Effect of Turmeric-Boswellia-Sesame Formulation in Menstrual Cramp Pain Associated with Primary Dysmenorrhea-A Double-Blind, Randomized, Placebo-Controlled Study.

Primary dysmenorrhea is a common menstrual disorder that significantly impacts women's quality of life, productivity, and healthcare utilization. In this randomized, double-blinded, placebo-controlled trial, sixty women with primary dysmenorrhea were randomly divided into two groups with thirty participants each, and were allocated either turmeric-boswellia-sesame formulation (treatment) or placebo. The participants were advised to take two softgels of 500 mg as a single dose of allocated study intervention (total dose 1000 mg) when their menstrual pain reached 5 or more on a numerical rating scale (NRS). Menstrual cramp pain intensity and relief were evaluated every 30 min post-dose until 6 h. Results indicated a promising role of turmeric-boswellia-sesame formulation for menstrual pain relief compared to the placebo. The mean total pain relief (TOTPAR) of the treatment group (18.9 ± 0.56) was found to be 12.6 times better than the placebo group (1.5 ± 0.39). The NRS analysis showed that there was a statistically significant difference in pain intensity between the treatment and placebo groups (p < 0.001) at every timepoint. Additionally, the sum of pain intensity difference at 6 h (SPID6) of the treatment group (34.32 ± 1.41) showed a significant difference (p < 0.0001) and was 20.19 times better when compared to placebo (1.7 ± 0.56). Based on the study results, the turmeric-boswellia-sesame formulation exhibited remarkable menstrual pain relief as compared to the placebo.

Multimodal imaging of reactive retinal astrocytic vasoproliferative tumour in a case of systemic tuberculosis.

A man in his 20s presented with diminished vision in the left eye. He had a history of Pott's spine and had been diagnosed elsewhere as having left eye tubercular granuloma in the retina. He was started on anti-tubercular therapy and high-dose oral steroids. He presented to us 1 month later. Presently fundus examination revealed a yellow to whitish mass temporal to disc with diffuse hard exudates throughout the retina. Swept-source optical coherence tomography (SSOCT) revealed a hyper-reflective mass involving the retina. SSOCT angiography and fundus fluorescein angiography revealed vascularity within the lesion. We made a diagnosis of a secondary reactive retinal astrocytic vasoproliferative tumour (VPT) and hence tapered the steroids and given intravitreal bevacizumab injection. At 6 weeks follow-up after intravitreal bevacizumab, there was some amount of resolution of hard exudates along with reduction of the vascular pattern of the lesion. The peripapillary location and development of a VPT following resolution of a presumed tubercular granuloma is rare.

Stereopsis following surgery in children with congenital and developmental cataracts: A systematic review and meta-analysis.

We estimated the proportion of children with stereopsis following surgery in congenital and developmental cataracts by systematic review and meta-analysis and also considered the factors influencing stereopsis, such as intervention age and presence of strabismus. Stereopsis is directly related to quality of life, and investigating its levels following cataract surgery in children may help decide the right time to intervene, particularly in the context of brain plasticity. We conducted a systematic literature search using Scopus, PubMed, and Web of Science and found 25 case series, 3 cohorts, and 3 clinical trial studies from 1/1/1995 to 31/12/2020. Study-specific proportions of stereopsis from 923 children were pooled using a random-effects model, and stratified analyses were conducted based on intervention age and pre-existing strabismus as a confounder. We appraised the risk of bias using tools published by National Institutes of Health and evaluated publication bias with funnel plots and the Egger test. The pooled proportions of stereopsis based on 8 unilateral and 6 bilateral congenital cataract studies were 0.37 (95% CIs: [0.24, 0.53]) and 0.45 (95% CIs: [0.24,0.68]) when patients with preexisting strabismus were excluded as a confounder. When the intervention age was ≤6 months, proportions in unilateral congenital cataract group significantly increased to 0.52 (95% CIs: [0.37, 0.66]; P = 0.49) compared to 0.26 (95% CIs: [0.14, 0.44]; P = 0.16) otherwise. A similar increase in proportions was found when intervention age ≤4 months. In both unilateral and bilateral congenital cataract groups, proportions increased significantly when the confounder was excluded. Overall, proportions in bilateral congenital cataracts were significantly greater than unilateral cases (irrespective of confounder). Eight unilateral and 5 bilateral developmental cataract studies resulted in pooled proportions of 0.62 (95% CIs: [0.27, 0.88] and 0.82 (95% CIs: [0.4, 0.97]), respectively. Although proportions for bilateral developmental cataracts were greater than unilateral cataracts (irrespective of confounder), results were not statistically significant. Finally, proportions in unilateral developmental cataracts were significantly greater than unilateral congenital cataracts (Z = 7.413, P = 6.173694e-14). We conclude that surgical intervention within first 4-6 months can significantly affect postoperative outcomes in unilateral congenital cataracts. Analysis of existing data does not show a significant effect of intervention age on stereopsis outcomes for developmental cataracts.

Optimization of a stochastic model having erratic server with immediate or delayed repair.

The thought to put forward a queuing model proposed in this work was its pertinence in everyday life wherever we can see the uses of computing and networking systems. Industrial software developers and system managers can consider the results of the model to evolve their system for better results. Here we present a novel queueing model having erratic server with delayed repair and balking. Two distinct breakdowns i.e. active and passive breakdown for the system are also considered with their respective amendments. This model is closely related with the smooth functioning of the system during some internal faults (virus attack, electricity failures etc.). The performance indicators which are utilized in enhancing the service standards are obtained using supplementary variable technique. Using ANFIS soft computing technique we have compared the analytical results with those of neuro fuzzy results. Furthermore single and bi-objective minimization problems are considered and minima is obtained using particle swarm optimization and multi objective genetic algorithm respectively. Also, the minimization problems are shown as a convex programming problem to ensure the global optimality of the result. The proposed approach makes it conceivable to accomplish a relevant harmony between operational expenses and administration quality.

The great recession and job loss spillovers: impact of tradable employment shocks on supporting services.

This paper explores the spillover effects of job losses via input-output linkages during the Great Recession. Exploiting exogenous variation in tradable employment shocks across US counties, the paper finds that job losses in a county's tradable industries cause further job losses in the county's supporting services. A 10% exogenous decline in tradable employment reduces supporting industries' employment by 3.1%. In addition, a county's regional supporting services are relatively less affected by its tradable job losses than its local supporting services, reinforcing the argument that the spillovers are due to input-output linkages.

Myopia in India.

India is a culturally and geographically diverse nation. Its vast demographic nature does not allow a single definition for any of the given medical conditions in its territory. One important clinical condition which has created an uproar in the rest of the world is myopia. Its cause, prevalence, etiopathogenesis and other factors are being explored constantly; however, data with respect to Indian subcontinent are genuinely missing. Hence, in this review, we enumerate the country's myopia journey from last 4 decades. The epidemiology, genetics, ocular/systemic association, quality of life, imaging, and management in myopia with necessary future directives are discussed to augment the overall management in future.

Comparison of anatomical and functional outcomes of vitrectomy with internal limiting membrane peeling in recalcitrant diabetic macular edema with and without traction in Indian patients.

PURPOSE: To study and compare the outcomes of pars plana vitrectomy (PPV) with the internal limiting membrane (ILM) peeling in the eyes with recalcitrant diabetic macular edema (DME) with and without vitreomacular traction. METHODS: A comparative prospective interventional study was undertaken in which group 1 included 45 eyes of 45 patients with DME with vitreomacular tractional component and group 2 included 45 eyes of 45 patients with recalcitrant DME without a tractional component. Both groups underwent standard PPV with ILM peeling. All the patients were followed up for a minimum of 6 months. The parameters evaluated were changes in the best-corrected visual acuity (BCVA), central macular thickness (CMT), multifocal electroretinogram (mfERG) parameters, and occurrence of any intraoperative/postoperative surgical complication. RESULTS: The mean CMT improved significantly from 540.6 and 490.2 µm at the baseline to 292.5 and 270.6 µm at 6 months in groups 1 and 2, respectively (P < 0.001). The mean BCVA logMAR improved from 0.78 ± 0.21 to 0.62 ± 0.22 in group 1 and 0.84 ± 0.19 to 0.65 ± 0.21 in group 2 at 6 months follow-up which was not statistically significant. The improvement in the mfERG was seen in group 2 as a significant increase in P1 wave amplitude in ring 2 (2-5°) (P < 0.004) and a significant decrease in P 1 wave implicit time in ring 1 (central 2°) (P < 0.001). None of the eyes suffered from the loss of BCVA or any major surgical complication in either group. CONCLUSION: PPV in recalcitrant DME provides good anatomical outcomes and the results are comparable in DME with and without a tractional component.

All India Ophthalmological Society Financial Impact Survey on ophthalmology practice in India during COVID-19.

PURPOSE: A survey was conducted by the All India Ophthalmological Society (AIOS) to document the initial coronavirus disease 2019 (COVID-19)-related financial impact on ophthalmology practice in India. It also assessed various measures taken by ophthalmologists and the possible role of AIOS in mitigating the economic crisis. METHODS: An online questionnaire-based cross-sectional survey was conducted among its registered members from July to August 2020. The prevalidated questionnaire contained 25 items related to the impact of COVID-19 on patient volume, the extent of financial distress faced by the ophthalmologists, and various proactive measures taken by them. All valid responses were tabulated and analyzed. RESULTS: Out of 1,026 respondents, more than 90% ophthalmologists faced a 25% or more reduction in outpatient and surgical volume. Nearly 59% reported that they can suffer from serious financial distress in near future due to COVID-19 pandemic-related losses. Those who are young (P < 0.0005), salaried (P < 0.0005), and practicing in private sector (P < 0.0005) and Tier 1 cities (P < 0.0005) are reported to be more vulnerable to become financially unstable. The major concerns were revenue losses (70%), preexisting debts (39%), and increased operating costs (27%). The majority (90%) believed that AIOS can help in alleviating the distress. There was also hesitancy regarding the adoption of teleophthalmology and home-based care. CONCLUSION: COVID-19 has significantly affected the financial sustainability of ophthalmologists practicing in India. Identification of vulnerable groups and timely advocacy efforts by AIOS can help in mitigating this financial crisis.

Clinical Role of Smartphone Fundus Imaging in Diabetic Retinopathy and Other Neuro-retinal Diseases.

Purpose: In today's life, many electronic gadgets have the potential to become invaluable health care devices in future. The gadgets in this category include smartphones, smartwatches, and others. Till now, smartphone role has been highlighted on many occasions in different areas, and they continue to possess immense role in clinical documentation, clinical consultation, and digitalization of ocular care. In last one decade, many treatable conditions including diabetic retinopathy, glaucoma, and other pediatric retinal diseases are being imaged using smartphones.Methods: To comprehend this cumulative knowledge, a detailed medical literature search was conducted on PubMed/Medline, Scopus, and Web of Science till February 2021.Results: The included literature revealed a definitive progress in posterior segment imaging. From simple torch light with smartphone examination to present day compact handy devices with artificial intelligence integrated software's have changed the very perspectives of ocular imaging in ophthalmology. The consistently reproducible results, constantly improving imaging techniques, and most importantly their affordable costs have renegotiated their role as effective screening devices in ophthalmology. Moreover, the obtained field of view, ocular safety, and their key utility in non-ophthalmic specialties are also growing.Conclusions: To conclude, smartphone imaging can now be considered as a quick, cost-effective, and digitalized tool for posterior segment screenings, however, their definite role in routine ophthalmic clinics is yet to be established.

Vitrectomy without encircling band for rhegmatogenous retinal detachment with inferior break utilizing 3D heads up viewing system.

Purpose: This study aimed to determine the anatomical and functional outcomes of pars plana vitrectomy without encircling band for primary rhegmatogenous retinal detachments with inferior breaks utilizing 3D heads up viewing system. Method: This prospective, single-center study included 22 consecutive eyes with primary rhegmatogenous retinal detachments with only inferior breaks with proliferative vitreoretinopathy (PVR) CP2 or less, who underwent pars plana vitrectomy without encircling band, with silicon oil as tamponade. All surgeries were performed by a single surgeon. The single operation success rate was recorded after silicon oil removal. Results: The patient population consisted of 08 women (36%) and 14 men (64%) with a mean age of 56.6 +/- 14.7 years. The mean follow-up period was 8 months. A single break was present in 13 cases (59%), and 2-4 breaks were present in 9 cases (40.9%). The mean time for the surgical procedure was 35 min (range: 25-50). The macula was found to be detached in 19 cases (86.36%) and attached in 3 cases (13.6%). Single operation success rate (SOSR) of vitrectomy, after silicon oil removal without encircling band, for primary rhegmatogenous retinal detachment (RRD) with inferior breaks was 95.4%. One case redetached due to PVR changes and underwent re-surgery. Final reattachment was achieved in all 22 cases (100%). Mean best-corrected visual acuity (BCVA) significantly improved from 1.43 ± 0.59 logarithm of the minimum angle of resolution (logMAR) to postoperative BCVA was 0.48 ± 0.34 logMAR (P = 0.001). Conclusion: Pars plana vitrectomy without encircling band, utilizing 3D heads up the system in RRDs with inferior breaks in eyes with PVR grade C2 or less, provides good outcome.

Clinical role of swept source optical coherence tomography in anterior segment diseases: a review.

PURPOSE: To note the comprehensive role of swept source anterior segment optical coherence tomography (SS-ASOCT) in anterior segment diseases. METHODS: A systematic literature search was carried out on various medical databases using the keywords, swept source anterior segment optical coherence tomography; SS-ASOCT; Cornea and SS-ASOCT; SS-ASOCT and glaucoma; SS-ASOCT and cataract; SS-ASOCT and biometer; SS-ASOCT and tear film and ocular surface.Original works and novel reports describing the potential role of SS-ASOCT in various anterior segment conditions were included. RESULTS: After a thorough assessment of literature, it was clear that the SS-ASOCT did provide newer insights into many anterior eye conditions. The rapid scan acquisition, deeper tissue penetration, and higher magnification did enhance many of our understandings, which were previously not possible. In addition, lenticular assessment under complex clinical scenarios with automated values on objective scale has made it a worthy tool with immense future possibilities. CONCLUSIONS: SS-ASOCT unveiled various anterior segment findings which were of clinical importance.

Study 3: Assessment of events during surgery on posterior polar cataracts using intraoperative optical coherence tomography.

Purpose: To describe the changes along nucleo-epinuclear and the opacity-capsular junction during hydrodelineation and the entire period of phacoemulsification using intraoperative optical coherence tomography (iOCT). Methods: A total of 12 eyes of 12 patients with clinically confirmed posterior polar cataract, who underwent cataract surgery by a single surgeon under the direct guidance of iOCT. The changes along nucleo-epinuclear junction and opacity-capsular junction during/following hydrodelineation and the changes along the opacity-capsular junction following nucleus removal, capsular changes before the opacity removal, and its dynamic changes throughout the surgical procedure were studied. Results: The mean age of patients was 48.25 ± 7.89 years. Eight of them were males and the right eye was operated in seven patients. With regular hydrodelineation, optimal separation of the nucleus-epinuclear layer was evident in 11 patients. Once a golden ring is achieved through the hydro procedure, then repeated attempts can be performed within it to decrease the chances of capsular damage. Fracture of the posterior opacity with tension over the underlying capsule (n = 1), inadvertent hydro dissection while performing hydrodelineation (n = 1), continuous posterior capsular billowing (n = 2), and posterior capsular ruptures (n = 2) were encountered in this observation with even well-judged surgical maneuvering. Conclusion: iOCT provides a better understanding of real-time changes along different layers of the human lens during posterior polar cataract surgery. The observations obtained here are likely to help in minimizing inadvertent complications in the future.

Heads-up 3D viewing system in rhegmatogenous retinal detachment with proliferative vitreoretinopathy - A prospective randomized trial.

Purpose: To compare the outcomes of vitreoretinal surgery in patients with primary and recurrent rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) on 3 dimensional digitally assisted visualization system (3D-DAVS) and conventional analogue microscope (CAM). Methods: 68 patients with primary (50) and recurrent (18) RRD with PVR > C1 were included. One group underwent surgery on 3D-DAVS while the other on CAM. The parameters studied included detachment rate, best-corrected visual acuity (BCVA), duration of surgery, mean endo-illumination levels of 23 G (Gauge) micro incision vitrectomy system (MIVS) and microscope and satisfaction of surgeon and observers based on a framed questionnaire. The mean duration of follow up was three months. Results: 68 eyes of 68 patients with median age 52.5 (range 18-68) years were included. 50 had primary RRD and 18 had recurrent RRD. Detachment rate at the end of three months was comparable in both groups of primary (P > 0.99) and recurrent (P = 0.21) RRD. Mean duration of surgery in minutes for 3D DAVS and CAM group was 61.8 (±22.07) and 58.04 (±12.33), respectively, in primary RRD and 37.22 (±10.27) and 36.55 (±5.92), respectively, in recurrent RRD group. Mean endo-illumination in 3D DAVS (14.5%) group was half of that in CAM (34.17%) group. Surgeon and observer satisfaction scores were significantly higher for 3D DAVS group. Conclusion: 3D DAVS is a safe and effective modality or performing VR surgery in RRD with PVR. 3D DAVS allows lower endo-illumination levels provides superior surgeon ergonomics and offers better learning opportunities to the trainees.