Collagen imaging reveals synergistic effects of sutures and host-donor misalignment on topographical irregularities in penetrating keratoplasty.

PURPOSE: Mitigating unwanted refractive errors is crucial for surgeons to ensure quality vision after penetrating keratoplasty (PK). The primary objective of the present study is to highlight the importance of microstructural matching of the host and the donor cornea during PK on the distribution of the corneal tissue while suturing. METHODS: For this purpose, the present study undertakes an in-vitro PK model to analyse the effect of suturing and host-donor misalignment on corneal birefringence. Five groups of experiments were performed using five corneoscleral buttons. In each group, N = 16 data points (corresponding to 16 simple interrupted sutures) were assessed before and after PK with five degrees of misalignments, 0°, 30°, 45°, 60° and 90° to detect the variations in corneal birefringence post-PK. The technique of digital photoelasticity is utilized to capture the corneal birefringence experimentally. RESULTS: The local and global features of corneal birefringence provided interesting insights into the nuances of corneal birefringence in PK. Statistical analysis was performed to study the effects of suturing on the birefringence around the suture bites. It was observed that the interaction of the suture tension and structural misalignment between the host and the donor cornea influences the corneal birefringence in PK. Conclusions The zero-degree structural misalignment of the host and the donor tissue is preferable to minimize the topographical irregularities and related astigmatism post-PK. The findings of the present study envisage an additional step of structurally aligning the donor tissue with the host before suturing to minimize topographical irregularities in PK.

Perceptions and Experiences of Healthcare Providers and Patients Towards Digital Health Services in Primary Health Care: A Cross-Sectional Study.

BACKGROUND: Digital health has the potential to help achieve the Sustainable Development Goals (SDGs) by supporting health systems and enhancing health promotion and disease prevention. However, obstacles such as restricted internet access, inadequate technical assistance, clinical resource disparity, and insufficient user training can impede the utilization and growth of digital health. Researchers should examine healthcare providers' and patients' perspectives to identify challenges and enhance usability. METHODOLOGY: The study was conducted among women health volunteers, staff nurses, and patients who used the VinCense mobile application (MedIoTek Health Systems Private Limited, Chennai, India) to record vital signs. A semi-structured questionnaire was used to evaluate participants' sociodemographic characteristics, perception of digital health monitoring, and patients' attitudes toward digital health monitoring devices. The data were analyzed using R programming, Version 4.3.3 (www.r-project.org). A multinomial logistic regression analysis was used to examine the association between sociodemographic characteristics and attitudes of patients toward digital health monitoring. RESULTS: The study involved 27 healthcare providers and 406 patients. The majority (66.6%) of healthcare providers found the device convenient and efficient. Around 74.1% faced technical difficulties like internet connectivity and device battery issues. Among patients, 79.8% were satisfied with their digital health monitoring experience, 86.2% found device usage comfortable and 78.1% expressed satisfaction with health education and feedback. Around 354 (87.2%) patients stated that technology has improved healthcare, and 326 (80.3%) said that health technologies have improved ease. The results indicate that female gender (p=0.00), age above 50 years (p=0.04), and occupation status as a semiskilled worker (p=0.03), skilled worker (p=0.00), and clerical/shop/farmer (p=0.01) were statistically significant and associated with the positive attitude for digital health monitoring. CONCLUSIONS: The digital health monitoring experience was found satisfactory by both patients and healthcare providers. The mobile health (mHealth) has tremendous potential for enhancing patient health. Therefore, it is advisable to contemplate an expansion of the VinCense mHealth Platform and other digital solutions to improve service delivery in primary healthcare setups.