transcript redundancy (12.1%). Putative functions were assigned only to 213 contigs (21%), comprising mainly of transcripts encoding protein synthesis machinery. Approximately 78% of the transcripts remain uncharacterized, illustrating a lack of sequence information about the genes expressed in the embryonic stages of mosquitoes. This study highlights several novel transcripts, which apart from insect development, may significantly contribute to the essential biological complexity underlying insect viability in adverse environments. Nonetheless, the generated sequence information from this work provides a comprehensive resource for genome annotation, microarray development, phylogenetic analysis and other molecular biology applications in entomology.

Anterior orbit and adnexal amyloidosis

To describe six cases of anterior orbital and adnexal amyloidosis and to report on proteomic analysis to characterize the nature of amyloid in archived biopsies in two cases. The clinical features, radiological findings, pathology, and outcome of six patients with anterior orbit and adnexal amyloidosis were retrieved from the medical records. The biochemical nature of the amyloid was determined using liquid chromatography/mass spectroscopy archived paraffin-embedded tissue in two cases. Of the six cases, three had unilateral localized anterior orbit and lacrimal gland involvement. Four of the six patients were female with an average duration of 12.8 years from the time of onset to presentation eyelid infiltration by amyloid caused ptosis in five cases. CT scan in patients with lacrimal gland involvement [n = 3] demonstrated calcified deformable anterior orbital masses and on pathological exmaintionamyloid and calcific deposits replaced the lacrimal gland acini. Ptosis repair was performed in three patients with good outcomes. One patient required repeated debulking of the mass and one patient had recurrenct disease. Proteomic analysis revealed polyclonal IgG-associated amyloid deposition in one patient and AL kappa amyloid in the second patient. Amyloidosis of the anterior orbit and lacrimal gland can present with a wide spectrum of findings with good outcomes after surgical excision. The nature of amyloid material can be precisely determined in archival pathology blocks using diagnostic proteomic analysis

Molecular analysis of gut microbiota in obesity among Indian individuals.

Obesity is a consequence of a complex interplay between the host genome and the prevalent obesogenic factors among the modern communities. The role of gut microbiota in the pathogenesis of the disorder was recently discovered; however, 16S-rRNA-based surveys revealed compelling but community-specific data. Considering this, despite unique diets, dietary habits and an uprising trend in obesity, the Indian counterparts are poorly studied. Here, we report a comparative analysis and quantification of dominant gut microbiota of lean, normal, obese and surgically treated obese individuals of Indian origin. Representative gut microbial diversity was assessed by sequencing fecal 16S rRNA libraries for each group (n=5) with a total of over 3000 sequences. We detected no evident trend in the distribution of the predominant bacterial phyla, Bacteroidetes and Firmicutes. At the genus level, the bacteria of genus Bacteroides were prominent among the obese individuals, which was further confirmed by qPCR (P<0.05). In addition, a remarkably high archaeal density with elevated fecal SCFA levels was also noted in the obese group. On the contrary, the treated-obese individuals exhibited comparatively reduced Bacteroides and archaeal counts along with reduced fecal SCFAs. In conclusion, the study successfully identified a representative microbial diversity in the Indian subjects and demonstrated the prominence of certain bacterial groups in obese individuals; nevertheless, further studies are essential to understand their role in obesity.

Parental attitude and knowledge towards the usage of barrier techniques by pediatric dentist.

To assess the parental attitude and knowledge towards the use of barrier techniques by the pediatric dentist, parents of 200 preschool pediatric patients were randomly selected and asked to fill the questionnaire related to the usage of barrier technique by the pediatric dentists. Seventy five percent of the parents felt, that pediatric dentist should wear gloves and 35% wanted their pediatric dentist to wear mouth mask, 70% of parents thought that both pediatric dentist and the patients will be protected from the spread of the infection. Thirty five percent of them also wanted pediatric dentist to wear protective glasses during the treatment procedure. Eighty five percent of them refused the treatment by pediatric dentists who were not wearing the gloves; 72% wanted the gloves to be changed for each patient. Fifty five percent of them thought that dental assistant also should wear gloves during treatment; only 55% of the parents were satisfied with the barrier techniques protocol of their pediatric dentist; Ninty percent of them thought that using gloves and mouth mask will scare the child. Quite high level of positive attitude and knowledge was seen in the present group of parents and they were not willing to take their child to the pediatric dentist who didn’t follow the proper barrier technique.