Physicians have to play the role of a team leader and counselor and take written informed consent for high-risk surgeries in many cases. This is the first step toward initiating a mutually ...trustworthy relationship with the patient and family. The situation is more sensitive when vulnerable patients like small premature babies or the elderly are under consideration. In the event of a death, leadership and processes in place become extremely critical. We share our experience and practice pattern during this process, especially suited to India, but the broad principles would apply to most human situations. Hopefully, some of these can be incorporated into the existing training curriculum for team building and the art of effective physician-patient communication that should be intricately woven into the curriculum for the Science of Ophthalmic care.
Imaging the pediatric retina: An overview Agarwal, Komal; Vinekar, Anand; Chandra, Parijat ...
Indian Journal of Ophthalmology/Indian journal of ophthalmology,
04/2021, Letnik:
69, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Recent decade has seen a shift in the causes of childhood blinding diseases from anterior segment to retinal disease in both developed and developing countries. The common retinal disorders are ...retinopathy of prematurity and vitreoretinal infections in neonates, congenital anomalies in infants, and vascular retinopathies including type 1 diabetes, tumors, and inherited retinal diseases in children (up to 12 years). Retinal imaging helps in diagnosis, management, follow up and prognostication in all these disorders. These imaging modalities include fundus photography, fluorescein angiography, ultrasonography, retinal vascular and structural studies, and electrodiagnosis. Over the decades there has been tremendous advances both in design (compact, multifunctional, tele-consult capable) and technology (wide- and ultra-wide field and noninvasive retinal angiography). These new advances have application in most of the pediatric retinal diseases though at most times the designs of new devices have remained confined to use in adults. Poor patient cooperation and insufficient attention span in children demand careful crafting of the devices. The newer attempts of hand-held retinal diagnostic devices are welcome additions in this direction. While much has been done, there is still much to do in the coming years. One of the compelling and immediate needs is the pediatric version of optical coherence tomography angiography. These needs and demands would increase many folds in future. A sound policy could be the simultaneous development of adult and pediatric version of all ophthalmic diagnostic devices, coupled with capacity building of trained medical personnel.
Silicon (Si), an essential nutrient in the plant health system, are gaining momentum in facilitating defense mechanisms against biotic and abiotic stresses. Recently, Si has received increased ...attention for its role in alleviating arthropod pests. Albeit many studies focused on direct mechanisms such as physical /mechanical barrier and the biochemical and molecular mode in reinforcing defense activity, the deep insight into the tri-trophic level is obscured. Our study emphasizes the key role of Si in tri-trophic interaction (plant-herbivore-natural enemies), its accumulation in plant tissue, and its consequences on beneficial arthropods. Evidently, the accumulation of Si is greater in monocot tissues than in dicots. We summarize how soil and climatic factors influence Si upregulation in plants. Ironically, the herbivore-induced plant volatiles play a crucial role in defense action, resulting in cascading effects on the attraction of natural enemies, facilitating locating the prey, subsequently strengthening the natural biocontrol. This review explores the abundance of Si in up-regulating the defense activity in the plant by favouring natural enemies and suppressing harmful arthropods, subsequently supporting a green environment and sustainable production system. Further, the present study elucidates variable functions of stress signal hormones like jasmonic acid, salicylic acid, and ethylene in both monocots and dicots. The study also highlights the availability and mode of Si application in response to plant health and emphasizes the future research needs on the role of Si in safeguarding plant health against arthropod pests.
Abstract Double perovskite have attracted substantial attention as prospective materials for applications in optoelectronics and photocatalysis. Significant efforts are devoted to modulating the ...properties of double perovskites to improve their performance. One promising approach involves substituting silver (Ag) with copper (Cu), which offers favorable electronic characteristics. Despite promising theoretical predictions, the experimental synthesis of copper‐based double perovskites has presented notable challenges. Here, the challenges of Cu incorporation in double perovskites and the subsequent – impact of Cu on the photocatalytic activity of halide perovskites toward CO 2 reduction are explored. Combining detailed computational thermodynamic studies, it is found that Cu does not form the traditional double perovskite structure that is Cs 2 CuBiCl 6 ; it stays as an interstitial dopant in its pristine Cs 3 Bi 2 Cl 9 structure. The Cu‐Cs 3 Bi 2 Cl 9 are found to exhibit enhanced CO 2 photoreduction activity than the pristine Cs 3 Bi 2 Cl 9 . Further, transient absorption results show that Cu dopants enhance the carrier generation because of introduced sub‐bandgap states, and it is found that carrier decay lifetime is elevated in Cu‐Cs 3 Bi 2 Cl 9 , which can enhance the participation of carriers in CO 2 photoreduction. The study explores the challenges and opportunities of copper doping in halide perovskites, offering the potential for developing efficient CO 2 reduction photocatalysts.
Aim: To evaluate clinical presentation, course and outcomes in patients without a history of penetrating ocular trauma who developed Sympathetic Ophthalmia (SO) following vitreoretinal surgeries
...Methods: Retrospective review of clinical records of all patients diagnosed and treated as S.O was done . All cases without a previous history of trauma were included and were analyzed with respect to clinical presentations, anatomic and visual outcomes.
Results: 175 cases of sympathetic ophthalmia were diagnosed and treated till June 2017. 16 of these cases had undergone a pars plana vitrecomy (PPV) in the past and had no history of prior ocular trauma. SO after vitreoetinal surgeries accounted for 9.14 percent of all cases of SO .In the same duration, till 2017,a total 41365 PPV were done. Thus 0.038 percent of PPV cases developed a SO . 10 patients were males and 6 were females. The median age at presentation was 45.7 years. The time interval from surgery to diagnosis of sympathetic ophthalmia ranged from 22 days to 4 years after undergoing a surgery. The mean visual acuity in the sympathizing eye was 1.26 logMAR (snellens equivalent of 20/320) which improved to 0.62 logMAR(snellens equivalent of 20/80) after treatment. The most common anterior segment finding was non granulomatous anterior uveitis, seen in 8 cases (50%) while neurosensory detachments were the most common posterior segment presentation (10 cases, 62.5%).12 patients had undergone more than 1 surgery (mean number of surgeries was 1.88). 10 patients had undergone a sutureless PPV (6 cases of 23 gauge and 4 cases of 25 gauge vitrectomy) while 4 patients had undergone a 20 gauge vitrectomy where all sclerotomies were sutured after surgery All patients were treated with systemic steroids and immunosuppresants and 15 out of 16 patients showed significant improvement in the final visual acuity in the sympathizing eye
Conclusions: Sympathetic ophthalmia after vitreoretinal surgeries is a rare but potentially sight threatening disease occurring in 0.038 percent of all cases of Pars Plana Vitrectomy. Presence of inflammation in the fellow eye after a vitreoretinal surgery in the other eye should alert the surgeon to possibility of sympathetic ophthalmia
Purpose: Intraocular infection in patients with COVID-19 could be different in the presence of treatment with systemic corticosteroid and immunosuppressive agents. We describe the epidemiology and ...microbiological profile of intraocular infection in COVID-19 patients after their release from the hospital. Methods: We analyzed the clinical and microbiological data of laboratory-confirmed COVID-19 patients from April 2020 to January 2021 presenting with features of endogenous endophthalmitis within 12 weeks of their discharge from the hospital in two neighboring states in South India. The data included demography, systemic comorbidities, COVID-19 treatment details, time interval to visual symptoms, the microbiology of systemic and ocular findings, ophthalmic management, and outcomes. Results: The mean age of 24 patients (33 eyes) was 53.6 ± 13.5 (range: 5-72) years; 17 (70.83%) patients were male. Twenty-two (91.6%) patients had systemic comorbidities, and the median period of hospitalization for COVID-19 treatment was 14.5 ± 0.7 (range: 7-63) days. Infection was bilateral in nine patients. COVID-19 treatment included broad-spectrum systemic antibiotics (all), antiviral drugs (22, 91.66% of patients), systemic corticosteroid (21, 87.5% of patients), supplemental oxygen (18, 75% of patients), low molecular weight heparin (17, 70.8% of patients), admission in intensive care units (16, 66.6% of patients), and interleukin-6 inhibitor (tocilizumab) (14, 58.3% of patients). Five (20.8%) patients died of COVID-19-related complications during treatment for endophthalmitis; one eye progressed to pan ophthalmitis and orbital cellulitis; eight eyes regained vision >20/400. Fourteen of 19 (73.7%) vitreous biopsies were microbiologically positive (culture, PCR, and microscopy), and the majority (11 patients, 78.5%) were fungi. Conclusion: Intraocular infection in COVID-19 patients is predominantly caused by fungi. We suggest a routine eye examination be included as a standard of care of COVID-19.
Background: The vast majority of common bile duct (CBD) stones was secondary, formed within the gall bladder (GB) and migrates down the cystic duct into CBD or rarely due to primary stones formed in ...CBD. Intra-operative bile culture prevents development of infectious complications and guide selection of future appropriate antibiotic prophylaxis. Hence, this study focussed on investigation of microbiological profile of routine bile cultures in endo-biliary stenting patients undergoing cholecystectomy.Methods: In this study, 50 patients with CBD stone(s) were undergone endoscopic retrograde cholangio-pancreatography (ERCP) followed by stenting and then cholecystectomy (either laparoscopically or open). GB extraction was done in a sterile bag and after opening sterile bag; bile was collected and sent for microbiological culture and sensitivity for analysis.Results: Most of the cases had cholelithiasis with choledocholithiasis (38.0%) which were significantly higher than other diagnosis (Z=2.51; p<0.05) and there was no significant association found between surgical site infections and bile culture positivity of studied patients (Z=9.61; p<0.0001). Among 35 patients with positive bile cultures, E. coli in 26 patients followed by Klebsiella species in 5 patients were the most prevalent bacteria isolates and over all, colistin (91.4%) and tigecycline (91.4%) were found as sensitive antibiotics. Also, certain strains of multi drug resistance E. coli in 6 patients were resistant to gentamicin/amikacin only sensitive to tigecycline and colistin, which was high.Conclusions: Most prevalent isolates microorganism is gram negative bacteria that were mostly gut bacteria and the incidence of post ERCP infection is high and drug resistance among the causative organism is common.
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.
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