Knowledge, Awareness, and Determinants of Medication Adherence in Hypertensive Patients: A Hospital-Based Cross-sectional Study in North India.

Background: Knowledge and awareness studies reveal the basic information of the community and the misconceptions in relation to practices of a disease. The identification of such factors is important as they directly influence the health care-related interventions. Hypertension is one of the emerging noncommunicable diseases (NCDs) globally. So, we conducted this study to assess the status of our community regarding hypertension. Materials and Methods: The study was conducted on 300 hypertensive patients to assess the knowledge and awareness by a hypertension fact questionnaire. Medication adherence was assessed in the same group of patients by Hill-Bone scale-a uniform scale used worldwide. Results: Our study revealed a greater number of females with hypertension as compared to males and a maximum number of patients being in the age-group of 61-70 years and belonging to rural areas. Most of the patients had a secondary education as a highest educational qualification with only 10% of patients being postgraduates. A fair number of patients had a good knowledge and awareness about their disease, and most of the respondents accounted forgetfulness as a main reason for nonadherence to therapy over other reasons. Conclusion: Our population has good knowledge and awareness about their disease despite not having very good educational qualifications, and we need to strengthen our healthcare programs for even more greater dissemination of information.

Comparative evaluation of blind supraglottic airway device insertion versus videolaryngoscope-guided technique in adults undergoing laparoscopic cholecystectomy.

OBJECTIVES: A videolaryngoscope may decrease the high incidence of aberrant positioning of supraglottic airway devices (SAD) inserted with blind techniques. We aimed to compare Igel insertion characteristics between blind and videolaryngoscope-assisted techniques. METHODS: In this study 70 adult patients scheduled for elective laparoscopic cholecystectomy under general anesthesia were randomly divided into blind (Group B, n = 35) and videolaryngoscope-guided (Group V, n = 35) Igel insertion. Oropharyngeal leak pressure (OLP), fiber-optic view score, time for device insertion, first attempt success, ease of insertion, ventilation score, maneuvers, and adverse events were assessed. RESULTS: OLP was significantly higher in group V at 1 and 10 minutes (24.80 ± 1.91 vs 21.71 ± 2.37; p < 0.001 and 32.60 ± 2.32 vs 30.68 ± 2.93; p = 0.006). The mean fiberoptic scoring (3.63 ± 0.49 vs 3.38 ± 0.49; p = 0.043), a fibreoptic score of grade 4 (24 vs 13; p = 0.012) and time-to-device insertion (25.6 ± 3.5 vs 21.7 ± 4.1; p < 0.001) was considerably higher in group V. First-attempt success (p = 0.630), ease of insertion of SAD (p = 0.540) and nasogastric tube (p = 1), ventilation score (p = 1), number of maneuvers required (p = 1), number of attempts (p = 0.592) and postoperative complications (p = 0.800) were comparable in the two groups. CONCLUSION: The videolaryngoscope-guided technique provided superior airway sealing and reduced malposition of Igel without an increase in adverse events compared to the blind technique. However, this was at the cost of increased time of device insertion. CLINICAL TRIAL REGISTRATION: www.ctri.nic.in identifier is CTRI/2022/10/046269.

Size-Controlled Cu3VSe4 Nanocrystals as Cathode Material in Platinum-Free Dye-Sensitized Solar Cells.

In this work, we report the first single-step, size-controlled synthesis of Cu3VSe4 cuboidal nanocrystals, with the longest dimension ranging from 9 to 36 nm, and their use in replacing the platinum counter electrode in dye-sensitized solar cells. Cu3VSe4, a ternary semiconductor from the class of sulvanites, is theoretically predicted to have good hole mobility, making it a promising candidate for charge transport in solar photovoltaic devices. The identity and crystalline purity of the Cu3VSe4 nanocrystals were validated by X-ray powder diffraction (XRD) and Raman spectroscopy. The particle size was determined from the XRD data using the Williamson-Hall equation and was found in agreement with the transmission electron microscopy imaging. Based on the electrochemical activity of the Cu3VSe4 nanocrystals, studied by cyclic voltammetry, the nanomaterials were further employed for fabricating counter electrodes (CEs) in Pt-free dye-sensitized solar cells. The counter electrodes were prepared from Cu3VSe4 nanocrystals as thin films, and the charge transfer kinetics were studied by electrochemical impedance spectroscopy. The work demonstrates that Cu3VSe4 counter electrodes successfully replace platinum in DSSCs. CEs fabricated with the Cu3VSe4 nanocrystals having an average particle size of 31.6 nm outperformed Pt, leading to DSSCs with the highest power conversion efficiency (5.93%) when compared with those fabricated with the Pt CE (5.85%).

Highly Concentrated Linear Guanidine Amides from the Marine Sipunculid Phascolosoma granulatum.

The chemical diversity of annelids, particularly those belonging to the class Sipuncula, remains largely unexplored. However, as part of a Marine Biodiscovery program in Ireland, the peanut worm Phascolosoma granulatum emerged as a promising source of unique metabolites. The purification of the MeOH/CH2Cl2 extract of this species led to the isolation of six new linear guanidine amides, named phascolosomines A-F (1-6). NMR analysis allowed for the elucidation of their structures, all of which feature a terminal guanidine, central amide linkage, and a terminal isobutyl group. Notably, these guanidine amides were present in unusually high concentrations, comprising ∼3% of the dry mass of the organism. The primary concentration of the phascolosomines in the viscera is similar to that previously identified in linear amides from sipunculid worms and marine fireworms. The compounds from sipunculid worms have been hypothesized to be toxins, while those from fireworms are reported to be defensive irritants. However, screening of the newly isolated compounds for inhibitory bioactivity showed no significant inhibition in any of the assays conducted.

Retron Library Recombineering: Next Powerful Tool for Genome Editing after CRISPR/Cas.

Retron library recombineering (RLR) is a powerful tool in the field of genome editing that exceeds the scope and specificity of the CRISPR/Cas technique. In RLR, single-stranded DNA produced in vivo by harnessing the in-built potential of bacterial retrons is used for replication-dependent genome editing. RLR introduces several genomic variations at once, resulting in pooled and barcoded variant libraries, thus permitting multiplexed applications. Retron-generated RT-DNA has already shown promise for use in genome editing. Thus, this new tool will result in fresh, intriguing, and surprising developments in molecular biology and its juncture with other disciplines of research, including medicine, agriculture, and microbiology. In this review, we discuss the current state of this brand-new tool that could eventually boost genome editing research.

Atypical Presentation Resembling Acute Leukoencephalopathy With Restricted Diffusion in Staphylococcus aureus Meningoencephalitis.

Meningoencephalitis refers to inflammation of the brain and meninges. It can be caused by various organisms, such as Neisseria meningitidis, Streptococcus pneumoniae, and so on. Staphylococcus aureus causing meningoencephalitis is relatively rare. It is mainly encountered in patients who have undergone surgeries in the past. Acute leukoencephalopathy with restricted diffusion (ALERD) is a type of encephalopathy that can involve both white and grey matter of the brain, and it has a characteristic "bright tree appearance" on MRI. It can be because of various infectious etiologies or caused by various toxins. Neurological sequelae are observed in about two out of three cases. Here, we describe a case of S. aureus meningoencephalitis with ALERD, which has been seldom reported. More awareness about this is required among primary care physicians for timely diagnosis and management to prevent any complications.

A coronene diimide based radical anion for detection of picomolar H2O2: a biochemical assay for detection of picomolar glucose in aqueous medium.

Coronene diimide functionalized with 4-(2-nitrovinyl)phenyl (CDI 2) serves as a precursor for generating a stable radical anion (CDI 2˙-) using H2S as a reductant in 40% H2O-THF solution in the NIR region with stability up to >50 min. The optical, cyclic voltammetry (CV), current-voltage (I-V) and electron paramagnetic resonance (EPR) studies revealed the formation of the radical anion (CDI 2˙-). The addition of a strong oxidant NOBF4 quenches the radical anion (CDI 2˙-). The aggregation studies revealed that CDI 2 exists in the aggregated state in 40% H2O-THF solution, which points to the possibility of stabilization of the radical anion in the aggregates. The radical anion (CDI 2˙-) was explored for the detection of 58.27 pM H2O2 in aqueous medium with the naked eye colour change from green to light yellow. The biochemical assay involving the radical anion (CDI 2˙-) and glucose oxidase (GOx) enzyme can be used for the detection of 16 pM (UV-vis method) and 82.4 pM (fluorescence method) glucose. The naked eye colour change from green to light yellow (daylight) and a colorless non-fluorescent solution to a green fluorescent solution (365 nm) allow the detection of 1 nM glucose.

Olefin Difunctionalization for the Synthesis of Tetrahydroisoquinoline, Morpholine, Piperazine, and Azepane.

This report outlines a versatile strategy for synthesizing a diverse array of N-heterocycles. By the utilization of common olefins, this simple protocol facilitates their coupling with various bifunctional reagents. Furthermore, it can be integrated with C-H amination techniques to directly produce N-heterocycles in a multicomponent cascade coupling process. The unique bond disconnection logic employed in this process underscores its efficiency in achieving rapid simplification through cascade couplings.

Perylene diimide-based radical anions for the rapid detection of picomolar H2O2 in an aqueous medium.

The formation of radical anions (PDI 1˙-) using H2S as a sacrificial electron donor in 50% HEPES buffer-THF solution is reported. PDI 1˙- was confirmed by optical, I-V plot, CV, DPV, NOBF4 and EPR studies. PDI 1˙- has a half-life of 96 minutes in solution and 11 days in the solid state without any additive. The formation of PDI 1˙- was confirmed by AFM and SEM. PDI 1˙- can be used for the detection of 26.6 pM of H2O2 supported by optical and CV data.

Prevalence of Psychiatric Comorbidities in Patients With Neurofibromatosis.

Objective: To assess the prevalence of psychiatric comorbidities in patients with neurofibromatosis.Methods: In this cross-sectional study, we used the 2010-2014 National Inpatient Sample database. Patients ≥ 18 years of age with a primary or secondary diagnosis of neurofibromatosis and psychiatric comorbidities were queried.Results: A total of 43,270 patients with a mean age of 48.7 years (female: 55.7%, White: 70.1%) were included in the study. Overall, psychiatric comorbidities were present in 46.5% of patients; mood disorders (22.1%) and anxiety disorders (12.2%) were the most prevalent comorbidities. Although previous studies report prevalence rates of attention-deficit/hyperactivity disorder in up to 50% of patients with neurofibromatosis, our study found that the rate was much lower at 1.10%. Female sex and non-White race were less associated with psychiatric comorbidities (odds ratio = 0.868 [P = .003] and 0.689 [P < .001], respectively). The moderate-to-extreme loss of function illness severity category was associated with 1.35-times higher odds of having psychiatric comorbidities compared to mild-to-moderate or no loss of function (P < .001). The total length of stay was similar in patients with and without psychiatric comorbidities (mean = 4.98 [95% CI, 4.72-5.24] vs mean = 4.83 [95% CI, 4.60-5.07], respectively; P = .34).Conclusions: In adult patients with neurofibromatosis, 46.5% were found to have at least one psychiatric comorbid diagnosis. The most frequent psychiatric comorbid disorders were mood disorders and anxiety disorders. Female sex and non-White race predicted a lower likelihood of having a psychiatric disorder.Prim Care Companion CNS Disord 2023;25(5):23m03514. Author affiliations are listed at the end of this article.

Atypical Asymmetric Presentation of Severe Graves' Orbitopathy.

Graves' disease is a self-limiting autoimmune thyroid disorder caused by stimulating antibodies to the thyroid-stimulating hormone receptor. It usually affects middle-aged females in the fourth to sixth decade of life. It is distinguished by keratopathy, chemosis, proptosis, and eyelid swelling, in addition to ocular discomfort. A total of 3-5% of cases present with a severe form of Graves' orbitopathy, which manifests with diminution of vision, optic nerve compression, optic neuropathy, and exposure keratopathy. We describe a case of a 34-year-old female patient who presented with the chief complaint of rapid deterioration of vision over a period of three months in the right eye. Ocular examination revealed proptosis, widened palpebral aperture, elevation of intra-ocular pressure (IOP) in the upgaze, restricted eye movements, and signs of optic nerve compression. Findings were confirmed on a CT scan of the orbit. The unusual presentation in this case was that she had rapid, significant deterioration of vision in the right eye, with a progression of proptosis more marked in the contralateral eye. This underlies the importance of thoroughly examining for any possible orbital apex syndrome in both eyes, not just the eye with marked proptosis. The patient, being reluctant for orbital decompression, was prescribed IV methylprednisolone 1 g for three consecutive days, which reduced her proptosis and improved her vision. This acted as a temporary measure to increase the duration of the surgical window until the time the patient undergoes the surgery.

Modulation of cigarette smoke induced alterations by aqueous Ocimum sanctum leaf extract in pulmonary tissue of rodents.

Smoking has been associated with an increased risk of asthma, lung cancer, cardiovascular diseases, chronic bronchitis, and a massive amount of oxidative stress. The present study was undertaken to determine the modulatory effects of Holi Basil/Tulsi, (Ocimum sanctum) leaf extract on cigarette smoke-induced pulmonary damage in mice. Cigarette smoke (CS) inhalation increased the levels of pulmonary lipid peroxidation, and reactive oxygen species and decreased the levels of glutathione. Histoarchitectural alterations and enhanced tissue lactate dehydrogenase (LDH) activity in pulmonary tissue was distinctly indicative of damage. Enhanced mucin production was also observed through mucicarmine and Alcian Blue-Periodic Acid Schiff (PAS) staining. Increased expression of MUC5AC was also observed. Alterations in the lung were also evident through FTIR studies. Administration of Ocimum sanctum leaf extract (80 mg/kg b.w) to CS exposed mice ameliorated these alterations to a greater extent. These findings are suggestive of the fact that Ocimum sanctum leaf extract effectively modulated CS-induced deleterious effects on pulmonary tissue.

Assessment of Corrected QT Interval and QT Dispersion in Patients with Uncomplicated Metabolic Syndrome.

Aim: Metabolic syndrome (MS) itself has become a new entity being a constellation of physiological, biochemical, metabolic, and clinical factors that have been related to an increased risk of cardiovascular diseases, type 2 diabetes mellitus (T2DM), and morbidity and mortality. The burden of MS is increasing all over the world with the current prevalence being 30%. The QT interval and QT dispersion (QTd) have been long associated with ventricular arrhythmia and sudden cardiac deaths. The association between QT and diabetes and healthy subjects has been clearly studied, but the association between QT and uncomplicated MS has not been very well defined. Methods: A total of 400 patients visiting the medicine clinics were assessed for blood pressure, anthropometric measurements, fasting serum lipid profile, FBS, and electrocardiogram (ECG). The patients diagnosed with uncomplicated MS as per the International Diabetic Federation (IDF) criteria were included in the study. QT interval in the ECG was recorded, and the relationship between various parameters of an uncomplicated MetS and the QT interval was recorded. Results: Our study revealed more females with uncomplicated MS as compared to males and increasing burden as age progressed. Body mass index (BMI), waist circumference (WC), hip circumference (HC), WHP, systolic blood pressure (SBP), Diastolic blood pressure (DBP), Fasting blood sugar (FBS), serum cholesterol, triglyceride (TG), and low-density lipoprotein (LDL) levels were positively correlated with QT values. Conclusion: QT interval, a strong predictor of malignant ventricular arrhythmias and sudden cardiac deaths, is associated with uncomplicated MS.

Anthropometric Indices and its Association with Hypertension in Indian Population: A Study from Tertiary Care Center of North India.

Introduction: Anthropometric indices such as body mass index (BMI), waist circumference (WC), and waist hip ratio (WHR) have been used for a long time as a measure of obesity and abdominal fat and the relationship between these indices and hypertension has been well established. But these indices cannot discriminate between fat and muscle mass, leaving a greater population not categorized adequately. Recent studies have also demonstrated that not only the amount of fat but also the distribution of fat is important in hypertensive patients. So, new indices have come up through various studies to overcome this lag. The indices ABSI-Body shape index and BRI-Body roundness index are now being increasingly used to assess the risk of hypertension. Very few studies have been conducted on the Indian population in relation to this index. Material and Methods: The study included 700 patients with hypertension visiting the medicine outpatient department (OPD). Anthropometric indices-Height, weight, WC, HC, and WHR were calculated. The indices ABSI-Body shape index and BRI-Body roundness index were calculated as per the respective formulas. The comparison of various indices of anthropometry and hypertension was done as per the statistical analysis. Results: Our study concluded the positive correlation of hypertension with older as well as newer hypertensive indices. Conclusion: Early screening for the detection of hypertensives should be carried out to ease the disease burden and the anthropometric indices being a cost-effective and easy-to-conduct method can be used to facilitate the detection of hypertension. Appropriate lifestyle interventions should be promoted to decrease the prevalence of hypertensive patients.

Plant lectins: Classical molecules with emerging roles in stress tolerance.

Biotic and abiotic stresses impose adverse effects on plant's development, growth, and production. For the past many years, researchers are trying to understand the stress induced responses in plants and decipher strategies to produce stress tolerant crops. It has been demonstrated that molecular networks encompassing an array of genes and functional proteins play a key role in generating responses to combat different stresses. Newly, there has been a resurgence of interest to explore the role of lectins in modulating various biological responses in plants. Lectins are naturally occurring proteins that form reversible linkages with their respective glycoconjugates. To date, several plant lectins have been recognized and functionally characterized. However, their involvement in stress tolerance is yet to be comprehensively analyzed in greater detail. The availability of biological resources, modern experimental tools, and assay systems has provided a fresh impetus for plant lectin research. Against this backdrop, the present review provides background information on plant lectins and recent knowledge on their crosstalks with other regulatory mechanisms, which play a remarkable role in plant stress amelioration. It also highlights their versatile role and suggests that adding more information to this under-explored area will usher in a new era of crop improvement.

Characterization of miR-335-5p and miR-335-3p in human osteoarthritic tissues.

OBJECTIVE: We aimed to characterize the expression patterns, gene targets, and functional effects of miR-335-5p and miR-335-3p among seven primary human knee and hip osteoarthritic tissue types. METHODS: We collected synovial fluid, subchondral bone, articular cartilage, synovium, meniscus/labrum, infrapatellar/acetabular fat, anterior cruciate ligament/ligamentum teres, and vastus medialis oblique/quadratus femoris muscle (n = 7-20) from surgical patients with early- or late-stage osteoarthritis (OA) and quantified miR-335-5p and miR-335-3p expression by real-time PCR. Predicted gene targets were measured in knee OA infrapatellar fat following miRNA inhibitor transfection (n = 3), and prioritized gene targets were validated following miRNA inhibitor and mimic transfection (n = 6). Following pathway analyses, we performed Oil-Red-O staining to assess changes in total lipid content in infrapatellar fat. RESULTS: Showing a 227-fold increase in knee OA infrapatellar fat (the highest expressing tissue) versus meniscus (the lowest expressing tissue), miR-335-5p was more abundant than miR-335-3p (92-fold increase). MiR-335-5p showed higher expression across knee tissues versus hip tissues, and in late-stage versus early-stage knee OA fat. Exploring candidate genes, VCAM1 and MMP13 were identified as putative direct targets of miR-335-5p and miR-335-3p, respectively, showing downregulation with miRNA mimic transfection. Exploring candidate pathways, predicted miR-335-5p gene targets were enriched in a canonical adipogenesis network (p = 2.1e - 5). Modulation of miR-335-5p in late-stage knee OA fat showed an inverse relationship to total lipid content. CONCLUSION: Our data suggest both miR-335-5p and miR-335-3p regulate gene targets in late-stage knee OA infrapatellar fat, though miR-335-5p appears to be more prominent, with tissue-, joint-, and stage-specific effects.

Tunable [3+2] and [4+2] annulations for pyrrolidine and piperidine synthesis.

N-heterocycles are privileged pharmaceutical scaffolds in drug discovery and development. We disclose here divergent intermolecular coupling strategies that can access diverse N-heterocycles directly from olefins. The radical-to-polar mechanistic switching is key for the divergent cyclization processes. These distinctive annulations result in the coupling of alkenes with simple bifunctional reagents for divergent N-heterocycle syntheses.

Perylene diimide-based sensors for multiple analyte sensing (Fe2+/H2S/ dopamine and Hg2+/Fe2+): cell imaging and INH, XOR, and encoder logic.

In this report, we present our results on the recognition of multiple analytes using trisubstituted PDI-based chemosensors DNP and DNB in 50% HEPES buffered-CH3CN solution. Upon the addition of Hg2+, DNB showed a decrease and increase in absorbance intensity at 560 and 590 nm, respectively, with a detection limit of 7.17 µM and bleaching of the violet color (de-butynoxy). Similarly, the addition of Fe2+ or H2S to the solution of DNP or DNB resulted in ratiometric changes (A688nm/A560nm) with respective detection limits of 185 nM and 27.6 nM for Fe2+, respectively, and a color change from violet to green. However, the addition of >37 µM H2S caused a decrease in absorbance at 688 nm with a concomitant blue shift to 634 nm. Upon the addition of dopamine, the DNP + Fe2+ assay showed ratiometric (A560nm/A688nm) changes within 10 s along with a color change from green to violet. Moreover, DNP has been successfully used for the exogenous detection of Fe2+ in A549 cells. Further, the multiple outputs observed with DNP in the presence of H2S have been used to construct NOR, XOR, INH and 4-to-2 encoder logic gates and circuits.

Exploratory Transcriptomic Profiling Reveals the Role of Gut Microbiota in Vascular Dementia.

Stroke is the second most common cause of cognitive impairment and dementia. Vascular dementia (VaD), a cognitive impairment following a stroke, is common and significantly impacts the quality of life. We recently demonstrated via gut microbe transplant studies that the gut microbe-dependent trimethylamine-N-oxide (TMAO) pathway impacts stroke severity, both infarct size and long-term cognitive outcomes. However, the molecular mechanisms that underly the role of the microbiome in VaD have not been explored in depth. To address this issue, we performed a comprehensive RNA-sequencing analysis to identify differentially expressed (DE) genes in the ischemic cerebral cortex of mouse brains at pre-stroke and post-stroke day 1 and day 3. A total of 4016, 3752 and 7861 DE genes were identified at pre-stroke and post-stroke day 1 and day 3, respectively. The Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis indicated pathways of neurodegeneration in multiple diseases, chemokine signaling, calcium signaling, and IL-17 signaling as the key enriched pathways. Inflammatory response genes interleukin-1 beta (Il-1ß), chemokines (C-X-C motif chemokine ligand 10 (Cxcl10), chemokine ligand 2 (Ccl2)), and immune system genes (S100 calcium binding protein 8 (S100a8), lipocalin-2 (Lcn2)) were among the most significantly upregulated genes. Hypocretin neuropeptide precursor (Hcrt), a neuropeptide, and transcription factors such as neuronal PAS domain protein 4 (Npas4), GATA binding protein 3 (Gata3), and paired box 7 (Pax7) were among the most significantly downregulated genes. In conclusion, our results indicate that higher plasma TMAO levels induce differential mRNA expression profiles in the ischemic brain tissue in our pre-clinical stroke model, and the predicted pathways provide the molecular basis for regulating the TMAO-enhanced neuroinflammatory response in the brain.

Cost Analysis of Orthoptist-Led Neurofibromatosis Type 1 Screening Clinics.

Purpose: To conduct a costing study comparing orthoptist-led with consultant-led clinics screening for optic pathway gliomas (OPGs) in children with neurofibromatosis Type 1 (NF1) attending the Royal Children's Hospital (RCH), Melbourne. Methods: Patients with NF1 examined in the orthoptist-led NF1 screening clinic and/or consultant-led clinics during the study period were identified. The workflow management software Q-Flow 6® provided data documenting patient's time spent with the orthoptist, nurse, and ophthalmologist. Time points were converted into minutes and multiplied by the cost-per-minute for each profession. A bottom-up micro-costing approach was used to estimate appointment level costs. Bootstrap simulations with 1000 replications were used to estimate 95% confidence intervals (CIs) for the difference in mean appointment time and cost between clinics. Results: Data for 130 consultant-led clinic appointments and 234 orthoptist-led clinic appointments were extracted for analysis. The mean time per appointment for the consultant-led clinic was 45.11 minutes, and the mean time per appointment for the orthoptist-led clinic was 25.85 minutes. The mean cost per appointment for the consultant-led clinic was A $84.15 (GBP £39.60) compared to the orthoptist-led clinic at A $20.40 (GBP £9.60). This represents a mean reduction of 19.25 minutes per appointment (95% CI, -24.85 to -13.66) and a mean reduction of A $63.75 (GBP £30.00) per appointment (95% CI, (A $-75.40 to $-52.10 [GBP £ -35.48 to £ -24.52]). Conclusion: An orthoptist-led clinic screening for OPGs in patients with NF1 can be a more cost-efficient model of care for ophthalmic screening in this patient group.