A Delphi survey-based development and validation of cognitive-communication assessment tool for Indian preschoolers

ABSTRACT Purpose To address the need for a standardized assessment tool for assessing cognitive-communication abilities among Indian preschoolers, the current study aimed at describing a Delphi based development and validation process for developing one such tool. The objectives of the research were to conceptualize and construct the tool, validate its content, and assess its feasibility through pilot testing. Methods The study followed a Delphi approach to develop and validate the tool across four phases i.e. conceptualization; construction; content validation; and pilot testing. The first three phases were performed with a panel of six experts including speech-language pathologists and preschool teachers while the pilot testing was done with 20 typically developing preschoolers. A literature review was also conducted with the Delphi rounds to support the developmental process. Results The first two rounds of the Delphi aided in the construction of a culturally and linguistically suitable story-based cognitive-communication assessment tool with the memory (free recall, recognition, and literary recall) and executive function (reasoning, inhibition, and switching) related tasks relevant for preschoolers. The content validation of the tool was continued with the experts till the revisions were satisfactory and yielded an optimum Content Validity Index. The pilot test of the finalized version confirmed its feasibility and appropriateness to assess developmental changes in the cognitive-communication abilities of preschoolers. Conclusion The study describes the Delphi-based conceptualization, construction, content validation, and feasibility check of a tool to assess cognitive-communication skills in preschool children.

Training ambidexterity – A survey-based analysis on the dexterity of ophthalmologists in performing standard ophthalmic procedures

Purpose: Our study was designed to determine ophthalmologists’ dexterity in performing standard ophthalmic procedures at various levels of expertise via a structured questionnaire. Methods: A structured questionnaire was administered via the Google platform from August 20 to September 19, 2022, to assess the perspectives and preferences of ophthalmologists concerning their proficiency in using their right hand, left hand, or both hands to perform routine tasks required in the practice of ophthalmic medicine and surgery. Results: Two hundred and three participants took part in the survey. A majority (n = 162, 79.8%) of the clinicians considered themselves right?handed, nine (4.4%) considered themselves left?handed, and 32 (15.7%) considered themselves ambidextrous. Also, 86% (n = 174) of the participants considered ambidexterity an essential trait in the practice of ophthalmic medicine and surgery. The number of cataract surgeries performed had an impact on the comfort of using both hands for performing anterior vitrectomy (P < 0.001), injection of viscoelastic (P < 0.001), and toric marking (P < 0.05), but not on the performance of capsulorhexis and switching of foot pedals. The number of procedures carried out had an impact on the comfort of using both hands in gonioscopy (P < 0.001), 90 D evaluation (P < 0.001), and 20 D evaluation (P < 0.05). More years of experience had an impact on skills involving the use of both hands for slit lamp joystick usage (P < 0.05) and laser procedures (P < 0.001). Conclusion: Irrespective of a person’s handedness, trained ambidexterity in the required fields is achievable and has a significant impact on one’s ability to perform the required skill optimally and appropriately.

Suture manipulation post-trabeculectomy: A practical guide

Background: Trabeculectomy is the gold standard filtration surgery for diverting aqueous from anterior chamber to the subconjunctival space. More than the surgery, postoperative follow?ups and management of the blebs play a critical role in the long?term success. This video is aimed at showing the real?world management of blebs postoperatively. Purpose: This video will serve as a practical guide to the postoperative management of trabeculectomy blebs with specific focus on the suture manipulation. Synopsis: This video will demonstrate various suturing techniques of trabeculectomy and their manipulation in the postoperative period. Complications related to each will be discussed. Highlights: We demonstrate how to place and remove, releasable, and fixed sutures. We also address the practical points on why and when to remove the sutures. Suture?related complications and their management have been shown along with practical examples

A novel two-surgeon technique of simultaneous bilateral cataract surgery with complete delinking

Though technological advancements have transcended beyond expectation, phacoemulsification remains a challenge in uncooperative patients, where the procedure may be contemplated under general anesthesia, with simultaneous bilateral cataract surgery (SBCS) being the surgery of choice. In this manuscript, we have reported a novel two-surgeon technique of SBCS on a 50-year-old mentally subnormal patient. Under general anesthesia, two surgeons performed phacoemulsification simultaneously, using two separate microscopes, irrigation lines, phaco machines, instruments, and assistants. Intraocular lens (IOL) implantation was performed in both eyes (OU). The patient had a visual recovery from 5/60, N36 in OU preoperatively to 6/12, N10 in OU on post-operative day 3 and 1 month, with no complications. This technique can potentially reduce the risk of endophthalmitis, repeated and prolonged anesthesia, and the number of hospital visits. To the best of our knowledge, this two-surgeon technique of SBCS has never been reported in the literature.

Visual outcome in pediatric uveitis: A retrospective data review in 277 children

Purpose: The research activity in pediatric glaucoma (PG) was qualitatively and quantitatively evaluated using a scientometric approach. Methods: The “Web of Science” database was accessed for primary bibliometric data regarding PG using search terms “pediatric glaucoma,” “paediatric glaucoma,” “congenital glaucoma,” and “childhood glaucoma.” The data was analyzed for total research productivity, citations, and scientific output in terms of journals, countries, institutions, and authors. The results were further characterized for coauthorship links and visualized by VOS viewer software. Also, the top 25 cited articles were reviewed with the above bibliometric characteristics. Results: One thousand two hundred and sixty?nine items were obtained from our search query from 1955 to 2022; these received 15,485 citations, originated from 78 countries. The top?3 contributing countries were the United States of America (n = 369), India (n = 134), and China (n = 127). LV Prasad Eye Institute (n = 58), Duke University (n = 44), and King Khalid Eye Specialist Hospital (n = 42) were the top?3 productive institutes. The top?3 prolific authors were Mandal AK (n = 53), Freedman, SF (n = 36), and Sarfarazi, M (n = 33). Journal wise, “Investigative Ophthalmology” (n = 187), “Journal of Glaucoma” (n = 92), and “Journal of AAPOS” (n = 68) were the journals in which the most articles were published. The top?25 cited documents received 3564 citations and were published between 1977 and 2016. The key areas of interest were basic sciences (genetics of childhood glaucoma) and surgical management. Conclusion: United States of America, LVPEI, Mandal AK, and “Investigative Ophthalmology” were the top rankers as far as the productivity and publications related to PG are concerned. Articles on molecular genetics in PG have received interest among the ophthalmology community.

Outcomes of therapeutic penetrating keratoplasty in Pythium insidiosum keratitis managed with a combination of antibiotics

Purpose: To describe the clinical outcomes of therapeutic penetrating keratoplasty (TPK) in patients with Pythium insidiosum keratitis following treatment with anti?pythium therapy (APT) consisting of linezolid and azithromycin. Methods: A retrospective review of medical records from May 2016 to December 2019 of patients with P. insidiosum keratitis was carried out. Patients who were treated with APT for a minimum of 2 weeks and then subsequently underwent TPK were included in the study. Data on demographic characteristics, clinical features, microbiology characteristics, and intraoperative details, postoperative outcomes were documented. Results: A total of 238 cases of Pythium keratitis were seen during the study period and 50 cases that satisfied the inclusion criteria were included. The median of the geometric mean of the infiltrate was 5.6 mm (IQR 4.0–7.2 mm). The patients received topical APT for a median of 35 days (IQR 25–56) prior to surgery. The most common indication of TPK was worsening keratitis (41/50, 82%). No recurrence of infection was observed. An anatomically stable globe was noted in 49/50 eyes (98%). The median graft survival rate was 2.4 months. A clear graft was present in 10 eyes (20%) with a final median visual acuity of 20/125 after a median follow?up period of 18.4 months (IQR 11–26 months). Graft size of less than 10 mm [OR: 5.824 (CI:1.292?41.6), P = 0.02] was found to be significantly associated with a clear graft. Conclusion: Performing TPK following the administration of APT has good anatomical outcomes. A smaller graft of <10 mm was associated with a higher chance of graft survival

The effect of levosimendan on the right ventricular function in patients with right ventricular dysfunction undergoing mitral valve surgery

Background: Right ventricular (RV) dysfunction is an important predictor of both immediate and long-term outcomes in valve surgeries. Levosimendan has proven beneficial in improving RV function. Aims: The objective was to study the effect of the addition of levosimendan to the conventional treatment on RV function in patients with RV dysfunction undergoing mitral valve (MV) surgeries. Setting and Design: Prospective randomized double-blinded controlled study at a tertiary care institution. Materials and Methods: Sixty adult patients aged 15� years, with preoperative transthoracic echocardiography (TTE) findings of RV dysfunction posted for elective MV surgery, were randomized into levosimendan (L) group and placebo (P) group. Patients in the L group were administered levosimendan at a rate of 0.1 mcg/kg/min after induction for 24 hrs, whereas patients in the P group were given multivitamin infusion at the same rate. Both the groups received standard inotropic therapy. The hemodynamic and echocardiographic parameters of RV function (RV size, Inferior vena cava (IVC) diameter, RV fractional area change (RVFAC) Tricuspid annular plane systolic excursion (TAPSE), and Systolic Pulmonary Artery Pressure (SPAP) were compared between the groups at 6 hrs, 24 hrs, and 7th day postoperatively. Results: All hemodynamic and echocardiographic parameters of RV function like RV size, IVC diameter, RVFAC, TAPSE, and SPAP improved from baseline to 24 hrs in both groups. Levosimendan caused a significant improvement in RV function compared to the P group at 24 hrs and 7th day postoperatively. Conclusions: The present study concludes that levosimendan is a promising option in patients with RV dysfunction undergoing MV surgeries.

Predictors-of-satisfaction-in-psychiatry-residents-in-india-a-webbased-crosssectional-study-

Background: Postgraduate education is the only path to creating specialists in the field they will be practicing. Providing high-quality health care and improving science through research & training will impart specific skills needed for the individual. The persons will get satisfaction will receiving post-graduate education. However, there was less data about the opinion of the postgraduate trainees and about the training received. Accordingly, this survey was done to evaluate the perception of psychiatrists about their determining factors of satisfaction in postgraduate training in India. Aim: Methods:To identify the predictors of satisfaction of psychiatry residents in India. An internet-based cross- sectional survey was conducted using snowball sampling technique from May to June 2022. Individuals (Psychiatry residents) were asked to fill a questionnaire with a series of questions, which included sociodemographic data, and a 41- item questionnaire indicating the relative importance of these items in determining their satisfaction with training on a five-point likert scale. A total of 193 residents completed the survey. “Safety of the environment” and “level ofResults: support from peers in the department” were the most important items on this list. These items were ranked significantly higher than all the rest of the items. Improving the institutional support and creating an amicable andConclusion: friendly atmosphere during training periods were essential. When attempting to improve resident training, regulatory bodies should consider this in determining resident satisfaction.

A Conceptual Study on Deerghayu According to Classics

“Life well spent is long”, is well stated by Leonardo Da Vinci. A person's quality of life throughout all of those years of survival, rather than how many years they live, is what defines a long-life span. Superior constitution, great bodily components, excellent soul, adoption of a wholesome diet, and living a healthy lifestyle are the factors of this longevity. The lifespan of the individual should be checked by the doctor before any other aspects such as ailment, season, bio-fire, age, mental agility, homologation, constitution, medication, and location are examined. The attributes of Deerghayu that is long life span, along with Aahara (eating habits) and vihara (routines) to preserve longevity of life with the highest quality, have been outlined by Acharya Charaka after the Namakarana (naming ceremony) and Sushruta in Jatisutriya adhyaya in their description of life span. The present study analyzes the characteristic features of Deerghayu and the maintenance of these characteristics playing an important role in a long and healthy life.

Blind docking of 4-Amino-7-Chloroquinoline analogs as potential dengue virus protease inhibitor using CB Dock a web server-Supplemenntary data

Currently, there is no approved drug to combat dengue. Various quinoline derivatives are known for potential antimalarial, antiviral activities, etc. In the present work docking between 4-Amino-7-Chloroquinoline analogs was performed with dengue virus NS2B/NS3 protease using CB dock, a web server. Lys74, Ile165, Val147, Asn152, Asn167, Trp83 and Leu149 amino acid residues were found to be in contact with designed 4-Amino-7-Chloroquinoline analogs. Different modes of binding like hydrogen bonding, hydrophobic interactions, etc with designed compounds improve potential anti-dengue characteristics in silico. ADME results are in acceptable range.

Blind docking of 4-Amino-7-Chloroquinoline analogs as potential dengue virus protease inhibitor using CB Dock a web server

Currently, there is no approved drug to combat dengue. Various quinoline derivatives are known for potential antimalarial, antiviral activities, etc. In the present work docking between 4-Amino-7-Chloroquinoline analogs was performed with dengue virus NS2B/NS3 protease using CB dock, a web server. Lys74, Ile165, Val147, Asn152, Asn167, Trp83 and Leu149 amino acid residues were found to be in contact with designed 4-Amino-7-Chloroquinoline analogs. Different modes of binding like hydrogen bonding, hydrophobic interactions, etc with designed compounds improve potential anti-dengue characteristics in silico. ADME results are in acceptable range.

Aspirin Use Is Associated With Improved Outcomes in Inflammatory Breast Cancer Patients / 한국유방암학회지

Purpose@#Inflammatory breast cancer (IBC) is the most aggressive form of breast cancer and has a high propensity for distant metastases. Our previous data suggested that aspirin (acetylsalicylic acid, ASA) use may be associated with reduced risk of distant metastases in aggressive breast cancer; however, there are no reported studies on the potential benefit of ASA use in patients with IBC. @*Methods@#Data from patients with non-metastatic IBC treated between 2000–2017 at two institutions, were reviewed. Overall survival (OS), disease-free survival (DFS), and distant metastasis-free survival (DMFS) were performed using Kaplan-Meier analysis. Univariate and multivariable logistic regression models were used to identify significant associated factors. @*Results@#Of 59 patients meeting the criteria for analysis and available for review, 14 ASA users were identified. ASA users demonstrated increased OS (p = 0.03) and DMFS (p = 0.02), with 5-year OS and DMFS of 92% (p = 0.01) and 85% (p = 0.01) compared to 51% and 43%, respectively, for non-ASA users. In univariate analysis, pT stage, pN stage, and ASA use were significantly correlated (p < 0.05) with OS and DFS. On multivariable analysis, ASA use (hazard ratio [HR], 0.11; 95% confidence interval [CI], 0.01–0.8) and lymph node stage (HR, 5.9; 95% CI, 1.4–25.9) remained significant for OS and DFS ASA use (HR, 0.13; 95% CI, 0.03–0.56) and lymph node stage (HR, 5.6; 95% CI, 1.9–16.4). @*Conclusion@#ASA use during remission was associated with significantly improved OS and DMFS in patients with IBC. These results suggest that ASA may provide survival benefits to patients with IBC. Prospective clinical trials of ASA use in patients with high-risk IBC in remission should be considered.

Laparoscopic right posterior sectionectomy for a large hepatocellular carcinoma close to inferior vena cava

Approximately 20% of hepatocellular carcinomas (HCC) occur in noncirrhotic livers. Resection may be considered for patients with HCC, provided sufficient future liver remnant is available, regardless of the tumor size. Tumors located posteriorly near the right hepatic vein (RHV), or inferior vena cava can be managed through anterior or caudal approaches. RHV is typically conserved during right posterior sectionectomy. When a large posteriorly placed tumor causes chronic compression on RHV, the right anterior section drainage is redirected preferentially to the middle hepatic vein. The division of RHV in such instances does not cause congestion of segments 8 and 5. The technical complexity of laparoscopic right posterior sectionectomy arises from the large transection surface, positioned horizontally. We describe in this multimedia article, a case of large HCC in segments 6 and 7, which was successfully treated using laparoscopic anatomic right posterior sectionectomy.

Posterior superior alveolar nerve block alone in the extraction of upper third molars: a prospective clinical study

Background@#Third molar extraction is the most commonly performed minor oral surgical procedure in outpatient settings and requires regional anesthesia for pain control. Extraction of the maxillary molars commonly requires both posterior superior alveolar nerve block (PSANB) and greater palatine nerve block (GPNB), depending on the nerve innervations of the subject teeth. We aimed to study the effectiveness of PSANB alone in maxillary third molar (MTM) extraction. @*Methods@#A sample size comprising 100 erupted and semi-erupted MTM was selected and subjected to study for extraction. Under strict aseptic conditions, the patients were subjected to the classical local anesthesia technique of PSANB alone with 2% lignocaine hydrochloride and adrenaline 1:80,000. After a latency period of 10 min, objective assessment of the buccal and palatal mucosa was performed. A numerical rating scale and visual analog scale were used. @*Results@#In the post-latency period of 10 min, the depth of anesthesia obtained in our sample on the buccal side extended from the maxillary tuberosity posteriorly to the mesial of the first premolar (15%), second premolar (41%), and first molar (44%). This inferred that anesthesia was effectively high until the first molars and was less effective further anteriorly due to nerve innervation. The depth of anesthesia on the palatal aspect was up to the first molar (33%), second molar (67%), and lateromedially; 6% of the patients received anesthesia only to the alveolar region, whereas 66% received up to 1.5 cm to the mid-palatal raphe. In 5% of the cases, regional anesthesia was re-administered. An additional 1.8 ml PSANB was required in four patients, and another patient was administered a GPNB in addition to the PSANB during the time of extraction and elevation. @*Conclusion@#The results of our study emphasize that PSANB alone is sufficient for the extraction of MTM in most cases, thereby obviating the need for poorly tolerated palatal injections.

Dolichoectasia of vertebrobasilar artery presenting as facial pain: a case report

Dolichoectasia of the intracranial arteries is a rare condition characterized by elongated and tortuous arteries due to progressive destruction of the vessel walls. Although most patients present with cerebrovascular accidents, our patient presented with intractable facial pain along the distribution of the trigeminal nerve. Clinical examination revealed involvement of the 5th, 7th, and 8th cranial nerves, and subsequent MRI showed dolichoectasia of the left basilar artery. The patient experienced symptomatic relief after a trial of carbamazepine along with botulinum toxin injections.

An interesting case of melioidosis: a mimicry of pulmonary tuberculosis

Melioidosis is caused by Burkholderia pseudomalleiwhich is a soil-dwelling aerobic bacterium reported mostly in tropical and subtropical areas, especiallyinAsia (Southeast) andAustralia (Northern part). Melioidosis is a severe infection that can manifest as chronic debilitating pneumonia mimics pulmonary tuberculosis. Here, we reporteda case of melioidosis, in 51-year-old menwith poorly controlled type 2 diabetes mellitus. The patient recovered with appropriate intravenous antibiotics and supportive medications.

Knowledge and Attitude of Adult Saudi Community towards Premarital Screening Program (Sickle Cell Anemia/Thalassemia) in Riyadh Province of Saudi Arabia

Background: Premarital Screening (PMS) program in Saudi Arabia aims at limiting the spread of hereditary diseases like Sickle Cell Anemia (SCA) and Thalassemia and infectious diseases like Hepatitis B&C and Human immunodeficiency virus (HIV). Although the PMS program is reducing the percentage of incompatible marriages, the prevalence of hemoglobinopathies is still remaining high. With the changing perception of the general population towards the PMS program, an examination of community awareness and attitude toward PM S is needed to find ways for reducing the prevalence of diseases. Objective : T o assess the present knowledge and attitude of the adult Saudi community from Riyadh Province to the premarital screening (PMS) program for hemoglobinopathies. Methods: This cros s - sectional study was conducted on 676 participants from the general population in June - September 2022. The electronic questionnaire was used to assess the sociodemographic data, knowledge, and attitude toward the PMS program. Results: Out of the 676 participants, 58% were females, and 42% were males. 54% had consanguineous marriages and 5.6% hemoglobinopathies in the family. 96.3% agreed on suggesting PMS to others, 83.2% considered PMS incompatible marriage is wrong, and 78.6% considered associated g enetic counselling is important. 22.7% preferred consanguineous marriage over non - consanguineous. For raising awareness, 97.6%, 85.9%, 84.6%, and 81.2% of respondents felt the need for community participation through the internet, social media, and medical education in schools respectively. Conclusion: Most participants have a positive attitude but only superficial knowledge of the PMS program and one - third are still unaware of its use for the prevention of hemoglobinopathies, especially thalassemia. Increa sing the knowledge about the importance of the PMS program and associated genetic counselling should be done with multiple information sources in a well - organized way that suits the community’s requirements.

Evaluation of prescribing pattern based on World Health Organization indicators in Maharashtra during COVID-19 pandemic

Introduction: Community pharmacy (CP) is one of the health care centers that have a key role to play in the current COVID-19 pandemic period. Prescriptions monitoring studies are essential as this helps in understanding the current prescribing pattern adopted by physicians. Furthermore, only few CP-based research studies were noted. This study was conducted with an aim to study prescribing pattern using World Health Organization (WHO) indicators from few community pharmacies in Maharashtra, India, during COVID-19 Pandemic period. Material and Methods: An observational study was conducted and sample comprised of prescriptions collected from different parts of Maharashtra (Mumbai, Pune. and Nashik). One thousand and fifty-six prescriptions were collected and data was collected for a period of 6 months (August 2020–January 2021). The variables of interest in this study were: Number of medications in each prescription, number of prescriptions with generic names, number of antibiotics and injectables in each prescription, number of prescribed drugs from essential drug list (EDL), and defined daily dose (DDD). Results: Out of 3058 drugs prescribed, it was found that average number of drugs per prescription was 2.89 (standard deviation ± 1.37). Only 23 (0.75%) were prescribed by generic name. Antibiotics and injectables were 399 (37.78%) and 29 (2.74%), respectively. Drugs that were prescribed from EDL were only 920 (30.08%). The total class of antimicrobial agents prescribed (Anatomical Therapeutic Chemical group J01) was 13. After calculating DDD, DDD of Azithromycin was found to the highest (81.6 g). Conclusion: Among five WHO indicators, only the percentage of encounters with an injection was in compliance with the WHO recommended value. Further studies are required for better understanding of this area.