Environmental-, social-, and governance-related factors for business investment and sustainability: a scientometric review of global trends.

Consideration of environmental, social, and governance (ESG) factors can contribute to the environmental and economic performance of organizations in terms of investment and sustainability. This article thoroughly reviews the following factors influencing decisions regarding ESG policy by businesses: economic performance, environmental sustainability, pollution and waste, corporate social responsibility, gender, and governance structure. Moreover, we review the impact of these factors considering ESG disclosure, the global pandemic, religion, governing board and size, national interest, and technological advancements. The literature reports that ESG disclosures of environmental, economic, and social sustainability performance can strengthen business sustainability and performance. Religion-based businesses demonstrated better socio-environmental performance but not governance. An independent governing board has a positive impact; however, dual-gender boards negatively impact ESG disclosure. Significant diversification potential in ESG investments was observed during the COVID-19 pandemic. Adopting an ESG policy enhances the innovation capacity, innovative activities, value creation, and financial performance of businesses. Overall, the social and environmental performance demonstrated a significantly positive relationship with business sustainability, indicating that business economy and creating value for society are mutually dependent. The literature summary presented in this review will help future research on ESG factors that influence business investments and sustainability.

An Early Warning System for Earthquake Prediction from Seismic Data Using Batch Normalized Graph Convolutional Neural Network with Attention Mechanism (BNGCNNATT).

Earthquakes threaten people, homes, and infrastructure. Early warning systems provide prior warning of oncoming significant shaking to decrease seismic risk by providing location, magnitude, and depth information of the event. Their usefulness depends on how soon a strong shake begins after the warning. In this article, the authors implement a deep learning model for predicting earthquakes. This model is based on a graph convolutional neural network with batch normalization and attention mechanism techniques that can successfully predict the depth and magnitude of an earthquake event at any number of seismic stations in any number of locations. After preprocessing the waveform data, CNN extracts the feature map. Attention mechanism is used to focus on important features. The batch normalization technique takes place in batches for stable and faster training of the model by adding an extra layer. GNN with extracted features and event location information predicts the event information accurately. We test the proposed model on two datasets from Japan and Alaska, which have different seismic dynamics. The proposed model achieves 2.8 and 4.0 RMSE values in Alaska and Japan for magnitude prediction, and 2.87 and 2.66 RMSE values for depth prediction. Low RMSE values show that the proposed model significantly outperforms the three baseline models on both datasets to provide an accurate estimation of the depth and magnitude of small, medium, and large-magnitude events.

Predictive modeling of pharmaceutical product removal by a managed aquifer recharge system: Comparison and optimization of models using ensemble learners.

Pharmaceutical products (PPs) are emerging water pollutants with adverse environmental and health-related impacts, owing to their toxic, persistent, and undetectable microscopic nature. Globally, increasing scientific knowledge and advanced technologies have allowed researchers to study PP-associated problems and their removal for water reuse. Experimental modeling methods require laborious, lengthy, expensive, and environmentally hazardous lab-work to optimize the process. On the other hand, predictive machine learning (ML) models can trace the complex input-output relationship of a process using available datasets. In this study, ensemble ML techniques, including decision tree (DT), random forest (RF), and Xtreme gradient boost (XGB), were used to explore PP (diclofenac, iopromide, propranolol, and trimethoprim) removal by a managed aquifer recharge (MAR) system. The model input parameters included characteristics of reclaimed water and soil used in the columns, pH, dissolved organic carbon, operating time, nitrogen dioxide, sulfate, nitrate, electrical conductivity, manganese, and iron. The selected PP removal was the model output. Datasets were collected through a one-year experimental study of continuous MAR system operation to predict the removal of PPs. DT, RF, and XGB models were then developed for one of the selected compounds and tested for the others to check the reliability of the ML model results. The developed models were assessed using statistical performance matrices. The experimental results showed >80% removal of propranolol and trimethoprim; however, removal of diclofenac and iopromide was only ≈50% by the MAR system. The proposed DT and RF models presented higher coefficients of determination (R2 ≥ 0.92) for diclofenac, propranolol, and trimethoprim than for iopromide (R2 ≤ 0.63). In contrast, the XGB model showed better results for diclofenac, iopromide, propranolol, and trimethoprim, with R2 values of 0.92, 0.72, 0.96, and 0.97, respectively. Therefore, XGB could be the best predictive model to provide insight into the adaptation of ML models to predict PP removal by the MAR system, thereby minimizing experimental work.

Trend analysis of temperature data using innovative polygon trend analysis and modeling by gene expression programming.

Presenting temperature data using recently introduced innovative polygon trend analysis (IPTA) can improve our understanding of the effects of climate change. This method was applied to analyze temperature trends at six stations in Turkey: Istanbul (17,064), Ankara (17,131), Bursa (17,116), Iznik (17,661), Gemilik (17,663), and Sakarya (17,069). At station 17,064, there was an increasing trend in temperature data for seven months, while only one month showed a decreasing trend, and the remainder presented no trend. For station 17,131, there was a decreasing trend for two months, an increasing trend for five months, and no trend for the remaining months. At station 17,116, an increasing trend was present for nine months, with a decreasing trend for two months and only one month indicating no trend. An increasing trend over seven months was noted at station 17,661, while two and three months showed a decreasing and no trend, respectively. For station 17,663, there was an increasing trend for nine months, one month showed no trend, and two months presented a decreasing trend. At station 17,069, five, four, and three months showed increasing, decreasing, and no trends, respectively. The gene expression programming (GEP) model was tested to predict the short-term monthly average temperature for this dataset. The proposed GEP model presented good prediction results for all selected stations by tracing the relationship with a coefficient of determination (R-Sq) ≥ 0.90. Trend analysis by IPTA can help understand temperature trends better, aiding future decision-making, and the GEP model can effectively predict short-term values.

Crystalglobulinemia causing cutaneous vasculopathy and acute nephropathy in a kidney transplant patient.

We present a rare case of crystalglobulinemia causing cutaneous vasculopathy and acute nephropathy in a 66-year-old female kidney transplant recipient. The patient presented with acute kidney injury (AKI), volume overload, anuria, retiform purpura, and blue-black necrosis of her toes. She received a living kidney transplant 7 months earlier with baseline creatinine of 0.6 mg/dl. Transplant kidney biopsy showed massive pseudo-thrombi filling glomerular capillary lumina. Electron microscopy of thrombi revealed an ultrastructural crystalline pattern of linear and curvilinear bundles with ladder-like periodicity typical of crystalglobulin-induced nephropathy. Similar crystalline pseudo-thrombi were detected ultrastructurally in a skin biopsy specimen, indicating systemic involvement. She required several sessions of hemodialysis. Plasmapheresis was initiated to decrease the number of circulating crystalglobulins. In order to treat the underlying paraproteinemia, the patient was started on bortezomib and dexamethasone. After treatment with five cycles of bortezomib, the patient's free kappa to lambda ratio improved to 2.35 from 5.52. Acute kidney injury (AKI) and the cutaneous vasculopathy gradually improved with treatment. This is an extremely rare occurrence of crystalglobulin in a living kidney transplant recipient.

Clinical characterization of NTCP deficiency in paediatric patients : A case-control study based on SLC10A1 genotyping analysis.

Na+ -taurocholate cotransporting polypeptide deficiency (NTCPD) is a newly described disorder arising from biallelic mutations of the SLC10A1 gene. As a result of a lack of compelling evidence from case-control studies, its genotypic and phenotypic features remain open for in-depth investigation. This study aimed to explore the genotypic and clinical phenotypic characteristics of paediatric patients with NTCPD. The SLC10A1 genotypes of all NTCPD patients were confirmed by screening for the prevalent variant c.800C>T and Sanger sequencing when necessary. The clinical presentations and laboratory changes were collected, reviewed and analysed, and then qualitatively and quantitatively compared with the relevant controls. A total of 113 paediatric NTCPD patients were diagnosed while c.374dupG and c.682_683delCT were detected as two novel pathogenic mutations. Hypercholanemia was observed in 99.12% of the patients. Indirect hyperbilirubinemia in affected neonates exhibited higher positive rates in comparison to controls. Moreover, transient cholestatic jaundice, elevated liver enzymes and 25-hydroxyvitamin D (Vit D) deficiency during early infancy were more commonly observed in patients than in controls. All NTCPD patients exhibited favourable clinical outcomes as a result of symptomatic and supportive treatment. The findings enriched the SLC10A1 mutation spectrum and provided comprehensive insights into the phenotypic characteristics of NTCPD. NTCPD should be considered and SLC10A1 gene should be analysed in patients with above age-dependent clinical features. Furthermore, over investigation and intervention should be avoided in the management of NTCPD patients.

Synthesis, biological activity and docking calculations of bis-naphthoquinone derivatives from Lawsone.

Some metabolic enzyme inhibitors can be used as Multi-target-Directed-Ligands (MTDL) in Medicinal chemistry therefore, synthesis and determination of alternative inhibitors are essential. In this study, novel bis-napthoquinone derivatives (5a-o) were synthesized through a multi-component cascade reaction of two molecules of 2-hydroxy-1,4-naphthoquinone with an aromatic aldehyde in basic media using triethylamine as a catalyst. This novel heterocyclic derivatives (5a-o) are applied to inhibit the carbonic anhydrase (hCA I and hCA II) isoform in low levels of nano molecules with Ki values exist between 4.62 ± 1.01 to 70.45 ± 9.03 nM for hCA I and for hCA II which is physiologically dominant Kis values are in the range of 5.61 ± 1.04 to 73.26 ± 10.25 nM. Further these novel derivatives (5a-o) efficiently inhibit AChE with Ki values in the range of 0.13 ± 0.02 to 3.16 ± 0.56 nM. The compounds are also applied for BChE with Ki values varying between 0.50 ± 0.10 to 9.23 ± 1.15 nM. For α-glycosidase, the most efficient Ki values of 5e and 5f are 76.14 ± 9.60 and 95.27 ± 12.55 nM respectively. Finally, molecular docking calculations against enzymes (acetylcholinesterase, butyrylcholinesterase, and the human carbonic anhydrase I and II) are compared using biological activities of heterocyclic derivatives. After these calculations, an ADME/T analysis is performed to study the future medicinal use of heterocyclic derivatives from lawsone.

Correction to: Survey: smartphone-based assessment of cardiovascular diseases using ECG and PPG analysis.

An amendment to this paper has been published and can be accessed via the original article.

Survey: smartphone-based assessment of cardiovascular diseases using ECG and PPG analysis.

A number of resources, every year, being spent to tackle early detection of cardiac abnormalities which is one of the leading causes of deaths all over the Globe. The challenges for healthcare systems includes early detection, portability and mobility of patients. This paper presents a categorical review of smartphone-based systems that can detect cardiac abnormalities by the analysis of Electrocardiogram (ECG) and Photoplethysmography (PPG) and the limitation and challenges of these system. The ECG based systems can monitor, record and forward signals for analysis and an alarm can be triggered in case of abnormality, however the limitation of smart phone's processing capabilities, lack of storage and speed of network are major challenges. The systems based on PPG signals are non-invasive and provides mobility and portability. This study aims to critically review the existing systems, their limitation, challenges and possible improvements to serve as a reference for researchers and developers.

Late pancreatic panniculitis in a simultaneous pancreas kidney transplant patient with failed allografts.

We present a rare case of pancreatic panniculitis in a 59-year-old male simultaneous pancreas-kidney (SPK) recipient with failed allografts. The patient presented with fever and painful erythematous nodules on his leg 1 month after stopping all immunosuppression. A thorough infectious and rheumatological workup was negative. He had pancreas rejection 4 years after SKP transplant and was restarted on dialysis after 14 years when his renal allograft failed due to chronic allograft nephropathy. His chronic immunosuppression (tacrolimus, azathioprine) was stopped and prednisone was weaned over 3 months at that time. A skin biopsy revealed saponification of the subcutaneous fat with inflammation pathognomonic of pancreatic panniculitis. Concurrent allograft pancreatitis confirmed with elevated lipase and a computed tomography scan finding of peripancreatic graft stranding and atrophic native pancreas. He was started on pulse steroid therapy for 3 days followed by oral taper. This resulted in dramatic resolution of all skin lesions and normalization of lipase levels within 1 week, followed by resumption of low-dose tacrolimus and azathioprine. This is an extremely rare occurrence of panniculitis in pancreas allograft after 10 years of pancreatic failure associated with stopping immunosuppression.

Cardiovascular disease in the kidney transplant recipient: epidemiology, diagnosis and management strategies.

Kidney transplantation (KT) is the optimal therapy for end-stage kidney disease (ESKD), resulting in significant improvement in survival as well as quality of life when compared with maintenance dialysis. The burden of cardiovascular disease (CVD) in ESKD is reduced after KT; however, it still remains the leading cause of premature patient and allograft loss, as well as a source of significant morbidity and healthcare costs. All major phenotypes of CVD including coronary artery disease, heart failure, valvular heart disease, arrhythmias and pulmonary hypertension are represented in the KT recipient population. Pre-existing risk factors for CVD in the KT recipient are amplified by superimposed cardio-metabolic derangements after transplantation such as the metabolic effects of immunosuppressive regimens, obesity, posttransplant diabetes, hypertension, dyslipidemia and allograft dysfunction. This review summarizes the major risk factors for CVD in KT recipients and describes the individual phenotypes of overt CVD in this population. It highlights gaps in the existing literature to emphasize the need for future studies in those areas and optimize cardiovascular outcomes after KT. Finally, it outlines the need for a joint 'cardio-nephrology' clinical care model to ensure continuity, multidisciplinary collaboration and implementation of best clinical practices toward reducing CVD after KT.

Intrahepatic Cholestasis of Pregnancy as a Clinical Manifestation of Sodium-Taurocholate Cotransporting Polypeptide Deficiency.

Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disorder. Although the etiology of ICP is not fully understood thus far, some genetic factors might contribute to the development of this condition. Sodium-taurocholate cotransporting polypeptide (NTCP), the protein encoded by the gene Solute Carrier Family 10, Member 1 (SLC10A1), is the primary transporter expressed in the basolateral membrane of the hepatocyte to uptake conjugated bile salts from the plasma. NTCP deficiency arises from biallelic SLC10A1 mutations which impair the NTCP function and cause intractably elevated levels of total bile acids (TBA) in the plasma (hypercholanemia). In this study, all the SLC10A1 exons and their flanking sequences were analyzed by Sanger sequencing to investigate the etiology for hypercholanemia in two male infants aged 2 and 20 months, respectively, from two unrelated families. As a result, both patients are homozygous for the reported pathogenic variant c.800C>T (p.Ser267Phe) that could impair the NTCP function to uptake bile acids, and the diagnosis of NTCP deficiency was thus made. Their mothers are also homozygotes of the same variant and both had been diagnosed to have ICP in the third trimester, with one of them undergoing cesarean section. The father of the first patient in this paper has the same SLC10A1 genotype c.800C>T/c.800C>T, also exhibiting slight hypercholanemia with a plasma TBA level of 21.5 µmol/L. In conclusion, we suggest that with hypercholanemia being a common laboratory change, NTCP deficiency may be a genetic factor leading to ICP and even cesarean section in clinical practice.

Steroid-free three-drug maintenance regimen for pancreas transplant alone: Comparison of induction with rabbit antithymocyte globulin +/- rituximab.

Graft survival following pancreas transplant alone (PTA) is inferior to other pancreas transplants. Steroid elimination is appealing, but a two-drug maintenance strategy may be inadequate. Additionally, recipients tend to have diabetic nephropathy and do not tolerate nephrotoxic medications. A three-drug maintenance strategy permits immunosuppression through different mechanisms as well as an opportunity to use lower doses of the individual medications. Induction consisted of five doses of rabbit antithymocyte globulin (1 mg/kg/dose). As of October 2007, a single dose of rituximab (150 mg/m2 ) was added. Maintenance consisted of tacrolimus, sirolimus and mycophenolate mofetil. From 2004 to 2017, 166 PTA were performed. Graft loss at 7 and 90 days were 4% and 5%, and 1-year patient and graft survival were 97% and 91%. Comparing induction without and with rituximab, there was no significant difference in 7- or 90-day graft loss, 1-year patient or graft survival, or in the rate of rejection or infection. Rabbit antithymocyte globulin induction and steroid withdrawal followed by a three-drug immunosuppression regimen is an excellent strategy for PTA recipients.

Kidney allograft survival outcomes in combined intestinal-kidney transplant: An analysis of the UNOS/OPTN database 2000-2014.

BACKGROUND AND OBJECTIVES: Intestinal transplants carry a high morbidity/mortality. Kidney allograft outcomes after combined intestinal (IT) with kidney transplant (CIKT) remain largely uninvestigated. MATERIALS AND METHODS: The UNOS STAR database was queried to identify all such combined organ transplants from 2000 to 2015. RESULTS: Out of a total 2215 (51.4% peds vs 48.6% adults) intestinal transplants, 111 (5.0%) CIKT were identified (32.4% peds vs 67.6% adults). Over the study period of CIKT, a total of 45.9% of these cases died with a functioning kidney graft. DGF rate was 9.0%. The 1-year reported kidney acute rejection rate was 6.3%. For the entire CIKT population over the entire study era, the 1-, 3-, and 5-year unadjusted kidney graft survival was 57%, 39%, and 34%, while death-censored kidney graft survival was 93%, 90%, and 86%, respectively. Overall conditional 5-year kidney graft survival (defined as 1-year kidney graft survival) was 58%. Overall, patient survival was significantly lower in recipients of CIKT compared to intestinal transplant (IT) (P < .005); However, the 5-year conditional (1 year kidney graft) patient survival in adults was not significantly different between IT and CIKT overall (P = .194). CONCLUSIONS: Kidney allograft survival is primarily dependent on 1-year patient survival. Guidelines regarding allocation of kidney allografts in CIKT need to take into consideration utility and urgency.

Synthesis and in vitro Bio-activity Evaluation of N4-benzyl Substituted 5-Chloroisatin-3-thiosemicarbazones as Urease and Glycation Inhibitors.

A series of fifteen N4-benzyl substituted 5-chloroisatin-3-thiosemicarbazones 5a-o were synthesized and screened mainly for their antiurease and antiglycation effects. Lemna aequinocitalis growth and Artemia salina assays were carried out to determine their phytotoxicity and cytotoxicity potential. All the compounds proved to be extremely effective urease inhibitors, demonstrating enzyme inhibition much better than the reference inhibitor, thiourea (IC50 values 1.31 ± 0.06 to 3.24 ± 0.15 vs. 22.3 ± 1.12 µM). On the other hand, eight out of fifteen compounds tested, i.e. 5b, 5c, 5h-k, 5m and 5n were found to be potent glycation inhibitors. Of these, five viz. 5c, 5h-j and 5n proved to be exceedingly efficient, displaying glycation inhibition greater than the reference inhibitor, rutin (IC50 values 114.51 ± 1.08 to 229.94 ± 3.40 vs. 294.5 ± 1.5 µM).

Agreement between Keratometric readings by VERION image guided System, Galilei G4 and Pentacam.

OBJECTIVE: To study Agreement between Keratometric readings by VERION image guided System, Galilei G4 and Pentacam. METHODS: The quasi experimental study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from August 2016 to December 2016. Twenty five patients fulfilling the inclusion criteria participated in the study. All Patients were subjected to Keratometric assessment using Galilei G4 Dual Scheimpflug analyzer (Ziemer, Switzerland), Wavelight Oculyzer II (Pentacam, Germany) and Verion image guided system (Alcon). Steep and flat meridian and diopter of astigmatism by three systems were recorded and endorsed. All readings were taken by the same observer. Statistical Program for Social Sciences (SPSS) version 22.0 was used for statistical analysis. Results analyzed for significance by t-tests and Interclass correlation analysis. In t tests, P values of <0.05 was considered statistically significant while interclass coefficient of >0.7 was considered acceptable. RESULTS: Fifty eyes of twenty-five patients (22 male, 28 female) with mean age of 29.50 ± 3.46 years were studied. Flat K, steep K and dioptric power of astigmatism were measured with verion, pentacam and Galilei G4. Interclass correlation analysis showed agreement between individual variables measured by the three devices, while one sample t test showed no significant difference between dioptric power of astigmatism between Verion-Pentacam and Verion- Galilei group. (p 0.178 for former and 0.622 for later group). CONCLUSION: Verion image guided system is comparable to other instruments used currently for keratometry. Verion can be interchangeably used with Pentacam and Galilee G4 in assessing corneal astigmatism.

Synthesis, X-ray molecular structure, biological evaluation and molecular docking studies of some N4-benzyl substituted 5-nitroisatin-3-thiosemicarbazones.

A series of fifteen N4-benzyl substituted 5-nitroisatin-3-thiosemicarbazones 5a-o was synthesized and evaluated for urease inhibitory, phytotoxic and cytotoxic influences. All the compounds proved to be highly potent inhibitors of the enzyme, showing inhibitory activity (IC50=0.87±0.25-8.09±0.23µM) much better than the reference inhibitor, thiourea (IC50=22.3±1.12µM) and may thus act as persuasive leads for further studies. In phytotoxicity assay, twelve out of fifteen thiosemicarbazones tested i.e. 5a-e, 5g, 5i and 5k-o appeared to be active, exhibiting weak or non-significant (5-35%) growth inhibition at the highest tested concentrations (1000 or 500µg/mL). In contrast, only one compound i.e. 5i was active in the brine shrimp (Artemia salina) lethality bioassay, demonstrating cytotoxic activity with LD50 value 2.55×10-5M. Molecular docking studies of compounds 5a-o were also performed to identify their probable binding modes in the active site of the enzyme.

Efficacy and safety of optic nerve sheath fenestration in patients with raised intracranial pressure.

OBJECTIVE: To evaluate the efficacy and safety of Optic Nerve Sheath Fenestration (ONSF) in patients with raised intracranial pressure (ICP). METHODS: This Quasi Experimental Study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi from July 2013 to July 2015. Thirty one eyes of 18 patients who underwent ONSF for raised ICP were followed up for one year to ascertain efficacy and safety of ONSF procedure. RESULTS: Thirteen (72.22%) patients underwent ONSF bilaterally, while five (27.78%) underwent unilateral ONSF. Best corrected visual acuity (BCVA) improved in 24 (77.4%), remained stable in four (12.9%) and deteriorated in three (9.7%) patients. Papilledema improved in 27 (87.1%) while remained stable in four (12.9%) according to Frisénscale of Papilledema. Change in BCVA and papilledema from pre-operative values was statistically significant (p<0.001). There was significant negative correlation (r= -0.434, p=.017) between duration of symptoms before presentation and improvement in BCVA. Common complications were a tonic pupil, subconjunctival haemorrhage, chemosis, weakness of recti and diplopia. CONCLUSION: ONSF is an effective procedure with statistically significant improvement in BCVA and reduction in severity of papilledema.

Efficacy of intravitreal bevacizumab combined with pan retinal photocoagulation versus panretinal photocoagulation alone in treatment of proliferative diabetic retinopathy.

OBJECTIVE: To compare effectiveness of pan-retinal photocoagulation alone versus panretinal photocoagulation combined with intravitreal bevacizumab on visual acuity and central macular thickness in patients presenting with proliferative diabetic retinopathy. METHODS: This Randomized controlled trial was carried out at Armed Forces Institute of ophthalmology, Pakistan from Jan 2016 to Aug 2016. Seventy six eyes of 50 patients having proliferative diabetic retinopathy and diabetic macular edema were included in the study. All the patients were subjected to detailed clinical examination that included Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), slit lamp examination of anterior and posterior segments. Optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) were carried out and patients were divided in two groups (GP and GI). Three monthly sessions of Pan retinal photocoagulation (PRP) using Pattern Scan Laser (PASCAL) alone was performed in group GP while PRP along with three monthly intravitreal bevacizumab (IVB) was performed in group GI. BCVA and CMT was recorded 04 weeks after the third PRP session in both the groups. RESULTS: Seventy six eyes of 50 patients (38 in each group) were treated with three sessions of PRP alone and PRP with IVB in Group GP and GI respectively. Mean age of the patient in group GP was 57.47± 6.08 years while that in group GI was 55.69 ±6.58. The magnitude of induced change in BCVA was 0.09 ± 0.15 in GP while 0.22 + 0.04 in GI groups while mean induced change in CMT after treatment was 77.44 ± 92.30 um and 117.50 ± 93.82 um in group GP and GI. CONCLUSION: Laser PRP combined with IVB has superior visual and anatomical outcome than PRP alone in patients with combined presentation of PDR and DME.

Comparison of analgesic effect of preoperative topical Diclofenac versus Ketorolac on postoperative pain after Corneal Collagen Cross Linkage.

OBJECTIVE: To compare post-operative pain relieving effect of topical diclofenac 0.1% versus ketorolac 0.5% in Corneal Collagen Cross Linking (CXL) for patients diagnosed with keratoconus. METHODS: This randomized controlled trial was carried out for six months from October 2016 to March 2017. We included young patients having keratoconus with k-readings greater than 47D and central corneal thickness more than 400 microns. All the patients received single dose one drop of topical diclofenac 0.1% to (Group-A) and ketorolac 0.5% to (Group-B) 30 minutes in advance of the corneal collagen cross linking (CXL) procedure. The CXL was performed with topical 0.1% riboflavin eye drops in 20% dextran as a photo sensitizer. After 36 hours of the CXL procedure, the postoperative intensity of pain was assessed verbally by patients with the help of visual analog scale (VAS) numbers from zero to five where 0 designated no pain & 5 symbolized worst pain. RESULTS: The study comprised sixty eyes of forty one patients. Out of total 16 were male while 25 female patients. The mean age of the patients was 24.27 ± 2.93 years (range 20 to 29 years). In the conclusive analysis, diclofenac 0.1% was used on 30 patients in Group-A and ketorolac 0.5% on 30 subjects in Group-B. Pain relieving scores in Group-A (diclofenac 0.1%) was 2.57 ± 0.67 while in Group-B (ketorolac 0.4% treated arm) was 3.20 ± 0.61. CONCLUSION: Topical diclofenac 0.1% is statistically comparable to topical ketorolac 0.5% in precluding severity of pain after corneal collagen cross linkage operation.