Management of acute corneal hydrops - Current perspectives.

Acute corneal hydrops (ACH) is a rare but sight-threatening complication of corneal ectasias. We aim to review the current literature on etiopathogenesis, histology, role of ancillary investigations, management, and outcomes of ACH by classifying the various management strategies based on their site of action and the underlying mechanism. A review of the literature was conducted by searching the following databases: PubMed (United States National Library of Medicine), Embase (Reed Elsevier Properties SA), Web of Science (Thomson Reuters), and Scopus (Elsevier BV) till April 2023. The literature search used various combinations of the following keywords: acute corneal hydrops, keratoconus, ectasia, management, keratoplasty. Nine hundred eighty-three articles were identified based on the above searches. Case reports which did not add any new modality of treatment to the existing literature, articles unrelated to management, those with no full text available, and foreign-language articles with no translation available were excluded. Eventually, 75 relevant articles that pertained to the management of ACH were shortlisted and reviewed. Recent studies have described newer surgical interventions like full-thickness or pre-Descemetic sutures, thermokeratoplasty, and plasma injection that aim to close the posterior stromal break. Posterior lamellar keratoplasties act by replacing the posterior torn Descemet's membrane (DM), and early deep anterior lamellar keratoplasty (DALK) has been attempted to combine the correction of the anatomical defect and visual rehabilitation in a single surgery. These surgical interventions may help by reducing the scarring and increasing the number of patients who can be visually rehabilitated with contact lenses rather than keratoplasty.

Proanthocyanidins isolated from the leaves of Ficus glomerata evaluated on the activities of rumen enzymes: in vitro and in silico studies.

Two new proanthocyanidins (2S:3S)-(-)-epicatechin-(4α→8)4-(2R:3R)-(+)-catechin (Compound 1) and (2R, 3R)-3-O-galloyl-(+)-catechin (4ß→8)3-(2R, 3R)-3-O-galloyl-(+)-catechin (Compound 2) were isolated from Ficus glomerata and characterized by ultraviolet spectroscopy (UV), proton nuclear magnetic resonance (1H NMR), 13C NMR, and heteronuclear multiple bond correlation . The bioactivity and drug scores of isolated compounds were predicted using OSIRIS property explorer applications with drug scores of 0.03 (compound 1) and 0.05 (compound 2). Predictive drug scores provided an indication of the compounds' potential to demonstrate desired biological effects. Furthermore, the newly discovered proanthocyanidins tended to interact with protein due to their chemical structure and molecular conformation. With the aim of maintaining this focus, compounds 1 and 2 were subjected to in vitro testing against ruminal enzymes to further explore their potential impact. Both compounds showed significant inhibition activities (p < 0.01) against glutamic oxaloacetic transaminase in both protozoa and bacterial fractions, with an effective concentration (EC50) of 12.30-18.20 mg/mL. The compounds also exhibited significant inhibition (p < 0.01) of ruminal glutamic pyruvic transaminase activity, with EC50 values ranging from 9.77 to 17.38 mg/mL. Furthermore, the inhibition was recorded in R-cellulase between EC50 values of 15.85 and 23.99 mg/mL by both compounds. Additionally, both compounds led to a decrease in protease activity with increasing incubation time and concentration. In conclusion, the results indicate that these novel proanthocyanidins hold the potential to significantly impact rumen enzyme biology. Furthermore, their promising effects suggest that they could be further explored for drug development and other important applications.

Presurgical depressive symptom and anaesthetic requirements in patients undergoing surgery for malignant and non-malignant conditions: A prospective observational cohort study.

The incidence and magnitude of depression are rarely assessed during preanaesthetic evaluation. The shared physiological mechanisms of depression and anaesthetic drugs are likely to alter the pharmacodynamics of propofol. Therefore, the study aimed to evaluate the burden of presurgical depression and its effect on propofol consumption during anaesthesia. This prospective, observational, cross-sectional, analytical study included adult patients (> 18 years) undergoing surgery. During the preoperative period, depressive symptoms were evaluated by the psychiatrist on 9-point Patient Health Questionnaire-9 (PHQ-9). The propofol requirements were recorded during anaesthesia and compared with those for patients without depression. One hundred and seventy-four patients (87 patients each with and without cancer) underwent presurgical evaluation. The prevalence of depression (>4 Patient Health Questionnaire-9) and moderate to severe depression (>9 PHQ-9) among patients with cancer was 58.6% and 35.6%, respectively. The prevalence of depression (>4 PHQ-9) and moderate to severe depression (>9 PHQ-9) among patients without cancer was 18.4% and 3.4%, respectively. In the cancer group, propofol requirement was significantly lower (114.7 ± 22.9mg vs. 126.4 ± 24.3mg; p = 0.025) in patients with depression than that in those without depression. In conclusion, the burden of depression during the preanaesthetic period among patients with cancer is substantial, and depression reduces propofol requirement during surgery.

Susceptibility status of Aedes aegypti (Diptera: Culicidae) against insecticides of public health use in Delhi and NCR region, India.

BACKGROUND & OBJECTIVES: Aedes (Stegomyia) aegypti is a primary vector responsible for the transmission of various arboviral diseases in India. Without an effective drug or vaccine against these diseases, chemical insecticide-based vector control supplemented with source reduction remains the best option for their effective management. The development of insecticide resistance due to the continuous use of insecticides might affect the control operations. METHODS: Adults and larvae of Aedes aegypti were collected from different localities in Delhi. Larvae were exposed to discriminating (0.02mg/l) and application (1mg/l) doses of temephos. WHO tube assay was conducted for F1 adults using impregnated insecticide papers of dichlorodiphenyltrichloroethane (DDT), malathion, deltamethrin, permethrin, cyfluthrin, and lambda-cyhalothrin. RESULTS: Larvae of Ae. aegypti were found resistant (76.0%) to the discriminating dose of temephos, whereas suscep-tible (100.0%) to the application dose of the temephos. Adult Aedes (Fl) mosquitoes were resistant to DDT (23.7%), malathion (90.5%), deltamethrin (76.0%), permethrin (96.2 %) cyfluthrin (85.5%), and lambda-cyhalothrin (94.0%). INTERPRETATION & CONCLUSION: Indoor residual spray is not used in Delhi for vector control. Resistance in Aedes might be due to pesticide usage for agricultural activities in peripheral regions of Delhi. There is a need to investigate more on the insecticide resistance mechanisms for indirect resistance development. Understanding the insecticide susceptibility status of urban vectors is critical for planning effective control strategies.

TiO2-guanine as a new amalgamation compound for fabrication of a disposable biosensor with high sensitivity and rapid detection of H1N1 swine flu virus.

A TiO2-guanine nanocomposite (TG NC)-based electrochemical biosensor was immobilized with hemagglutinin (HA) gene specific probe with 5' NH2 group on screen-printed gold electrode (probe(ss)DNA-TG-SPGE). The modified biosensor was examined for H1N1 swine flu virus. TG NCs along with precursors were characterized spectroscopically and morphologically by employing several approaches. Electrochemical investigations were performed with the help of cyclic voltammetric (CV) and electrochemical impedance spectroscopy (EIS) in 0.1 M phosphate buffer saline (PBS; pH 7.4) with 1 µM methylene blue (MB) redox indicator. For better detection of single-stranded virus DNA, the modified electrode was optimized at various concentrations, pH, and scan rates. The modified biosensor showed high sensitivity (40.32 µA/ng.cm2), low LOD (0.00024 ng/6 µL), and broad linear range 0.0002-20 ng/6µL with coefficient of determination of R2=0.9981 for H1N1 virus detection. The HA gene-modified biosensor presented decent stability and specificity against different infectious pathogens including H3N2 virus and human DNA with negative response. Furthermore, the modified biosensor also responded well for real sample target DNA detection with a recovery of >96%. The simply designed HA gene-modified biosensor transduces decreased current response towards target-specific (ss)DNA binding and could be used as a rapid detection tool for H1N1 swine flu virus diagnosis.

Tectonic Deep Anterior Lamellar Keratoplasty in Severe Ocular Chuna Particle Injury in a Child.

A 10-year-old child presented to eye casualty with pain, watering and photophobia of the left eye for one month. Parents gave a history of chuna (lime) falling inside the eye one month back, following which the patient consulted at a primary health centre. However, there was no relief of symptoms and the patient was referred to a higher centre. On examination under anaesthesia, the eye was full of chuna particles. Removal of all visible chuna particles and the corneal chuna plaque was planned. Intra-operatively, the stromal melt was noted around the corneal chuna plaque extending up to Descemet's membrane. Microscope-integrated optical coherence tomography (Mi-OCT) guided removal of corneal chuna particles was done. A tectonic deep anterior lamellar keratoplasty (DALK) along with amniotic membrane graft (AMG) and symblepharon ring placement was done. Two weeks post-operatively, the patient was having a persistent epithelial defect. A repeat AMG with a symblepharon ring was done. On one month follow-up, the epithelial defect had healed. This case emphasises the fact that ocular chemical injuries are an emergency requiring urgent and apt management. In cases of severe ocular chuna injury with delayed presentation, removal of all particles, maintenance of globe integrity and ocular surface restoration is a challenging goal. Healing is slow and visual prognosis is generally guarded in such cases.

Aedes aegypti container preference for oviposition and its possible implications for dengue vector surveillance in Delhi, India.

OBJECTIVES: Dengue is a mosquito-borne viral disease globally transmitted by Aedes aegypti. The most effective method to prevent the transmission of the disease is proficient vector control. Understanding the breeding behaviour of the responsible vectors is very pertinent in this regard; therefore, the present study was conducted to understand Ae. aegypti behaviour regarding the selection of containers for oviposition in the megacity of Delhi. METHODS: A household survey in different localities within Delhi was carried out during 2018-2019. All available containers were inspected for the presence of immature Ae. aegypti. In entomological surveillance, the ovipositional preference of Aedes was computed using the breeding preference ratio, container index in the field, and laboratory settings, and associations of dengue cases with monthly variation in environmental factors and container type were also calculated. RESULTS: The household larval survey in 40 localities showed that 40% of 27,776 water-holding containers in 3,400 houses were plastic, followed by overhead tanks (26.2%), and coolers (12.1%). The most preferred breeding habitat was clay pots (9.3%), followed by metallic containers (8.5%) and solid waste (7.1%). A laboratory-based study showed that Aedes preferred clay containers (81.8%) over 4 other types of containers (plastic, paper, metal, and glass). CONCLUSIONS: The present study provides a rationale for using clay containers as a possible surveillance tool (ovitraps) or as a vector control tool. This information might aid researchers in developing novel traps and targeting preferred containers for larval control activities during transmission and non-transmission seasons.

The study of structure and effects of two new proanthocyanidins from Anogeissus pendula leaves on rumen enzyme activities.

Two novel proanthocyanidins, (2R, 3R)-(+)-Gallocatechin-(4ß â†’ 8)4-(2R, 3R)-(+)-gallocatechin (compound 1) and 3-O-galloyl-(2S, 3S)-(-)-epicatechin-(4α → 8)-[3-O-galloyl-(2S, 3S)-(-)-epicatechin (4α → 8)]2-(2S, 3S)-(-)-epicatechin (compound 2), were structurally characterized from leaves of Anogeissus pendula. The structures were determined by ultraviolet spectroscopy (UV), proton nuclear magnetic resonance (1H NMR), 13C NMR, and heteronuclear multiple bond correlation. Molinspiration and Osiris property explorer applications were used to predict bioactivity and drug score. Drug scores of 0.08 and 0.05 were predicted for compounds 1 and 2, respectively. Predicted bioactivity scores were high. Due to their molecular weight, chemical structure, and conformation, the newly discovered proanthocyanidins possess an inclination to interact with proteins. Based on this premise, both compounds were subjected to in vitro testing against ruminal enzymes. They exhibited significant inhibition activities (p < 0.01) with a range of half maximal effective concentration (EC50) of 14.80-17.88 mg/mL of glutamic oxaloacetic transaminase in both protozoa and bacteria fractions. The ruminal glutamic pyruvic transaminase activity was significantly inhibited (p < 0.01) from EC50 12.59-16.29 mg/mL, and R-cellulase inhibition was recorded with EC50 18.20-21.98 mg/mL by compounds 1 and 2, respectively. Protease activity decreased with increasing incubation time and concentration of both compounds. The novel proanthocyanidins have potential roles in improving feed conversion ratios and in drug development.

Ppy/TiO2-SiO2 nanohybrid series: synthesis, characterization, photocatalytic activity, and antimicrobial potentiality.

A series of polypyrrole doped TiO2-SiO2 nanohybrids (Ppy/TS NHs) were synthesized thru in-situ oxidation polymerization by varying weight ratio of pyrrole. The structural analysis of NHs were characterized by X-ray Diffraction (XRD) spectra, UV-visible (UV-Vis) spectra and X-ray Photoelectron spectra (XPS) confirmed synthesis of nanomaterials. Surface and morphological study done by adopting, Scanning Electron Microscopy (SEM), Energy Dispersive Spectroscopy (EDS), Transmittance Electron Microscopy (TEM) and Brunauer-Emmett-Teller (BET) analysis confirmed the homogenous distribution, nano range size formation and mesoporous nature of nanohybrids. Further, electrochemical behavior of synthesized NHs investigated by adopting Electrochemical Impedance Spectroscopy (EIS) showed good kinetic behaviour and electron transport tendency. The nanohybrids and precursors were examined for photocatalytic degradation of methylene blue (MB) dye and revealed enhanced degradation tendency for the NHs series photocatalysts. It was found that variation of pyrrole (0.1 to 0.3 g) to TS nanocomposites (TS Nc) increased the photocatalytic potential of TS Nc. The maximum photodegradation efficacy was found to be 90.48% in 120 min for Ppy/TS0.2 NHs under direct solar light. Additionally, Ppy/TS0.2 NHs performed appreciably towards antibacterial studies against some Gram-positive and Gram-negative deleterious bacteria, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Shigella flexneri microbes.

Immunopathogenesis of corneal graft rejection.

The most common cause of corneal graft failure is corneal graft rejection (CGR). Although cornea is one of the immune-privileged sites, it can still get a rejection episode due to a breach in its natural protective mechanism. Both anatomical and structural properties of cornea and anterior chamber contribute toward its immune tolerance. Clinically, every layer of the transplanted cornea can get a rejection episode. A proper understanding of immunopathogenesis will help in understanding the various mechanism of CGR and the development of newer strategies for the prevention and management of such cases.

An eco-friendly corrosion inhibitor Cuscuta reflexa extract and PEG400 for mild steel inhibition in acidic medium: computational and experimental investigations.

Herein, the mechanism of corrosion prevention of mild steel (MS) by extract of Cuscuta reflexa/Amarbel (AME) as green inhibitor is explained by gravitational, electrochemical measurements. The viability of neat extract and after adding an intensifier was investigated as corrosion inhibitor for MS in hydrochloric acid. The presence of electron-rich moieties in AME was characterized through Fourier-transform infrared spectroscopy (FTIR). Furthermore, polarization measurements showed that AME acted as a mixed type inhibitor against corrosion. The formulation of 100 ppm AME with 50 ppm polyethylene glycol 400 (PEG400) as an intensifier showed inhibition efficiency of 97.51% for MS in 0.5 M HCl. The protection of MS in (AME + PEG) formulation was also assessed through the Langmuir, Freundlich, and Flory-Huggins adsorption isotherm model. The surface studies of the MS were examined by atomic force microscopy (AFM) and scanning electron microscopy (SEM) that indicated a smoothened surface of the metal in the presence of the studied compounds. XPS study was executed to analyze the interaction of the inhibitor with the metal surface. In addition, computational quantum study provides the molecular structural relationship with corrosion inhibitive competence of the extract.

Polyvinylpyrrolidone/TiO2 composites' preparation via sol-gel procedure furthered with non-enzymatic glucose sensing and antibacterial effectiveness.

An amperometric non-enzymatic glucose sensing based on polyvinylpyrrolidone and titanium dioxide nanocomposites (PVP-TiO2 NCs) fabricated over stainless-steel (SS) electrode was experimented. The electrode was fabricated of PVP-TiO2 NCs onto SS surface through drop casting coating. The NCs and the electrode were analyzed using Fourier transform infrared (FTIR) and UV-visible (UV-Vis) spectroscopy, X-ray diffraction spectra (XRD), X-ray photoelectron spectra (XPS), particle analyzer, scanning electron microscopy (SEM), EDS and transmission electron microscopy (TEM) and Brunauer-Emmett-Teller (BET) analysis for surface. For electrochemical investigation, cyclic voltammetry, electrochemical impedance spectra, including Nyquist plots and Bode plots, and chronoamperometry were adopted. PVP-TiO2/SS-modified electrode manifested high sensitivity of 360.13 µA/mM.cm2, lower detection limit of 756.8 µM and 0 to 13 mM linear range with regression coefficient of R2 = 0.992. The electrode exhibited high stability with good anti-interference tendency against fructose, uric acid, ascorbic acid and sucrose. The modified electrode also performed well in real sample glucose detection. Further, PVP-TiO2 NCs performed appreciably toward antibacterial studies against some Gram-positive and Gram-negative deleterious bacteria, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Shigella flexneri microbes.

In-situ composited g-C3N4/polypyrrole nanomaterial applied as energy-storing electrode with ameliorated super-capacitive performance.

Graphitic carbon nitride (g-C3N4) and polypyrrole (ppy) nanocomposites are synthesized and cast off as material for electrodes intended for energy storage, where the amount of pyrrole is being kept static after optimization by altering the amount of g-C3N4 to make a series of g-C3N4/ppy (pcn) nanocomposites. These nanocomposites are successfully synthesized by employing in-situ oxidation polymerization by oxidizing pyrrole. The nanocomposites are further characterized by Fourier transform infrared spectroscopy (FT-IR) for structural investigation, thermal gravimetric analysis (TGA) for thermal stability analysis, and field emission scanning electron microscopy (FESEM) and transmission electron microscopy (HR-TEM) for surface morphological scrutiny. The electrochemical measurements of the series are inspected with the help of galvanostatic charge-discharge (GCD), electrochemical impedance spectroscopy (EIS), and cyclic voltammetry (CV) measurements. It is detected that 0.4 pcn has the highest specific capacitance value of 555 F g-1 at 10 mV s-1 scan rate through CV and 475 F g-1 at a current density of 0.5 A g-1 through GCD in 1 M H2SO4 in contrast with neat g-C3N4 as well as ppy where both the precursors have this value below 100 F g-1. This composite exhibited good cyclic stability with high retention. The high energy density of 0.4 pcn composite is analyzed at 86 Wh/kg at a power density of 300 W/kg. Due to facile synthesis, significant specific capacitance, and excellent energy density, pcn is a promising candidate for its application in energy storage purposes.

Proanthocyanidins Modulate Rumen Enzyme Activities and Protein Utilization In Vitro.

This study investigated the principal leaf protein (rubisco) solubilization and in vitro ruminal enzyme activity in relation to the molecular structure of proanthocyanidins extracted from leaves of Anogeissus pendula and Eugenia jambolana. Six proanthocyanidin fractions were extracted by 50% (v/v) methanol−water followed by 70% (v/v) acetone−water and then distilled water from leaves of A. pendula (AP) and E. jambolana (EJ) to yield EJ−70, EJ−50, EJ−DW, AP−70, AP−50 and AP−DW. Fractions were examined for their molecular structure and their effects on sheep ruminal enzymes and solubilization of rubisco in vitro. All fractions significantly (p < 0.05) inhibited the activity of ruminal glutamic oxaloacetic transaminase and glutamic pyruvic transaminase. The fractions AP−50 and EJ−50 significantly inhibited the activity of the R-cellulase enzyme. Most of the fractions inhibited R-glutamate dehydrogenase activity (p < 0.05) by increasing its concentration, while protease activity decreased by up to 58% with increasing incubation time and concentration. The solubilization of rubisco was observed to be comparatively higher in A. pendula (16.60 ± 1.97%) and E. jambolana (15.03 ± 1.06%) than that of wheat straw (8.95 ± 0.95%) and berseem hay (3.04 ± 0.08%). A significant (p < 0.05) increase in protein solubilization was observed when wheat straw and berseem hay were supplemented with A. pendula and E. jambolana leaves at different proportions. The efficiency of microbial protein was significantly (p < 0.05) greater with the supplementation of leaves of A. pendula in comparison to E. jambolana. The overall conclusion is that the proanthocyanidins obtained from E. jambolana exhibited greater inhibitory activities on rumen enzymes, whereas A. pendula recorded higher protein solubilization. Thus, PAs from A. pendula and E. jambolana appear to have the potential to manipulate rumen enzyme activities for efficient utilization of protein and fiber in ruminants.

Sequential Extraction of Proanthocyanidin Fractions from Ficus Species and Their Effects on Rumen Enzyme Activities In Vitro.

Three proanthocyanidin fractions per species were sequentially extracted by 50% (v/v) methanol−water, 70% (v/v) acetone−water, and distilled water from leaves of Ficus racemosa (fractions FR) and F. religiosa (fractions FRL) to yield fractions FR-50, FR-70, FR-DW, FRL-50, FRL-70, and FRL-DW. Fractions were examined for their molecular structure, effect on ruminal enzyme activities, and principal leaf protein (Rubisco) solubilization in vitro. All fractions except FRL-70 contained flavonoids including (+) catechin, (−) epicatechin, (+) gallocatechin, (−) epigallocatechin, and their -4-phloroglucinol adducts. The fractions FRL-50 and FRL-DW significantly (p < 0.05) inhibited the activity of ruminal glutamic oxaloacetic transaminase and glutamic pyruvic transaminase. All fractions inhibited glutamate dehydrogenase activity (p < 0.05) with increasing concentration, while protease activity decreased 15−18% with increasing concentrations. Fractions FRL-50 and FRL-DW completely inhibited the activity of cellulase enzymes. Solubilization of Rubisco was higher in F. religiosa (22.36 ± 1.24%) and F. racemosa (17.26 ± 0.61%) than that of wheat straw (WS) (8.95 ± 0.95%) and berseem hay (BH) (3.04 ± 0.08%). A significant (p < 0.05) increase in protein solubilization was observed when WS and BH were supplemented with FR and FRL leaves at different proportions. The efficiency of microbial protein was significantly (p < 0.05) greater in diets consisting of WS and BH with supplementation of F. racemosa leaves in comparison to those supplemented with F. religiosa leaves. The overall conclusion is that the fractions extracted from F. religiosa showed greater inhibitory effects on rumen enzymes and recorded higher protein solubilization in comparison to the F. racemosa. Thus, PAs from F. religiosa are potential candidates to manipulate rumen enzymes activities for efficient utilization of protein and fiber in ruminants.

Effect of positive end-expiratory pressure on central venous pressure in the closed and open thorax.

Objective.The magnitude and mechanism of the rise of central venous pressure (CVP) after positive end-expiratory pressure (PEEP) among patients with cardiac disease is poorly understood. Therefore, the study aimed to compare the magnitude of change in CVP after PEEP in patients with TR (tricuspid regurgitation), high CVP, and high PCWP (pulmonary capillary wedge pressure) and in those with no TR, low CVP, and low PCWP. Additionally, we hypothesized that PEEP in the open thorax would also lead to a rise in CVP.Approach.This prospective, quasi-experimental study was conducted in patients undergoing cardiac surgery. Three consecutive readings of variables were obtained at 1 min intervals after PEEP (5 and 10 cm H2O) application in the closed and open thorax. Patients were stratifieda prioriinto low CVP (<10 cm H2O) and high CVP (≥10 cm H2O), no TR and TR, and low PCWP (<15 mm Hg) and high PCWP (≥15 mm Hg) in the closed and open thorax.Main Results.Sixty-two patients were eligible for final analysis. The mean difference (MD) in ΔCVP (CVP10 cm H2O of PEEP-CVPzero end-expiratory pressure) was 2.33 ± 1.13 (95% CI, 2.04-2.62, P = 0.000) and 1.02 ± 0.77 (95% CI, 0.82-1.22, P = 0.000) in the closed and open thorax, respectively. The increase in CVP was higher among patients who had a lower CVP (2.64 ± 0.9 mm Hg versus 1.45 ± 1.17 mm Hg; p=0.000), in patients without TR (2.64 ± 0.97 mm Hg versus 2.14 ± 1.2 mm Hg, p=0.09) and in patients with a lower PCWP (2.4 ± 0.9 mm Hg versus 2.3 ± 1.4 mm Hg, p=0.67) at 10 cm H2O PEEP in the closed thorax.Significance.The rise in CVP was higher among patients without TR, low CVP, and low PCWP. Zero intrathoracic pressure in the open thorax did not abolish the effect of PEEP on CVP rise altogether.

Hitch suture assisted tuck in Tenon's Patch Graft for management of Corneal Perforations.

PURPOSE: To describe a novel modification of tuck-in Tenon's patch graft (TPG) using temporary horizontal mattress sutures and fibrin glue to hitch the graft in the management of corneal perforations. DESIGN: Ambispective interventional case series. METHODS: Modified technique of autologous TPG was used to seal corneal perforations measuring 3-5 mm, using horizontal mattress sutures to hitch the graft in a lamellar pocket, followed by application of fibrin glue. The horizontal mattress sutures were removed after the reformation of the anterior chamber. The primary outcome measure was a well formed anterior chamber in the post-operative period and the secondary outcome was epithelization time. RESULTS: The surgery was performed in 22 eyes. The mean age was 43.86 ± 16.02 (26-66) years, with 14 males and eight females. The etiologies of corneal perforation included dry eye (n = 10), neurotrophic keratitis (n = 6), trauma (n = 2), chemical injury (n = 2) and exposure (n = 2). The mean size of the perforation with the thinned-out area was 4.3 mm (range 3-5 mm). The mean duration of epithelialization was 14.31 ± 2.63 days (7-21 days). No intraoperative complications were observed. All eyes had a well-formed anterior chamber in the immediate postoperative period. Postoperatively, two eyes had graft pseudoectasia due to a thick graft and supra tenon haemorrhage each; one eye each had graft thinning with the formation of pseudopterygium and graft melting. CONCLUSION: Tenon's patch graft, along with the use of temporary horizontal mattress sutures and fibrin glue, is an effective modification of the technique for managing corneal perforations measuring 3-5 mm.

Detection of Leishmania donovani in Wild-Caught Phlebotomine Sand Flies in Endemic Focus of Leishmaniasis in Himachal Pradesh, India.

An endemic focus of cutaneous leishmaniasis (CL) is located in the Sutlej River Valley in Himachal Pradesh (India) in the north-western Himalaya where CL co-exists with visceral leishmaniasis (VL). In areas of the Indian subcontinent such as Rajasthan, cutaneous leishmaniasis is transmitted by Phlebotomus papatasi (Scopoli) and Phlebotomus salehi. In Himachal Pradesh, Phlebotomus longiductus (Parrot) is suspected to be the vector for CL. In the current study, sand flies were collected and tested for Leishmania infection and to confirm the vector species causing CL. Sand flies were collected during April and September of 2017-2019 from CL endemic villages of Rampur (Shimla), Nirmand (Kullu) and Nichar (Kinnaur) districts of Himachal Pradesh. The sand flies were identified as Phlebotomus (adlerius) longiductus (Parrot) and Phlebotomus (larrousisus) major (Annandale). The density of P. longiductus was found highest. The elevation of villages ranged from 947 m to 2,130 m and were far from the presence of subsoil water. Field collected sand flies tested positive (7.69%) for Leishmania donovani by PCR-RFLP. The L. donovani sequences detected from P. longiductus were 97% similar to L. donovani sequences reported from the cases of CL in Himachal Pradesh.The Leishmania positive sand flies were morphologically identified as Phlebotomus adlerious longiductus providing one step further evidence towards the vector status of CL in Himachal Pradesh. The findings of the study are of epidemiological significance for strategic planning of vector control for leishmaniasis in India.

Management of small perforated corneal ulcers: Training model in mammalian eye to enhance surgical skills of residents.

PURPOSE: To demonstrate a training technique on the mammalian eye for optimum Cyanoacrylate Tissue adhesive application in cases of perforated corneal ulcers. METHODS: A full-thickness defect simulating a perforation was created on the goat's eye cornea to teach the technique of cyanoacrylate glue application in cases of corneal perforations to novice surgeons. RESULTS: This training model on the mammalian eye was tested by 10 residents at our centre. All the 10 candidates involved in our series were newly joined Cornea fellows with proficient skill in cataract surgeries and minor ophthalmic procedures such as suture removal, chalazion excision, pterygium removal and administration of an intravitreal injection. None of the candidates had prior experience of corneal surgeries. Each resident made an average of 4.4 attempts to seal the corneal defect, obtain a regular corneal surface and form the anterior chamber. CONCLUSION: This training model helps in mastering one of the skills of corneal surgeries.

Optic disc pit with multiquadrant peripapillary retinoschisis and choroidal coloboma.

An 18-year-old man presented with decreased vision in the right eye (OD) noticed for 1 month. On examination, OD best-corrected visual acuity was 3/60 and the left eye (OS) was 6/6 with intraocular pressure of 12 mm Hg in both the eyes (OU). OD fundus revealed an inferior optic-disc-pit with macular-retinoschisis and an inferior choroidal coloboma. OS fundus was normal. On swept-source optical coherence tomography (SSOCT) radial scans, peripapillary-retinoschisis was seen not only in the macular region but in all the four quadrants. To the best of our knowledge, no such case has been reported of optic disc pit with multiquadrant peripapillary retinoschisis and choroidal coloboma coexisting in the same eye. SSOCT radial scans can help detect subclinical retinoschisis as in this case.