Combined topography-guided photorefractive keratectomy and corneal collagen crosslinking.

PURPOSE: This study aimed to report the long-term results of combined topography-guided photorefractive keratectomy (PRK) and accelerated corneal collagen cross-linking (CXL) for keratoconus using the Zeiss refractive coordinated system. METHODS: A prospective interventional study was conducted in a tertiary eye care hospital in South India. Patients with mild-to-moderate progressive keratoconus and corneal pachymetry greater than 450 µm were included. They underwent customized topography-guided PRK followed by CXL. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and keratometry readings and complications were evaluated at 1, 3, 6, 12, and 24 months postoperatively. RESULTS: Thirty patients (30 eyes) were included in the study. All study parameters showed a statistically significant improvement postoperatively over baseline values. At 24 months, the mean UDVA improved from 0.8 ± 0.180 logarithm of the minimum angle of resolution (logMAR) to 0.38 ± 0.118 logMAR ( P -value <0.001) and CDVA improved from 0.467 ± 0.142 logMAR to 0.227 ± 0.078 logMAR ( P -value <0.001). The mean flat, steep, and maximum keratometry values were significantly reduced by 2.133, 3, and 4.54 diopters, respectively, at the last follow-up examination ( P -value <0.001). CONCLUSION: The combined topography-guided PRK and accelerated CXL procedure seem to be a promising treatment alternative for early keratoconus. This is the first such study on the Zeiss refractive coordinated system. However, further studies with a larger study population and longer follow-up periods are required to draw final conclusions about the benefits of this procedure in keratoconus.

Outcomes of accelerated collagen cross linking in progressive paediatric keratoconus.

Purpose: To determine the efficacy and safety of pediatric accelerated cross linking (CXL). Methods: A prospective study on progressive keratoconus (KC) cases under ≤18 years of age. Sixty four eyes of thirty nine cases underwent epithelium-off accelerated CXL protocol. Visual acuity (VA), slit-lamp examination, refraction, pentacam reading of keratometry (K), corneal thickness, and thinnest location pachymetry were noted. Cases were followed up on days 1, 5, and at 1st, 3rd, 6th, and 12th-month post procedure. Results: Statistically, significant improvement of the mean aided VA, K, and mean corneal astigmatism (p < 0.0001) was noted. Mean Kmax reading reduced from 55.5 ± 5.64 (47.4-70.4) diopter (D) preoperatively to 54.41 ± 5.51 (46-68.3) D at 12 months postaccelerated CXL. Two cases had progression. Complications encountered were sterile infiltrate and persistent haze. Conclusion: Accelerated CXL is effective and efficacious in pediatric KC.

To compare central corneal thickness measurements obtained by Pentacam with those obtained by IOLMaster 700, Cirrus anterior segment optical coherence tomography and Tomey specular microscopy in normal healthy eyes.

Purpose: To compare central corneal thickness measurements obtained by Pentacam with those obtained by IOL Master 700, Cirrus Anterior segment optical coherence tomography and Tomey Specular microscopy in normal healthy eyes. Methods: Two hundred and six eyes of healthy subjects were included in the study. Each subject was assessed by four different methods of measuring central corneal thickness using Pentacam, IOL Master 700, Cirrus AS-OCT and Tomey Specular microscopy by a single examiner. Results: The mean CCT [± standard deviation (SD)] for Pentacam, IOL Master 700, Cirrus AS-OCT and Tomey Specular microscopy were Pentacam (Oculus), AS-OCT (Cirrus), IOL Master 700 and Specular microscopy (Tomey) were 523.75 (±27.75), 525.29 (±28.81),517.13 (±28.43) and 512.82 (±27.60) µm, respectively. All the means were significantly different from one another (P < 0.000). The differences between pairs of mean central corneal thickness (CCT) for Pentacam and IOL Master, Pentacam and anterior segment- optical coherence tomography (AS-OCT), and Pentacam and Specular microscopy are statistically significant. Bland-Altman plots showed that pentacam and IOL Master 700 have the closest agreement, followed by AS-OCT. Specular microscopy was found to have the poorest agreement with Pentacam. Conclusion: We found that CCT measurements of Pentacam did not correlate with measurements of IOL Master, or AS-OCT or Specular microscopy. In clinical practice, the devices analyzed should not be used interchangeably due to low agreement regarding CCT values.

Pre-Operative SARS CoV-2 Rapid Antigen Test and Reverse Transcription Polymerase Chain Reaction: A conundrum in surgical decision making.

PURPOSE: Since the eye is in close proximity to the oro-nasal cavity, transmission of SARS CoV-2 is higher during ophthalmic surgical procedures, it is vital to ensure the safety of the healthcare team by pre-operative Rapid Antigen Test (RAT) and real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for SARS CoV-2 viral RNA of all patients planned for elective or emergency surgery. Hence, understanding the profile of pre-operative RAT and real-time RT-PCR among patients planned for various ophthalmic procedures, will help us make better decisions for future guidelines, for optimal planning of ophthalmic elective or emergency surgeries, keeping in mind the current scenario. METHODS: This is a prospective descriptive study conducted on patients planned for elective or emergency ophthalmic surgeries, who had no COVID-19-related symptoms pre-operatively and were subjected to preoperative RAT and real-time RT-PCR of nasopharyngeal and throat swabs for SARS CoV-2 viral RNA. Data was compiled and statistically analysed. RESULTS: 204 patients underwent pre-operative RAT and RT-PCR testing; of which, 85 were females and 119 were males. Mean age of the study population was 51.44 ± 16.501 years. Among the 204, 2 tested positive for SARS CoV-2 with Rapid Antigen testing as well as RT-PCR and 10 patients tested positive via RT-PCR after a negative RAT result of the same sample. CONCLUSION: Pre-operative testing for COVID-19 disease is indispensable as there is a high chance of transmission from patient to healthcare workers. RAT has the advantage of quick results and may play a role in case of emergency procedures. However, it is prudent to perform the more sensitive real-time RT-PCR before any elective, non-emergency procedures or surgeries to avoid any undue risk to the healthcare team.

Fungal and Bacterial Endophytes as Microbial Control Agents for Plant-Parasitic Nematodes.

Endophytes are symbiotic microorganisms that colonize plant tissues and benefit plants in multiple ways including induced systemic resistance to biotic and abiotic stresses. Endophytes can be sustainable alternatives to chemical nematicides and enhance plant health in a variety of cropping and natural environments. Several in vitro and in vivo studies demonstrated the potential of multiple species of Fusarium and Bacillus against plant-parasitic nematodes in horticultural, agricultural, and fodder crops and in forestry. While there were efforts to commercialize some of the endophytes as bionematicides, a lack of good formulations with consistent field efficacy has been a major hurdle in commercializing endophytes for nematode control. Identification of efficacious and environmentally resilient strains, a thorough understanding of their modes of action, interactions with various biotic and abiotic factors, and developing strategies that improve their effectiveness are critical areas to advance the commercialization of bionematicides based on fungal and bacterial endophytes.

Ophthalmic manifestations in the COVID-19 clinical spectrum.

PURPOSE: The aim of this study was to determine the frequency and various types of ophthalmic manifestation of patients with COVID-19. METHODS: This is a prospective observational study conducted on patients with SARS-Co-V-2 infection, at a dedicated tertiary COVID-19 hospital in South India from April 1 to July 31, 2020. At the time of their admission to the COVID hospital, demographic data such as name, age, sex was recorded. A thorough history regarding the onset, duration, progression, nature of symptoms and its associated factors, medication history, treatment history were elicited and documented. Ocular examination was performed under torchlight by an ophthalmologist posted for COVID duty. Further investigations including imaging were sought for, depending on clinical indications. Serial follow-up examinations of all patients were carried out every 72 hours or when patients complained of any ocular symptoms whichever earlier, until discharge. All relevant data were compiled and statistically analyzed. RESULTS: A total of 2742 patients were examined. Of them, 1461 (53.28%) were males and 1281 (46.72%) were females. The mean age (±SD) was 39.46 ± 17.63 years. None of the patients in our study had any ocular symptoms or signs as the presenting complaint at the time of their admission. On subsequent follow-up, only 20 (0.72%) developed ocular manifestations, of which 19 (95%) had features suggestive of Bilateral viral conjunctivitis. However, 1 (5%) patient had orbital cellulitis secondary to pansinusitis. CONCLUSION: Ophthalmic manifestations in the clinical spectrum of COVID-19 infection are uncommon and unlikely to be the presenting clinical impression. However, it has broadened our view to a wider spectrum of COVID-19 presentations enhancing our clinical acumen for staunch detection of COVID-19 suspects in our daily practice, augmenting early diagnosis and management and also break the chain of transmission for the greater good of humanity.

Accidental displacement of primary anterior teeth following extraction of neonatal teeth.

Eruption of the first tooth at 6 months of age is a significant stage in a child's life. However, the presence of a tooth in the oral cavity of a newborn can lead to a lot of delusions. Natal and neonatal teeth are of utmost importance not only to a dentist but also for a pediatrician due to parental anxiety, folklore superstitions, and numerous complications associated with it. The present case report describes a 1.5 cm × 1.5 cm, slow-growing, soft-tissue gingival mass which developed following the extraction of a tooth-like structure in a 4-month-old male patient. Histological examination revealed that it contained a tooth-like hard tissue intermingled with bone and fibrous tissue. Based on clinical and histological findings, the present case was diagnosed as gingival hyperplasia with displaced tooth buds of 71 and 81, which might be due to chronic irritation or traumatic extraction of the neonatal teeth. No abnormal recurrence of the lesion was detected during the follow-up period. However, postoperative clinical and radiographic photographs further reconfirmed the absence of tooth in relation to 71 and 81.

A Survey among Teachers of Psychiatry to Improve the Quality of Undergraduate Training: Outcomes from Karnataka.

BACKGROUND: In India, there is a large gap between the mental health morbidity in society and the availability of psychiatrists. However, the latest Indian undergraduate medical curriculum does not require any competency in psychiatry to be fulfilled for certification of medical graduates as doctors. Thus, the role of Indian psychiatry teachers is quite challenging. Interestingly, there has been hardly any effort to understand the felt needs of psychiatry teachers that may further improve the quality of undergraduate training. METHODS: We used a survey questionnaire that was both qualitative and quantitative, with questions on topics such as years of psychiatry training and experience as a psychiatry teacher. Do they feel the need for training in undergraduate psychiatry teaching? Do they require training in teaching psychiatry theory or clinics or both? What are the specific areas where they want training? What more should be planned for psychiatry teachers? Based on an online survey further steps in the direction of psychiatry teachers felt needs were initiated. RESULTS: Around 55 responses with a response rate of 37% were received. More than 50% were working in medical colleges for the last 5 years. About 80% felt the need for further training to teach medical students while 97% felt that additional training is required for handling theory as well as bedside clinic. More than 60% were keen to attend a 1-day workshop to upgrade their teaching skills. A majority wanted to have a forum to share their experiences and to learn from others. Based on the felt needs of psychiatry teachers from the survey, a 1-day workshop was carried out and a forum for psychiatry teachers was inaugurated. CONCLUSION: Training of psychiatry teachers is an important felt need for the challenges that are unique to Indian medical education. The outcome from the Karnataka survey is a progressive step in addressing this challenge.

Cephalometric Evaluation of Natural Head Position in Lingayat Population of Karnataka.

AIMS AND OBJECTIVES: To ascertain norms in cephalometry for 11- to 13-year-old Lingayat children in natural head position (NHP). MATERIALS AND METHODS: Lateral cephalograms of children were obtained by using fluid level device. We determined the variance in Frankfort horizontal plane (FHP) inclination to extracranial horizontal in NHP. The G*Power, version 20 for Windows was used for analysis. RESULTS: Reduced facial convexity was observed when the analysis was carried out in relation to true horizontal with significant difference of "t" value of 3.05 and percentage difference of 1.1 (P < 0.01) and for girls "t" value of 9.69 and percentage difference of 2.5 (P < 0.001). The highest correlation coefficient for Lingayat boys (r = 0.77) was seen between palatal plane and occlusal plane. We found least correlation coefficient among FHP and Sella-nasion plane (SNP). The coefficient was r = 0.62 and correlation coefficient of r = 0.70 was between FHP and determination coefficient r 2 = 0.38 or 38%. For girls, highest correlation coefficient of r = 0.70 was seen among FHP and palatal plane. CONCLUSION: Conventional study of craniofacial forms of Lingayat children showed the average skeletal pattern as Class II with retrognathic mandible in comparison to Caucasians. However, when seen in NHP by new method of analysis based on the true horizontal, the skeletal model was Class III in comparison to Caucasians.

Microbial biopesticides for insect pest management in India: Current status and future prospects.

The biopesticide industry in India is undergoing rapid change, reflecting increased global trade in agricultural commodities, a changing regulatory environment and evolving consumer preferences. Currently biopesticides comprise ≈ 5% of the Indian pesticide market, with at least 15 microbial species and 970 microbial formulations registered through the Central Insecticides Board and Registration Committee (CIBRC). As of 2017, over 200 products based on entomopathogenic fungi (Beauveria bassiana, B. brongniartii, Metarhizium anisopliae s.l., Lecanicillium lecanii and Hirsutella thompsonii) and nematicidal fungi (Purpureocillium lilacinum and Pochonia chlamydosporia) are registered for use against various arthropods and plant parasitic nematodes. Regarding bacteria, over 30 products based on Bacillus thuringiensis (Bt) subsp. kurstaki are registered against bollworms, loopers and other lepidopterans, while 12 based on Bt subsp. israelensis and three with Bt subsp. sphaericus have been used against mosquitoes. Two viruses are registered, namely Helicoverpa armigera nucleopolyhedrovirus (22 products) and Spodoptera litura nucleopolyhedrovirus (5 products) for use against bollworms and armyworms. Four entomopathogenic nematode species are sold in Indian market. These include long-lasting wettable powder formulations of Heterorhabditis indica developed by the ICAR-National Bureau of Agricultural Insect Resources, Bengaluru which have been distributed on a large scale to control white grubs and other sugarcane pests. Biopesticide research on the subcontinent is at a relatively early stage, but evolving rapidly, and focusing on indigenous entomopathogens. Despite onerous regulation, quality-control issues and limited large-scale production facilities, investment in domestic fermentation technologies, improved delivery systems, and promotion of biological control through private and public initiative will increase the share of microbial biopesticides in the country.

Histological evaluation of mineral trioxide aggregate and enamel matrix derivative combination in direct pulp capping: An in vivo study.

AIM: The aim of this study is to evaluate the response of human pulp tissue to mineral trioxide aggregate (MTA), Emdogain (EMD), and combination of MTA/EMD. MATERIALS AND METHODS: This study was performed on sixty intact first and second premolars of human maxillary and mandibular teeth. A standard pulpal exposure was done on all the teeth and was divided into three groups of twenty teeth each and was capped with MTA, EMD, and MTA/EMD combination. The final restoration was done with resin-modified glass ionomer cement. The teeth were then extracted on the 15th or 45th day and histological evaluation done. RESULTS: Differences in inflammatory response and thickness of dentin bridge formation of the exposed pulp to the three different groups were statistically evaluated using Chi-square and Mann-Whitney tests and were found to be significant. No significant difference was found between MTA/EMD and MTA in terms of calcified bridge formation and pulp inflammatory response to the capping materials. CONCLUSIONS: MTA and MTA/EMD combination produced a better quality hard tissue response compared with the use of EMD.

A comparative study of different modalities of treatment in nicotine dependence syndrome.

UNLABELLED: There are different modalities for management of Nicotine dependence, but it is still inconclusive which is the best modality for the treatment of Nicotine dependence syndrome (NDS). In this background the present study was carried out to assess the efficacy and to compare different modalities for the treatment of NDS. METHODS: Patients diagnosed as NDS as per ICD-10 were taken up for study. These patients were administered proforma to elicit sociodemographic details, Fagerstrom test for Nicotine Dependence, Questionnaire of Smoking Urges-Brief and breath analysis was done using carbon monoxide meter. Assessment was done at base line and at weekly follow-ups for 12 weeks. Patients were divided into six groups randomly. Group A received BUP at a dose of 150mg/day for 3 days; subsequently increased to 300mg/day, Group B: for initial 6 weeks Nicotine gum of 4mg every 1-2 hourly was used and next 6 weeks every 2-4 hourly was used, Group C: BI, Group D: BI+BUP, Group E: BI+NRT, Group F received BUP+NRT+BI. RESULTS: The quit rates at end of the study were BUP-30%, NRT-26.66%, BI-23.33%, BI+BUP-43.33%, BI+NRT-33.33%, and BI+BUP+NRT-50%. BI+BUP+NRT had 2-3 times more quit rates than the individual modality treatment group. CONCLUSION: There was no statistically significant difference between the study groups, but there was clinical difference in quit rates. Among the groups BI+BUP+NRT had higher quit rates compared to other groups. Combination modalities yield better quit rates than individual modalities.

Comparative Evaluation of Friction Resistance of Titanium, Stainless Steel, Ceramic and Ceramic with Metal Insert Brackets with Varying Dimensions of Stainless Steel Wire: An In vitro Multi-center Study.

BACKGROUND: The orthodontist seeks an archwire-bracket combination that has both good biocompatibility and low friction. Hence, the aim of this multicenter in vitro study was to evaluate and compare the frictional resistance generated between titanium (Ti), stainless steel (SS), ceramic and ceramic with metal insert (CMI) brackets with SS wires of varying dimensions in a specially designed apparatus. MATERIALS AND METHODS: The material used in this study were Ti, SS, Ceramic and CMI with 0.018″ slot manufactured with zero degree tip and -7° torque premolar brackets (3M, Unitek) and SS wires of varying dimensions (0.016″ round, 0.016 × 0.016″ square, 0.016 × 0.022″ rectangular and 0.017 × 0.025″ rectangular) used. The frictional resistance was measured using Instron Universal testing machine (Model no. 4301). The specimen population in each center composed each of 160 brackets and wires. Differences among the all bracket/wire combinations were tested using (one-way) ANOVA, followed by the student Newman Keuls multiple comparisons of means ranking (at P < 0.05) for the determination of differences among the groups. RESULTS: Ti bracket in combination with 0.017 × 0.025″ SS rectangular wire produced significant force levels for an optimum orthodontic movement with least frictional resistance. CONCLUSION: Ti brackets have least resistance and rectangular wires produced significant force. These can be used to avoid hazards of Nickel. SS brackets revealed higher static frictional force values as the wire dimension increased and showed lower static friction than Ti brackets for all wires except the thicker wire. Our study recommends the preclusion of brackets with rough surface texture (Ti brackets) with SS ligature wire for ligating bracket and archwire are better to reduce friction.

A study on oral mucosal lesions in 3500 patients with dermatological diseases in South India.

BACKGROUND: Oral mucosal lesions that are observed in the dermatological diseases are categorized under mucocutaneous conditions. The oral lesions in dermatological diseases may be the early aspects of the disease manifestation or the most significant clinical appearance or the only sign/and or symptom of such dermatological diseases and occasionally lesions occur simultaneously in the skin as well as mucous membrane. AIM: This present study attempts to find out the prevalence of oral mucosal lesions in patients with dermatological diseases. SUBJECTS AND METHODS: The study includes 3500 patients who attended out-patient Department of Dermatology. Patients with oral manifestation were subjected for clinical examination in the Department of Oral Pathology. Diagnostic procedures were performed to confirm the clinical oral diagnosis. The results of the study were analyzed by SPSS software version 19.0 (Armonk, NY) and presented as descriptive statistics. Correlation of oral manifestions with their respective dermatological disease was statistically analysed by Pearson's correlation test.(P < 0.05 were considered as statistically significant). RESULTS: The prevalence rate of oral mucosal lesions in the present study was 1.8% (65/3500). The most frequent lesions observed were psoriasis 32.3% (21/65), lichen planus 18.4% (12/65), Stevens Johnson Syndrome 18.4% (12/65), pemphigus 10.7% (7/65), toxic epidermal necrolysis 4.6% (3/65), systemic lupus erythematosus 3% (2/65), discoid lupus erythematosus 1.5% (1/65), pemphigoid 1.5% (1/65). Gender distribution in the study population was statistically significant (P < 0.001). Employed and unemployed individuals in the study population were statistically significant (P < 0.001). Pearson's correlation analysis of oral manifestations with their respective dermatological disease showed r = 0.466 and signifies a positive correlation and is statistically significant at the 0.01 level (two-tailed). CONCLUSION: The prevalence rate of oral mucosal lesions in patients with dermatological diseases was relatively low. However, predominant oral mucosal lesions observed in the study were autoimmune in origin with a high morbidity and mortality index. Hence, multidisciplinary approach will definitely help in the prognosis of patients.

Comparison of Opal self-ligating brackets with manually ligating brackets.

This study was conducted with aim to evaluate the efficiency of the newly introduced Opal self-ligating brackets (SLB). The chairside time saved, appliance efficiency, bracket bond failures, breakages and bracket staining in the Opal SLBs were compared with the conventional standard metal manually ligating brackets (MLBs) of MBT system. Seven patients were compared in each group. Standard light curing bonding methods were used in both the group. Chairside time saving, appliance efficiency and bracket bond failures were compared among the groups whereas staining was observed with the SLBs. Appliance efficiency was evaluated by PAR scores. Results showed significant chairside time being saved in SLBs, whereas the appliance efficiency was not significant. Bond failures were found only in SLBs as well as breakages along with staining. Henceforth, we could conclude that though SLBs had advantage of saving chairside time but also had disadvantage of losing more time with bond failures.

Mural unicystic ameloblastoma crossing the midline: a rare case report / Ameloblastoma uniquístico mural traspasando la línea mediana: reporte de un caso infrecuente

Ameloblastoma is a benign odontogenic neoplasm which frequently affects the mandible. The term ameloblastoma includes several clinico-radiological and histological types. Apart from the most commonly encountered clinico- pathologic models there are few variants, whose biological profile is unknown or not elicited. The reason for lack of understanding is the scarcity of case report published in the literature. Among the types, unicystic ameloblastoma is the least encountered either it presents as unilocular or multilocular radiolucency, but peculiar radiographic presentation of multilocular radiolucency in posterior mandible with unilocular radiographic appearance crossing the midline is extremely rare, which has not been reported yet. Here we report a distinctive case of mural unicystic ameloblastoma of mandible in a 17-year- old- girl with the radiographic presentation as mentioned above.

El ameloblastoma es un tumor odontogénico benigno que frecuentemente afecta a la mandíbula. El término ameloblastoma incluye varias características clínico-radiológicas y tipos histológicos. Aparte de los modelos clínicopatológicos que se encuentran con frecuencia existen algunas variantes, cuyo perfil biológico es desconocido o aún no elucidado. La razón de la falta de comprensión es la escasez de informes de casos publicados en la literatura. Entre los tipos, el ameloblastoma uniquístico es el menos frecuente y puede presentarse como una radiolucidez unilocular o multilocular, pero la peculiar presentación radiográfica de radiolucidez multilocular en el posterior de la mandíbula con aspecto radiográfico unilocular que cruza la línea mediana es extremadamente rara, y aún no se ha reportado. Se presenta un caso de ameloblastoma uniquístico mural de la mandíbula en una paciente de 17 años con la presentación radiográfica anteriormente descrita.

Unusual presentation of Kimura's disease involving the parotid gland in an Indian male: a case report and review of literature.

Kimura's disease (KD) is a rare chronic inflammatory disorder that involves the subcutaneous tissues and occurs predominantly in the head and neck region, frequently associated with regional lymphadenopathy or salivary gland involvement. Although, not an uncommon condition in the Asian countries, it is quite rare among the occidental civilization and in the western countries is more commonly diagnosed among Asian migrants. Kimura's disease is sometimes confused with angiolymphoid hyperplasia with eosinophilia, which occurs in the superficial skin of the head and neck region. The classical features of angiolymphoid hyperplasia with eosinophilia are characterized by a triad of painless subcutaneous masses in the head and neck region, blood and tissue eosinophilia, and markedly elevated immunoglobulin E (IgE) levels. Here, we report a case of a 33-year-old Indian male with KD who presented with unilateral nodular swelling in the right parotid region. The diagnosis was based on characteristic histopathologic findings in conjunction with peripheral eosinophilia and elevated serum IgE levels.