Percentage of patients shifting to another treatment modality: An experience-guided decision

ABSTRACT Objective: This study aimed to assess the frequency with which orthodontic patients decided to shift to another type of orthodontic appliance, among conventional metal brackets, ceramic brackets, lingual brackets and clear aligner, based on their personal experiences of pain, ulcers, bad breath, hygiene issues and social difficulties. Material and Methods: This study comprises of patients seeking orthodontic treatment. The sample (n = 500; age group = 19-25 years) was divided equally into four groups based on the treatment modality: conventional metal brackets, ceramic brackets, lingual brackets and clear aligner. Patients rated the questionnaire using a visual analogue scale, to assess variables (such as pain, ulcer etc) that impact various treatment modalities. Subsequently, patients from all groups provided feedback regarding their treatment experiences, and expressed their preference for an alternative modality. Intergroup comparison among the four groups was done using one-way analysis of variance with Tukey's HSD post-hoc test (p ≤ 0.05). Results: Patients who received lingual brackets reported higher levels of pain and ulceration, as compared to those who received clear aligners. All four groups showed statistically significant differences for ulcers during treatment (p ≤ 0.05). Of the 125 patients who received conventional metal brackets, 28% expressed a preference for clear aligner therapy, while 20% preferred ceramic brackets. In the lingual group, 56% of 125 patients preferred clear aligner therapy, and 8% preferred ceramic brackets to complete their treatment. In the ceramic group, 83% did not want to switch, whereas 17% desired to switch to clear aligner, while in aligner group no patient desired to switch. Conclusions: A higher percentage of patients from lingual brackets group chose to shift to clear aligners, followed by conventional metal brackets group and by ceramic brackets group, in this descending order. The clear aligner group demonstrated fewer issues than the other treatment modalities.

RESUMO Objetivo: Este estudo teve como objetivo avaliar a frequência com que pacientes ortodônticos decidiram mudar para outro tipo de aparelho ortodôntico, entre braquetes convencionais de metal, braquetes cerâmicos, braquetes linguais e alinhadores transparentes, com base em suas experiências pessoais de dor, aftas, mau hálito, problemas de higiene e dificuldades sociais. Material e Métodos: Esse estudo foi composto por pacientes que procuram tratamento ortodôntico. A amostra (n = 500; faixa etária = 19-25 anos) foi dividida igualmente em quatro grupos, com base na modalidade de tratamento: braquetes metálicos convencionais, braquetes cerâmicos, braquetes linguais e alinhadores transparentes. Os pacientes responderam a um questionário, usando uma escala visual analógica, para avaliar variáveis como dor e aftas, que impactam diferentes modalidades de tratamento. Posteriormente, os pacientes de todos os grupos forneceram feedback sobre suas experiências de tratamento e expressaram sua preferência por uma modalidade alternativa. A comparação intergrupos entre os quatro grupos foi feita usando análise de variância unidirecional com teste post-hoc HSD de Tukey (p ≤ 0,05). Resultados: Os pacientes que usaram braquetes linguais relataram níveis mais elevados de dor e aftas, em comparação com aqueles que usaram alinhadores transparentes. Todos os quatro grupos apresentaram diferenças estatisticamente significativas para aftas durante o tratamento (p ≤ 0,05). Dos 125 pacientes que usaram braquetes metálicos convencionais, 28% expressaram preferência pelo tratamento com alinhadores transparentes, enquanto 20% preferiram braquetes cerâmicos. No grupo com braquetes linguais, 56% dos 125 pacientes preferiram o tratamento com alinhadores transparentes e 8% preferiram braquetes cerâmicos para completar o tratamento. No grupo com braquetes cerâmicos, 83% não queriam trocar de tratamento, enquanto 17% desejavam mudar para os alinhadores transparentes; enquanto no grupo de alinhadores nenhum paciente desejou mudar. Conclusões: Uma porcentagem maior de pacientes do grupo com braquetes linguais optou pela mudança para alinhadores transparentes, seguido pelo grupo com braquetes metálicos convencionais e pelo grupo com braquetes cerâmicos, em ordem decrescente. O grupo de alinhadores transparentes demonstrou menos problemas do que as outras modalidades de tratamento.

A rare optineurin mutation in an Indian family with coexistence of JOAG and PCG

Purpose: This study focused on the genetic screening of Myocilin (MYOC), Cytochrome P450 family 1 subfamily B member 1 (CYP1B1), Optineurin (OPTN), and SIX homeobox 6 (SIX6) genes in a family with coexistence of primary congenital glaucoma (PCG) and juvenile open?angle glaucoma (JOAG). Methods: Sanger sequencing was used to examine the coding region of all four genes. Six different online available algorithms were used for the pathogenicity prediction of missense variant. Structural analysis was done using Garnier–Osguthorpe–Robson (GOR), PyMol, ChimeraX, and Molecular Dynamic (MD) Simulations (using Graphics Processing Unit (GPU)?enabled Desmond module of Schrödinger). Results: There were a total of three sequence variants within the family. All seven algorithms determined that a single mutation, G538E, in the OPTN gene is pathogenic. The loops connecting the strands became more flexible, as predicted structurally and functionally by pathogenic mutations. Mutations create perturbations and conformational rearrangements in proteins, hence impairing their functioning. Conclusion: In this study, we describe a North Indian family in which members were having JOAG and PCG due to a rare homozygous/ heterozygous mutation in OPTN. The coexistence of two types of glaucoma within a single pedigree suggests that certain OPTN mutations may be responsible for the onset of different glaucoma phenotypes.

Microkeratome chronicles: Management of a free flap

Background: In LASIK (laser in situ keratomileusis), a hinged corneal flap is made, which enables the flap to be lifted and the excimer laser to be applied to the stromal bed. If the hinge of the corneal flap detaches from the cornea, the flap is called a free cap. A free cap is a rare intra-operative complication of LASIK most commonly associated with the use of a microkeratome on corneas with flat keratometry, which predisposes to a small flap diameter. Free caps are preventable and treatable. Rarely does the complication lead to a severe or permanent decrease in visual acuity. Purpose: As free caps are avoidable, prevention is critical. Our video gives some tips and tricks on how to avoid a free flap and also focuses on how to manage a cut through a free flap. Synopsis: If a free cap is created, the surgeon must decide whether to continue with excimer laser ablation or to abort the procedure. When to abort: If the stromal bed is irregular, the flap is replaced without applying laser ablation. Without ablation, generally, there is no change in refractive error or significant loss of visual acuity. When to continue: If the stromal bed is regular and the cap is of normal thickness, the surgeon may proceed with ablation. To prevent desiccation, the free cap should be handled with caution and should be placed on a drop of balanced salt solution. The free cap should be placed epithelial facing up, along with a bandage contact lens. The endothelial cell pump mechanism typically allows the cap to re-adhere tightly. Highlights: Risk factors for a free cap are generally anatomic or mechanical. Especially in flat corneas, an appropriate ring and stop size should be chosen looking at the nomogram on the basis of the keratometry values. Deep orbits and deep-seated eyes should be looked for as PRK is a better option in such cases. Inadequate suction should be dealt with a lot of care, and once this is done, the vacuum should be stopped. Re-docking of the microkeratome with suction can be done again. Prior testing of the microkeratome and a good verbal anesthesia are a few more such important points to be pondered upon. This video gives us such tips and is a comprehensive video for a novice surgeon performing microkeratome LASIK

Optic nerve sheath fenestration: A second lease at sight

Purpose: To study the safety and efficacy of optic nerve sheath fenestration surgery in patients with optic disc edema due to different etiologies. Methods: Records of 18 eyes of 15 patients who underwent optic nerve sheath fenestration for vision threatening optic disc edema were reviewed retrospectively, and results were analyzed. Improvement of visual acuity was the main measure of outcome. Improved visual fields, resolution of optic disc edema, diplopia, and headache were other benefits that were observed. Results: Fifteen patients between 13 and 54 years of age were included in the study. Three patients underwent successive bilateral surgery. Idiopathic intracranial hypertension was the most common cause for optic disc edema and was found in 80% of the patients. Mean preoperative logMAR acuity was ?1.9789 ± 1.46270, which improved to ?0.9022 ± 1.23181 (p < 0.005) in the operated eye, and mean logMAR acuity of contralateral eye improved from ?1.3378 ± 1.50107 to ?1.0667 ± 1.33813 (p < 0.05). Conclusion: Early optic nerve sheath fenestration is an effective modality for treating optic disc edema due to a wide myriad of causes and helps resolve the associated symptoms.

Post-vitrectomy secondary macular holes: Risk factors, clinical features, and multivariate analysis of outcome predictors

Purpose: We report clinical characteristics, risk factors, treatment outcomes, and prognostic predictors of post?vitrectomy secondary macular holes (MHs). Methods: This was a retrospective observational case series from November 2014 to December 2020. Eyes that developed secondary MH, two weeks and beyond after primary vitrectomy for non?MH indications, were enrolled. Pre? and intraoperative records were screened to exclude pre?existence of MH. Eyes with multiple vitreoretinal surgeries prior to MH detection and tractional myopic maculopathy were excluded. Results: A total of 29 eyes of 29 patients with a mean age of 52 years developed secondary MH post?vitrectomy. The most common indications for primary vitrectomy were rhegmatogenous retinal detachment (RRD, 48.2%) and tractional retinal detachment (TRD, 24.1%). Time to MH detection after primary vitrectomy was 91.5 ± 117.6 days. The mean minimum hole diameter was 530 ± 298 microns. Epi?retinal membrane and cystoid degeneration was noted in 6 (20.7%) and 12 (41.3%) eyes, respectively (p = 0.088). The mean time from MH detection to MH repair was 34 ± 42 days. The surgical intervention included internal limiting membrane peeling with tamponade in 25 eyes. Overall, 80% showed anatomic hole closure, 90.9% versus 57.1% in the RRD and TRD (p = 0.092), respectively. The mean best?corrected visual acuity (BCVA) at the final visit was 0.71 logarithm of the minimum angle of resolution. Thirteen eyes (52%) had a BCVA of 20/100 or better. Minimal hole diameter (p = 0.029) only predicted final visual acuity. The interval between MH diagnosis and repair did not affect hole closure significantly (p = 0.064). Conclusion: Secondary MH post?vitrectomy closed successfully with limited visual improvement and trails behind idiopathic MH.

Enterococcus avium bed-sore infection: A rara avis

Enterococci are Gram-positive cocci that are normal inhabitants of the urogenital and intestinal tracts of human beings and animals. Of the pathogenic species of Enterococci, Enterococcus avium is an infrequent cause of human infections. This report is an atypical case of bed-sore infection caused by E. avium in an elderly male with multiple comorbidities. Although the patient was given antibiotics along with surgical debridement, he passed away. This case calls attention to the pathogenic prospect of E. avium in clinical settings

A Cross-Sectional Study to Assess the Knowledge Regarding Rights and Responsibilities of Nurses at a Selected Tertiary Care Hospital

.Health care system could not function efficiently, if nurses were not present to perform their part. Nurses do their work responsibly and passionately to serve the mankind and the needy ones. Sense of responsibility makes a person more accountable to their duty, while the knowledge of the rights gives personal security and confidence. It is essential for the nurses to be well aware of their rights and responsibilities to provide comprehensive care to the patients. A cross-sectional survey was carried out at AIIMS, New Delhi, to assess nurses'#39; knowledge regarding rights and responsibilities. Convenient sampling was used to select 210 samples from ICU, ward, OPD, OT and emergency department. Structured knowledge questionnaire was used to collect the data. The study found that nurses had good knowledge regarding nurse'#39;s rights (mean score 27'plusmn;3.7). Similarly the nurses were well aware of their responsibilities with mean knowledge score of 15'plusmn;1.29. Knowledge regarding the rights of the nurses was significantly associated with age (p=0.034), educational qualification (p=0.018) and years of experience (p=0.003) whereas knowl- edge regarding the responsibility of the nurses was independent of socio-demographic variables; 65.7 percent of subjects had attended empowerment programmes. To conclude, nurses were well aware about their rights and responsibilities. Formal educational and empowerment programme are proved to be helpful in enhancing their knowledge. Therefore, the employers should plan an ongoing, appropriate empowerment programme for the nurses to keep them updated.

Causes & risk factors for unscheduled readmissions in the paediatric ward of a major public hospital

Background & objectives: Readmissions are often considered as an indicator of poor quality of care during previous hospitalization, although many of these are unavoidable or unrelated to the past admission. The identification of high-risk cases for readmissions and appropriate interventions will help not only reduce the hospital burden but also to establish the credibility of the hospital. So this study aimed to determine the readmission percentage in the paediatric wards of a tertiary care hospital and to identify the reasons and risk factors that can help minimize preventable re-hospitalizations. Methods: This prospective study from a public hospital included 563 hospitalized children, classified as first admission or readmissions. Readmissions were defined as one or more hospitalizations within preceding six months, excluding scheduled admissions for investigations or treatment. Reason-wise, the readmissions were classified into various categories, based on the opinion of three paediatricians. Results: The percentage of children getting readmitted within six, three and one month time from the index admission was 18.8, 11.1 and 6.4 per cent, respectively. Among readmissions, 61.2 per cent were disease-related, 16.5 per cent unrelated, 15.5 per cent patient-related, 3.8 per cent medication/procedure-related and 2.9 per cent physician-related causes. Patient- and physician-related causes were deemed preventable, contributing to 18.4 per cent. The proximity of residence, undernutrition, poor education of the caretaker and non-infectious diseases were associated with increased risk of readmission. Interpretation & conclusions: The findings of this study suggest that readmissions pose a substantial burden on the hospital services. The primary disease process and certain sociodemographic factors are the major determinants for the increased risk of readmissions among paediatric patients.

Type I Arnold Chiari Malformation with Syringomyelia and Scoliosis: Radiological Correlations between Tonsillar Descent, Syrinx Morphology and Curve Characteristics: A Retrospective Study

Methods@#Data regarding patients, who underwent PFD for ACM-I presenting with SM and scoliosis between January 2009 and December 2018, were retrospectively collected. Only patients with 2-year follow-up were included. Sagittal/coronal deformity and sagittal spinopelvic parameters were examined. Symmetry and extent of tonsillar descent, as well as morphology (configuration/variation) and extent of syrinx were determined. @*Results@#A total of 42 patients (20 females; age: 14.2±5.8 years) were included; 35 patients (83.3%) had atypical curves. Mean preoperative coronal Cobb was 57.7°±20.9°; and 12 (28.6%) had significant coronal imbalance. Tonsillar descent was classified as grade 1, 2, and 3 in 16 (38.1%), 11 (26.2%), and 15 (35.7%) patients; 35 patients (83.3%) had asymmetric tonsillar descent; 17 (40.4%), 3 (7.1%), 16 (38.1%), and 6 (14.4%) had circumscribed, moniliform, dilated, and slender syrinx patterns; and 9 (21.4%), 12 (28.6%), and 21 (50%) of syrinx were right-sided, left-sided, and centric. There was no significant relationship between side of tonsillar dominance (p =0.31), grade of descent (p =0.30), and convexity of deformity. There was significant association between side of syrinx and convexity of scoliosis (p =0.01). PFD was performed in all, and deformity correction was performed in 23 patients. In curves ≤40°, PFD alone could stabilize scoliosis progression (p =0.02). There was significant reduction in syrinx/cord ratio following PFD (p 40°.

Serum albumin is the strongest predictor of anti-tumor necrosis factor nonresponse in inflammatory bowel disease in resource-constrained regions lacking therapeutic drug monitoring

Background/Aims@#Evidence on predictors of primary nonresponse (PNR), and secondary loss of response (SLR) to anti-tumor necrosis factor (anti-TNF) agents in inflammatory bowel disease is scarce from Asia. We evaluated clinical/biochemical/molecular markers of PNR/SLR in ulcerative colitis (UC) and Crohn’s disease (CD). @*Methods@#Inflammatory bowel disease patients treated with anti-TNF agents (January 2005–October 2020) were ambispectively included. Data concerning clinical and biochemical predictors was retrieved from a prospectively maintained database. Immunohistochemistry for expression of oncostatin M (OSM), OSM receptor (OSM-R), and interleukin-7 receptor (IL-7R) were done on pre anti-TNF initiation mucosal biopsies. @*Results@#One-hundred eighty-six patients (118 CD, 68 UC: mean age, 34.1±13.7 years; median disease duration at anti-TNF initiation, 60 months; interquartile range, 28–100.5 months) were included. PNR was seen in 17% and 26.5% and SLR in 47% and 28% CD and UC patients, respectively. In CD, predictors of PNR were low albumin (P<0.001), postoperative recurrence (P=0.001) and high IL-7R expression (P<0.027) on univariate; and low albumin alone (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.03–0.28; P<0.001) on multivariate analysis respectively. Low albumin (HR, 0.31; 95% CI, 0.15–0.62; P=0.001) also predicted SLR. In UC, predictors of PNR were low albumin (P<0.001), and high C-reactive protein (P<0.001), OSM (P<0.04) and OSM-R (P=0.07) stromal expression on univariate; and low albumin alone (HR, 0.11; 95% CI, 0.03–0.39; P=0.001) on multivariate analysis respectively. @*Conclusions@#Low serum albumin at baseline significantly predicted PNR in UC and PNR/SLR in CD patients. Mucosal markers of PNR were high stromal OSM/OSM-R in UC and high IL-7R in CD patients.

Interferon-gamma release assay has poor diagnostic accuracy in differentiating intestinal tuberculosis from Crohn’s disease in tuberculosis endemic areas

Background/Aims@#Intestinal tuberculosis (ITB) and Crohn’s disease (CD) frequently present with a diagnostic dilemma because of similar presentation. Interferon-gamma release assay (IGRA) has been used in differentiating ITB from CD, but with sparse reports on its diagnostic accuracy in tuberculosis endemic regions and this study evaluated the same. @*Methods@#Patients with definitive diagnosis of ITB (n=59) or CD (n=49) who underwent IGRA testing (n=307) were retrospectively included at All India Institute of Medical Sciences, New Delhi (July 2014 to September 2021). CD or ITB was diagnosed as per standard criteria. IGRA was considered positive at >0.35 IU/mL.Relevant data was collected and IGRA results were compared between ITB and CD to determine its accuracy. @*Results@#Among 59 ITB patients (mean age, 32.6±13.1 years; median disease duration, 1 year; male, 59.3%), 24 were positive and 35 tested negative for IGRA. Among 49 CD patients (mean age, 37.8±14.0; median disease duration, 4 years; male, 61.2%), 12 were positive and 37 tested negative for IGRA. Hence, for diagnosing ITB, IGRA showed a sensitivity, specificity, positive and negative predictive values of 40.68%, 75.51%, 66.67%, and 51.39%, respectively. The area under the curve of IGRA for ITB diagnosis was 0.66 (95% confidence interval, 0.55–0.75). In a subset (n=64), tuberculin skin test (TST) showed sensitivity, specificity, positive and negative predictive values of 64.7%, 73.3%, 73.3%, and 64.71%, respectively. IGRA and TST were concordant in 38 (59.4%) patients with κ=0.17. @*Conclusions@#In a tuberculosis endemic region, IGRA had poor diagnostic accuracy for differentiating ITB from CD, suggesting a limited value of IGRA in this setting.

The outcome of primary percutaneous coronary intervention in patients with stent thrombosis

Background: Primary percutaneous coronary intervention (PCI) is a recommended management strategy for patients with de novo ST-segment elevation myocardial infarction (STEMI). Still, the efficacy of primary PCI in-stent thrombosis (ST) induced STEMI is unclear. The aim was to assess the clinical characteristics and the in-hospital outcomes of patients undergoing primary PCI for STEMI caused by acute, sub-acute, or late ST. Methods: A sample of hundred consecutive patients who presented with STEMI due to ST were included in this study. The angiographic evidence of a flow-limiting thrombus or total vessel occlusion (thrombolysis in myocardial infarction (TIMI) flow grade 0 to II) at the site of the previous stent implant was taken as ST. Primary PCI was performed, and all enrolled patients and in-hospital mortality were observed. Results: Male patients were 69, and the mean age was 58.9 ± 7.78 years. ST was categorized as acute in 40 patients, sub-acute in 53, and late in the remaining seven patients. Killip class III/IV was observed in 45 patients. Dissection was observed in 25, under deployment in 74, and/or malposition in 24 patients. Thrombus aspiration was performed in 97, plain old balloon angioplasty in 76, and stenting in 22 patients. Final TIMI III flow was achieved in 32 patients. During a mean hospital stay of 4.93 ± 2.46 days, the mortality rate was 27%. Conclusion: In-hospital mortality after primary PCI was observed in more than 1/4th of the patients with STEMI due to ST undergoing primary PCI

A Case of Paediatric Non-union of Tibia Treated With Tibialization of Fibula

Management of non-union with bone gap in tibia is difficult, especially if superimposed by infection of bone. Various modalities have been described for the treatment of gap non-union, with their own advantages and disadvantages. A case of a paediatric patient with traumatic left tibia fracture which was complicated by subsequent osteomyelitis and non-union presented to tertiary care hospital. After failure of different modalities of treatment, to provide union, the patient was managed with tibialization of fibula with fibula strut graft supported by a rush nail

Deciphering the enigma of astigmatism in cataract surgery

Background: With about 87% of patients with cataracts having astigmatism, management of astigmatism in cataract surgery not only yields an improved unaided visual acuity and image quality but also higher patient satisfaction. The video will give a step?wise guide to cataract surgeons to manage astigmatism with cataracts. Purpose: To hit the bull’s eye as far as target refraction is concerned, it is necessary to understand the benefits and limitations of currently available cutting?edgetechnology and formulae and apply them to the cataract surgery practice. The purpose of the video is to make sure that we have no surprises in our Toric intraocular lens (IOL) planning. Synopsis: After a brief introduction to available modalities for the treatment of astigmatism, a step?wise approach to diagnostics is discussed, which will include the role of corneal topography and aberrometers and their application to planning Toric IOLs. Appropriate planning, implementation, and execution in form of preoperative and intraoperative pearls of using Toric IOLs are shown in the video. This will be followed by troubleshooting and case?based discussions and future perspectives including the possible role of corneal biomechanics. Highlights: What this video adds new is the importance of topography, interpretation of Belin?Ambrosio display map and the equivalent keratometry reading (EKR) map, aberrometry, and higher order aberration (HOA) analysis and role of biomechanics in Toric IOL planning. Video also highlights the importance of posterior corneal astigmatism and accurate axis marking. With a case?based approach and relevant examples, we are trying to decipher the enigma of astigmatism by giving a step?wise approach for the same

Aspergillus spp., a versatile cell factory for enzymes and metabolites: Interventions through genome editing

Aspergillus sp. is widely distributed in nature and plays significant roles in the degradation of lignocellulose biomass and extensively used in bioprocess and fermentation technology and many species are also a generally regarded safe. Many of the Aspergillus species are established cell factories due to their inherent capacity in secreting large number of hydrolytic enzymes. With the advent of next generation genomic technologies and metabolic engineering technologies, the production potential of Aspergillus cell factory has improved over the years. Various genome editing tools has been developed for Aspergillus like engineered nucleases, zinc finger nucleases, TALEN and CRISPR-Cas9 system. Currently, the CRISPR/Cas9-based technique is extensively used to enhance the effectiveness of gene manipulation in model system Aspergillus nidulans and other strains like Aspergillus oryzae, Aspergillus niger and Aspergillus fumigatus. This review describes the recent developments of genome editing technologies in Aspergillus the synthesis of heterologous proteins and secondary metabolites in the Aspergillus species.

Assessment of zinc inadequacy among tribal adolescent population of central India - A cross-sectional study

Background & objectives: Zinc is a crucial micronutrient in adolescence, required for promoting growth and sexual maturation. Adolescents of some tribes may be at high risk of zinc deficiency due to dietary inadequacy and poor bioavailability of zinc from plant-based diets. This study aimed to evaluate the risk of zinc deficiency by estimating prevalence of inadequate zinc intake, prevalence of low serum zinc and stunting among tribal adolescents. Methods: A cross-sectional community-based survey was conducted among adolescents (10-19 yr) in three purposively selected districts where Bhil, Korku and Gond tribes were in majority. Structured data collection instrument comprising information about sociodemographic characteristics and dietary recall data was used. Anthropometric assessment was conducted by standardized weighing scales and anthropometry tapes, and blood sample was collected from antecubital vein into trace element-free vacutainers. Serum zinc was estimated using an atomic absorption spectrophotometer. Results: A total of 2310 households were approached for participation in the study, of which 2224 households having 5151 adolescents participated. Out of these enlisted adolescents, 4673 responded to dietary recall (90.7% response rate). Anthropometry of 2437 participants was carried out, and serum zinc was analyzed in 844 adolescents. The overall prevalence of dietary zinc inadequacy was 42.6 per cent [95% confidence interval (CI) 41.2 to 44.1] with reference to the estimated average requirement suggested by International Zinc Nutrition Consultative Group (IZiNCG) and 64.8 per cent (95% CI 63.4 to 66.2) with Indian Council of Medical Research-recommended requirements. Stunting was observed in 29 per cent (95% CI 27.2 to 30.8) participants. According to IZiNCG cut-offs, low serum zinc was detected in 57.5 per cent (95% CI 54.1 to 60.8) of adolescents, whereas it was 34.4 per cent (95% CI: 31.2-37.5) according to the national level cut-off. Interpretation & conclusions: Risk of dietary zinc inadequacy and low serum zinc concentration amongst adolescents of the Gond, Bhil and Korku tribes is a public health concern.

Refractive errors among commercial drivers

Purpose: To determine the pattern of refractive error among commercial drivers in north India. Methods: Descriptive study with convenient sampling conducted among commercial drivers of north India. Results: A total of 213 (75.8%) heavy?vehicle and 68 (24.2%) light?vehicle drivers were screened for eye diseases. Refractive error for distance was reported in 44 (15.7%; 95% CI: 11.6–20.4) drivers. Hyperopia was reported in 23 (8.2%; 95% CI: 5.2–12) drivers, followed by myopia in 15 (5.3%; 95% CI: 3–8.6) drivers and astigmatism in six (2.1%; 95% CI: 0.7–4.5) drivers. Presbyopia was reported in 157 (55.8%) drivers. Dry eye was reported in 70 (24.9%), stereo deficiency in 77 (27.4%), and color vision deficiency in 11 (3.9%) drivers. Three drivers were diagnosed with cataract, and two were referred for retina evaluation. Conclusion: Hyperopia in both eyes was the most common refractive error. Dry eye disease and color vision deficiency were also reported. Most of the drivers were not using spectacles for refractive error correction. Due to their mobile nature, drivers with cataract and retina diseases did not turn up for follow?up.

Comparative analysis of P-POSSUM score at admission and pre-operatively in predicting postoperative mortality in patients undergoing emergency laparotomy

Introduction: Laprotomy remains one of the commonest emergency surgical procedure performed worldwide. But over the last few years, various perioperative quality improvement initiatives involving early interventions, intensive postoperative care, and indivisualised care approaches have ensured a decrease in the average mortality rate by 3.8%-8.3. An ideal scoring system should accurately predict outcomes, help determine who deserves more aggressive care, guide in deciding the extensiveness of surgery, and can be used broadly access emergency laprotomies for various disease pathologies. The scoring system should also be capable of analyzing risk adjusted morbidity and mortality amongst various healthcare providers. Aim: To access the accuracy of P-POSSUM score on predicting the mortality and morbidity in emergency laparotomy patients and to establish that the preoperative score is more accurate that admission score. Materials and Methods: 150 Cases of emergency laparotomy in General Surgery Department in IGIMS, Patna from September, 2020 to February, 2022 were taken up in this study. Patients below 18 years, routine surgery and 6 patients who could not be followed up for complete 30 days were excluded. Physiological P-POSSUM was calculated at the time of admission and just before operation, post resuscitation. Operative score was same for both Physiological P-POSSUM scores. Results: Mortality predicted at admission had statistically significant difference and p value was<0 xss=removed>.05. Most common complication was wound infection followed by septicaemia. Conclusion: P-POSSUM is a better predictor of mortality and morbidity in emergency laparotomies when scoring is done preoperatively.

Effect of Mycobacterium w on IL-6 and Oxygen Requirement in COVID-19

The efficacy and safety of heat-killed Mycobacterium w (Mw) in severe COVID-19 were evaluated. Twenty-five hospitalized patients (mean age, 52.9 ± 13.1 years) with severe COVID-19 and having multiple comorbidities were intradermally injected with 0.3 mL of Mw daily for three consecutive days. Changes in leukocyte and platelet counts; C-reactive protein (CRP), interleukin-6 (IL-6), serum creatinine, and liver enzyme levels; and oxygen saturation were compared before and after treatment. An ordinal scale assessed the clinical response. There were significant improvements in the IL-6 level and oxygen saturation following treatment (p < 0.001). There were marked improvements in the platelet count, CRP level, serum aspartate transaminase level, and ordinal scale score. Eighty percent of patients who were on oxygen support were successfully shifted to room air within 5.6 days of treatment and discharged. No systemic adverse events were noted. Thus, Mw treatment could be a promising therapeutic modality in severe COVID-19.

Fulminant fungal endogenous endophthalmitis following SARS-CoV-2 infection: A case report

Systemic corticosteroids and immunocompromised state following SARS?CoV?2 infection can predispose individuals to endogenous endophthalmitis. A 66?year?old gentleman presented with complaints of diminution of vision and redness one week post discharge after hospitalization for COVID?19 infection. Clinical examination suggested fulminant endogenous endophthalmitis which responded poorly even after aggressive treatment requiring evisceration. Culture and gene sequenced analysis confirmed Aspergillus fumigatus to be the causative organism. A high degree of suspicion is warranted in the presence of recent onset of floaters in COVID?19?infected individuals to facilitate early diagnosis and outcomes.