Performance of the non-invasive point-of-care device, EzeCheck, for haemoglobin assessment in adults and children in community and institutional care settings.

Anaemia is a major public health problem, especially in resource constrained settings. Dependency on assessment of blood hemoglobin (Hgb) concentration impedes anemia detection, risk stratification and intervention. Thus, valid, frugal and scalable technologies are needed. EzeCheck is a noninvasive portable device developed in India for predicting hemoglobin levels in human beings aged 4 years and above using a finger-tip biosensor. In this assessment, we aimed to: (i) evaluate EzeCheck's performance with an automated whole blood hemato-analyzer (Sysmex XN 1000) as the gold standard, and (ii) estimate EzeCheck's agreement with Sahli's method and HemoCue (Hb-301) in real-world primary and higher care facilities. Paired assessments were done at five sites across India i.e., Bhubaneshwar, Shimla, Solan and Mashobra and Ulhasnagar. Participants across all age groups (4 years and above) were assessed. We used a range of statistical tests to evaluate the performance of EzeCheck. It was found that EzeCheck performed well across age and gender categories with convincing validity, concordance, precision and accuracy, and acceptable bias. While comparing EzeCheck with Hemato-analyzer, no statistically significant systematic bias was found. However, EzeCheck showed significant systematic bias when compared to Sahli's method and HemoCue. We concluded that EzeCheck could detect anemia (as per WHO Hgb cut-offs) in 'real-world settings' and 'across age and gender categories', with high sensitivity, specificity and accuracy, and can serve as a replacement to traditional methods of hemoglobin assessment. Further, for countries with higher prevalence of anemia where universal screening may be mandated, the positive predictive value of EzeCheck will be higher. The likelihood ratios also indicated that the device had moderate-to-good utility. EzeCheck is suitable for embedment into program and out-patient health care settings in resource constrained contexts as a spot-check hemoglobinometer.

Dental Services and their Awareness and Utilization among the Health Care Workers in a South Indian District - A Cross Sectional Study.

Aim: The present research was carried out to evaluate the amount of usage of dental care opportunities and also to assess the problems faced by health care workers (HCWs) of a south Indian district in using dental services. Methodology: This study had around 500 participants who belonged from various health care sectors who were selected with the help of multistage sampling. The data obtained from this cross-sectional research was analysed statistically using SPSS 22.0. Results: It was noticed that around 35% of participants went for a dentist's appointment in past 1 year where male members predominated (45%). One of the commonest reasons for utilizing dental care services was pain as an dental emergency factor (70%). Other reasons were dental caries (18%) restoration, breakage of tooth (10%) and a host of other factors (11%). Around 350 participants felt that going to the dentist was only necessary when there was an emergency (61%). Conclusion: The target population less frequently visited the dentist to maintain their teeth as they believed when you have pain, that is the time you go to a dental specialist.

Retinopathy of prematurity in triplets - Indian twin city ROP study report number 12.

PURPOSE: To evaluate the incidence and severity of retinopathy of prematurity (ROP) amongst surviving triplets. METHODS: Records of preterm babies born to mothers with triplet pregnancies were retrieved from our Indian twin city ROP study database between 1 Jan 2000 and 31 Dec 2020 and analyzed. RESULTS: 253 surviving triplet babies born to 108 mothers were evaluated. 48 out of 108 (44%) mothers received treatment for infertility. Data was available and analyzed for 242 babies (484 eyes). Mean gestational age was 31.76 ± 3.74 weeks (26- 38 weeks). The mean birth weight was 1.44 ± 0.37 kg (0.57-2.76 kg). At the first screening, incomplete vascularization was noted in 67% (131 babies;322 eyes) of which ROP was diagnosed in 14% (28 babies; 56 eyes). Among them, only 18 babies (53%) were the smallest birth weight babies in each of the triplet sets. Treatment with laser or bevacizumab was performed in 14 babies (5.8%), one eye of one baby additionally needed vitreoretinal surgical intervention. Good anatomical outcomes in terms of regression of ROP without sequelae were achieved in all babies. CONCLUSION: The present study reveals low incidence and favorable outcomes of ROP in triplet pregnancies in a large cohort of babies from a middle-income country. Our cohort did not show any difference in the treatment-requiring ROP among the larger or smaller birth weight babies of the same gestational age. In multiple pregnancies, gestational age remains a critical factor for ROP development; however, this does not necessitate modifying screening or treatment criteria in such triplet pregnancies.

Psoriasis and its Association with Metabolic Syndrome.

Psoriasis is a multifactorial, chronic, immune-mediated inflammatory condition. Psoriasis often goes beyond the skin, nails and scalp and involves the eyes (uveitis), joints (arthritis) and several metabolic derangements, as seen in various studies. It is strongly associated with features of the metabolic syndrome (MetS) like hypertension, obesity, dyslipidaemia, type 2 diabetes, insulin resistance and non-alcoholic fatty liver disease. Amongst various skin diseases, MetS has the strongest association with psoriasis. The risk of having MetS is almost doubled in patients with psoriasis as compared to healthy individuals. Both conditions share a common pathophysiological background in terms of genetics, inflammatory markers, lifestyle choices, etc. The association of psoriasis with MetS is clinically important as it influences the prognosis, quality of life and choice of treatment. Systemic conventional drugs should be used with caution in such patients, as their long-term use may contribute to metabolic impairment. The treating dermatologist should be aware of such associations and their implications, and a more holistic approach should be taken to manage psoriasis where equal importance is given to lifestyle and dietary modifications and comorbid conditions, in addition to the pharmacological therapy so as to decrease the burden of the disease for both the patient and the health system.

Color fundus imaging in retinopathy of prematurity screening: Present and future.

Advent of pediatric handheld fundus cameras like RetCam, 3netra Forus, and Phoenix ICON pediatric retinal camera has aided in effective screening of retinopathy of prematurity (ROP), especially in countries with limited number of trained specialists. Recent advent of various smartphone-based cameras has made pediatric fundus photography furthermore affordable and portable. Future advances like ultra-wide field fundus cameras, trans-pars-planar illumination pediatric fundus camera, artificial intelligence, deep learning algorithm, and handheld SS-OCTA can help in more accurate imaging and documentation. This article summarizes the features of existing and upcoming imaging modalities in detail, including their features, advantages, challenges, and effectiveness, which can help in implementation of telescreening as a standard screening protocol for ROP across developing as well as developed countries.

Electronic medical records driven big data analytics in retinal diseases, report number 1: non-oncological retinal diseases in children and adolescents in India.

PURPOSE: To describe the spectrum and demographic distribution of non-oncological retinal diseases in children and adolescents presenting to a multi-tier ophthalmic hospital network in India. METHODS: This is a cross-sectional hospital-based retrospective study over nine years (March 2011-March 2020) from a pyramidal eye care network in India. The analysis included 477,954 new patients (0-21 years), collected from an International Classification of Diseases (ICD) coded electronic medical record (EMR) system. Patients with a clinical diagnosis of retinal disease (non-oncological) in at least one eye were included. Age-wise distribution of these diseases in children and adolescents was analysed. RESULTS: In the study, 8.44% (n = 40,341) of new patients were diagnosed with non-oncological retinal pathology in at least one eye. The age group-specific distribution of retinal diseases was 47.4%, 11. 8%, 5.9%, 5.9%, 6.4%, 7.6% in infants (< 1 year), toddlers (1-2 years), early childhood (3-5 years), middle childhood (6-11 years), early adolescents (12-18 years) and late adolescents (18-21 years), respectively. 60% were male, and 70% had bilateral disease. The mean age was 9.46 ± 7.52 years. The common retinal disorders were retinopathy of prematurity (ROP, 30.5%), retinal dystrophy (19.5%; most commonly, retinitis pigmentosa), and retinal detachment (16.4%). Four-fifth of the eyes had moderate to severe visual impairment. Nearly one-sixth of patients needed low vision and rehabilitative services, and about 1 in 10 patients required surgical intervention (n = 5960, 8.6%). CONCLUSION AND RELEVANCE: About 1 in 10 children and adolescents seeking eye care in our cohort had non-oncological retinal diseases; the common ones were ROP (in infants) and retinitis pigmentosa (in adolescents). This information would help future strategic planning of eye health care in the institution in pediatric and adolescent age groups.

RETINAL CHANGES IN PORETTI-BOLTSHAUSER SYNDROME: RETINA AS A WINDOW TO THE BRAIN.

PURPOSE: LAMA 1 gene as a pathologic variant leading to cerebellar dysplasia and cysts, nonprogressive ataxia, language, and motor developmental delay without any muscular involvement was recently described as Poretti-Boltshauser syndrome (PBS). Ocular involvement is a common associated feature in this neurodegenerative disorder. In this case report, we describe the retinal changes associated with Poretti-Boltshauser syndrome. METHODS, PATIENT, AND RESULTS: A 4-year-old female child presented with the progressive decreased vision for the past 6 to 8 months. Ophthalmic examination revealed mild myopia and ocular motor apraxia with retinal disruptions appearing as holes that were confined only to inner retinal layers. The child also had motor and speech developmental delays. Magnetic resonance imaging of the brain showed vermis hypoplasia with cerebellar dysgenesis and multiple cystic spaces in both cerebellar hemispheres. Whole exome sequencing revealed a homozygous pathogenic variant of exon 2-63 deletion in the LAMA 1 gene, which was confirmatory for Poretti-Boltshauser syndrome. CONCLUSION: Oculomotor apraxia and retinal changes can lead to visual disturbances in Poretti-Boltshauser syndrome. Identification of these features and prompt rehabilitative measures can improve the quality of life of these children.

Non-contact widefield neonatal retinal imaging for retinopathy of prematurity using the Clarus 700 high resolution true colour reflectance imaging.

OBJECTIVE: To illustrate the role of non-contact widefield retinal imaging (NC-WFI) of retinopathy of prematurity (ROP) using the Clarus 700 high resolution true colour reflectance imaging. METHODS: All babies were examined by the vitreoretinal faculty in a tertiary eye care centre from a period of March 2021 to November 2021 using the indirect ophthalmoscope after pupillary dilatation. ROP grading was done according to the revised ICROP (2005) classification. NC-WFI was then performed using the Clarus 700 high resolution true colour reflectance imaging (Carl Zeiss Meditec, Dublin, CA) in the retina diagnostic set up of a tertiary eye care centre. RESULTS: A total of 22 babies (44 eyes) underwent NC-WFI from March 2021 to November 2021. 13 unique cases of retinopathy of prematurity with images captured on Clarus 700 and the clinical summary is described. CONCLUSION: Clarus is a non-contact wide field imaging (NC-WFI) system that can capture high resolution and true colour images (images of the fundus appear similar colour to direct observation by ophthalmoscopy) helping in more accurate diagnosis and grading of the severity of ROP.

Impact of Psoriasis on Quality of Life.

Psoriasis is a multisystem disorder with a significant impact on the quality of life (QoL) of the patient. QoL in psoriasis is influenced by epidemiological factors, the type and extent of the disease, and underlying comorbidities. Various tools have been developed to assess the QoL in patients with psoriasis, namely psoriasis specific, skin specific, generic QoL, and mixed measures. In this review, we present a concise overview of the different indices and the pros and cons of various tools to assess the impact of psoriasis on patients.

Metabolic syndrome and dyslipidemia in xanthelasma palpebrarum and associated risk-2 factors-A case-control study.

BACKGROUND: Xanthelasma palpebrarum (XP) primarily causes cosmetic disfigurement. However, systemic associations like metabolic syndrome (MetS) and dyslipidemia need consideration. OBJECTIVE: Determining the prevalence of MetS and dyslipidemia in XP patients and explore risk factors. METHODS: Our case-control study included 106 XP patients(cases) and 106 age-and-sex matched healthy controls. All subjects underwent detailed history taking, physical examination, and biochemical investigations. MetS and obesity were diagnosed by NCEP-ATP III criteria and modified BMI classification for Asian-Indians, respectively. RESULTS: The odds ratio (OR) and 95% CI for XP patients vs. non-XP controls were 1.6 (95% CI 0.8-3.2, p = 0.1) for MetS, 1.4 (95% CI 0.6-3.1, p = 0.4) for dyslipidemia and 0.2 (95% CI 0.07-0.4, p < 0.0001) for overweight/obesity. Extensive disease, DM, and low serum HDL-C were significantly associated with MetS in XP patients (vs. controls). Normal waist circumference (AOR 21.3, 95% CI 3.5-127.6, p = 0.0008), normal blood glucose (AOR 21.4, 95% CI 3.1-145.1, p = 0.002), and normal blood pressure (AOR 22.3, 95% CI 3.9-124.9, p = 0.0004) significantly reduced the risk of MetS, while bilateral ocular involvement (AOR 4.3, 95% CI 1.1-18.7, p = 0.04) significantly increased the risk of dyslipidemia in XP patients. CONCLUSION: Xanthelasma palpebrarum patients are more prone to develop MetS and dyslipidemia and need evaluation, despite being a primarily cosmetic concern. Extensive disease and bilateral ocular involvement are significant risk factors. Adequate counseling and healthy life-style measures are crucial to minimize systemic complications.

Effectiveness and future implications of COVID-19-related risk stratification for managing retinopathy of prematurity: The Indian twin cities retinopathy of prematurity study report number 10.

Purpose: To evaluate the effectiveness and future implications of COVID-related risk stratification for managing retinopathy of prematurity (ROP). Methods: A prospective study was conducted at a tertiary eye care center from the beginning of the lockdown in India from 23 March 2020 till the end of the first phase of lockdown on 29 May 2020. We evaluated 200 prematurely born infants (< 34 weeks of gestational age) using the new safety guideline protocols for low-risk babies developed in conjunction with the Indian ROP Society for care during the COVID-19 pandemic. Low risk included babies born at more than 30 weeks of gestational age, post menstrual age 34 weeks or above at presentation, more than 1000 grams of birth weight, and stable systemically with good weight gain. Results: New guidelines were implemented in 106 (53%) infants who were low risk while 94 (47%) infants with high risk were followed up as per the old guidelines. Out of the 106 infants (212 eyes) managed by the new guidelines, good outcome (group 1) was seen in 102 (96.2%) infants. Twenty-seven of the 102 infants had some form of ROP and 5 of these infants needed treatment. None of the low-risk babies with no detachment at presentation managed by new guidelines required surgery later (group 2). Two (1.9%) infants came with retinal detachment at presentation and underwent successful surgery (group 3) and two infants (1.9%) were lost to follow up. Conclusion: New risk stratification during the COVID-19 pandemic was an efficient and safe strategy in managing low-risk ROP babies.

Evaluation of a revised care plan for babies with retinopathy of prematurity during SARS-CoV-2 pandemic in India.

Purpose: To analyze the impact of a revised care plan for retinopathy of prematurity (ROP) during SARS-CoV-2 pandemic in a tertiary eye care facility in eastern India. Methods: In a retrospective study, we analyzed the medical records of babies managed for ROP during the peak of the SARS-CoV-2 pandemic, with particular reference to the challenges, and the revised strategies addressing travel restrictions for five months, from April to August 2020. The strategy included selective referral (babies with higher treatment probability), longer follow-up intervals (babies with non-alarming findings), use of locally available workforce, and teleconsultation whenever feasible. Results: In the given period, 222 babies were examined versus 624 in the preceding year (P = 0.001). The average gestational age, birth weight, and postmenstrual age at presentation were 30.4 weeks, 1.31 kg, and 37.7 weeks, respectively. The first examination was on time in 40.1% of babies but was delayed by a median of 23 days in the remaining babies. In the cohort, 56.7% of babies had any ROP, and 27.9% required treatment (versus 8.8% in the previous year; P < 0.001). The intravitreal anti-vascular growth factor (anti-VEGF) injection was more often used than in the previous year (n = 72 vs 36; P < 0.0001). The treatment outcome was comparable before and after the SARS-CoV-2 lockdown period. There was no report of health issues among the care providers attributable to ROP care. Conclusion: The revised strategy resulted in a smaller pool of babies screened but a larger proportion of babies treated for ROP. This strategy could be used more profitably in future ROP care.

Exudative retinal detachment as an initial presentation of retinopathy of prematurity: Clinical profile and outcomes of a rare presentation.

Purpose: To describe the clinical profile and treatment outcomes of infants with retinopathy of prematurity (ROP) presenting with isolated exudative retinal detachment (ERD). Methods: Retrospective interventional case series. Preterm infants diagnosed with ROP with ERD at presentation were included. All demographic details, clinical findings, and treatment given were documented. The anatomical outcome was categorized as good, fair, and poor. Refractive outcome was classified into mild, moderate, and severe according to spherical equivalent at the last visit. Results: Fifteen eyes (8 patients) were included. Mean gestational age was 31.3 weeks, and birth weight was 1462.6 g. All eyes presented with aggressive ROP. Patches of retinal edema in avascular retina were seen in all eyes. A total of 86.6% of eyes had vascular sclerosis while 86.6% of eyes had subretinal exudates. The anatomical outcome was good in all eyes. In addition, 40% of eyes had a mild refractive error. Conclusion: Exudative retinal detachment in ROP is rare. The use of unregulated oxygen can be a contributory factor. Vascular sclerosis is consistent with hyperoxia-induced retinopathy models. Retinal edema and subretinal exudates indicate disrupted inner and outer blood-retinal barrier. Treatment outcomes are good when diagnosed and treated in time.

Clinical and visual electrophysiological characteristics of vitelliform macular dystrophies in the first decade of life.

Purpose: To evaluate patterns of pediatric vitelliform macular dystrophy (PVMD). Methods: This is a retrospective analysis of Indian children with vitelliform macular dystrophy (VMD) presenting within the first decade of life. Records were evaluated for clinical findings, family screening, and investigative findings including optical coherence tomography (OCT), fundus autofluorescence (FAF), full-field electroretinogram (ERG) and electrooculogram (EOG). Electrophysiology was scrutinized and audited for acquisition and interpretation errors. Findings on follow-up were also recorded. Results: 46 eyes of 24 patients were included. Mean age at presentation was 7.17 ± 2.17 years. Mean follow-up duration was 1.55 ± 1.69 years. Best disease was the commonest type of VMD detected (21 patients), while autosomal recessive bestrophinopathy was seen in three cases. Mean logMAR BCVA was 0.364 which decreased to 0.402 on follow-up. Hyperopia was noted in 29 out of 46 eyes (mean being +3.87 D, range ebing +0.75 to +8.75 D). Four eyes of four children had choroidal neovascular membrane at presentation, while another child developed while in follow-up. Solid type subretinal deposit was the commonest OCT finding (n = 29/38) and central hyper FAF was the commonest pattern (n = 18/32). EOG was available for review in 32 eyes, but was unreliable in 11 eyes. Seven eyes demonstrated complete absence of light rise on EOG. Conclusion: PVMD can present in advanced forms. Progression to complications with loss of visual acuity can happen within the first decade of life. EOG shows grossly suppressed waveforms in the light phase in a large number of such children.

Retinitis pigmentosa in Laurence-Moon-Bardet-Biedl syndrome in India: Electronic medical records driven big data analytics: Report II.

Purpose: To describe the clinical presentation and demographic distribution of retinitis pigmentosa (RP) in Laurence-Moon-Bardet-Biedl (LMBB) syndrome patients. Methods: This is a cross-sectional observational hospital-based study wherein 244 patients with RP in LMBB syndrome presenting to our hospital network between March 2012 and October 2020 were included. An electronic medical record database was used for data retrieval. Results: There were 244 patients in total, with a hospital-based prevalence rate of 0.010% or 1000/100,000 population. The mean and median age of patients was 15.22 ± 7.56 and 14 (IQR: 10-18.5) years, respectively, with the majority being in the age group of 11-20 years (133/244 patients; 54.50%). Males were more commonly affected (164 patients; 67.21%), and the majority (182 patients; 74.59%) were students. All 244 patients (100%) complained of defective central vision at presentation. More than one-fourth of the patients had severe visual impairment to blindness at presentation. Prominent retinal feature at presentation was diffuse or widespread retinal pigment epithelial degeneration in all patients. Conclusion: Patients with RP in LMBB syndrome present mainly in the first to second decade of life with severe visual acuity impairment to blindness early in life. It is important to rule out LMBB syndrome in early-onset RP with central visual acuity impairment. On the contrary, all patients diagnosed or suspected with LMBB syndrome systemic features at physician clinic should also be referred for ophthalmic evaluation, low vision assessment, rehabilitation, and vice versa.

Retinitis pigmentosa in Usher syndrome in India: Electronic medical records driven big data analytics: Report III.

Purpose: To describe the clinical presentation and demographic distribution of retinitis pigmentosa (RP) in patients with Usher syndrome (USH). Methods: This is a cross-sectional observational hospital-based study including patients presenting between March 2012 and October 2020. In total, 401 patients with a clinical diagnosis of USH and RP in at least one eye were included as cases. The data were retrieved from the electronic medical record database. For better analysis, all 401 patients were reclassified into three subtypes (type 1, type 2, and type 3) based on the USH criteria. Results: In total, there were 401 patients with USH and RP, with a hospital-based prevalence rate of 0.02% or 2/10,000 population. Further, 353/401 patients were subclassified, with 121 patients in type 1, 146 patients in type 2, and 86 patients in the type 3 USH group. The median age at presentation was 27 years (IQR: 17.5-38) years. There were 246 (61.35%) males and 155 (38.65%) females. Males were more commonly affected in all three subtypes. Defective night vision was the predominant presenting feature in all types of USH (type 1: 43 (35.54%), type 2: 68 (46.58%), and type 3: 40 (46.51%) followed by defective peripheral vision. Patients with type 2 USH had more eyes with severe visual impairment. Conclusion: RP in USH is commonly bilateral and predominantly affects males in all subtypes. Patients with USH and RP will have more affection of peripheral vision than central vision. The key message of our study is early visual and hearing rehabilitation in USH patients with prompt referral to otolaryngologists from ophthalmologists and vice versa.

Modeling Impact Mechanics of 3D Helicoidally Architected Polymer Composites Enabled by Additive Manufacturing for Lightweight Silicon Photovoltaics Technology.

When silicon solar cells are used in the novel lightweight photovoltaic (PV) modules using a sandwich design with polycarbonate sheets on both the front and back sides of the cells, they are much more prone to impact loading, which may be prevalent in four-season countries during wintertime. Yet, the lightweight PV modules have recently become an increasingly important development, especially for certain segments of the renewable energy markets all over the world-such as exhibition halls, factories, supermarkets, farms, etc.-including in countries with harsh hailstorms during winter. Even in the standard PV module design using glass as the front sheet, the silicon cells inside remain fragile and may be prone to impact loading. This impact loading has been widely known to lead to cracks in the silicon solar cells that over an extended period of time may significantly degrade performance (output power). In our group's previous work, a 3D helicoidally architected fiber-based polymer composite (enabled by an electrospinning-based additive manufacturing methodology) was found to exhibit excellent impact resistance-absorbing much of the energy from the impact load-such that the silicon solar cells encapsulated on both sides by this material breaks only at significantly higher impact load/energy, compared to when a standard, commercial PV encapsulant material was used. In the present study, we aim to use numerical simulation and modeling to enhance our understanding of the stress distribution and evolution during impact loading on such helicoidally arranged fiber-based composite materials, and thus the damage evolution and mechanisms. This could further aid the implementation of the lightweight PV technology for the unique market needs, especially in countries with extreme winter seasons.

A retrospective analysis of ultra-widefield photograph (Optos) documentation of retinopathy of prematurity at a tertiary eye care outpatient setup: the Indian Twin Cities ROP Study, report number 11.

PURPOSE: To demonstrate the usefulness of ultrawide-field fundus (UWF) photography for documentation in retinopathy of prematurity (ROP). METHODS: The medical records of infants with ROP who underwent at least one sitting of UWF fundus photography in addition to binocular indirect ophthalmoscopy (BIO) from April 2018 to September 2020 were analyzed retrospectively. BIO was conducted by a trained ROP specialist, and final diagnosis and treatment were based solely on BIO findings. All fundus photographs were captured on Optos UWF camera (Dunfermline, UK) in a flying baby position. Demographic details and fundus findings on BIO and fundus photographs were analyzed. RESULTS: Of the 187 infants who met inclusion criteria for successful imaging, 22 (11.7%) had findings that were discordant with BIO. Although no posterior disease was missed, 4 infants who received treatment would not have been treated based solely on UWF photography findings. Of the 60 babies whose images did not meet the inclusion criteria for successful imaging, 41 had ROP that required intervention. CONCLUSIONS: In our patient cohort, UWF photography proved useful in documenting the initial and follow-up findings of preterm babies with ROP.