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Amar Pujari, Sujeeth Modaboyina, Rajeswari Thangavel, Monika Yadav, Swati Phuljhele, Rohit Saxena Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Amar Pujari, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 212, RPC-1, AIIMS, New Delhi, India, Email dramarpujari@gmail.comPurpose: To describe novel Y splitting procedure of inferior oblique muscle to mitigate the anti-elevation syndrome.Methods: A pilot, prospective interventional study was undertaken to assess the effect of inferior oblique muscle Y-splitting in patients with unilateral 3+ or more overaction. To correct primary gaze hypertropia and the excyclotorsion, a Y-splitting procedure was performed (along with routine horizontal muscle surgery as per the deviation) in 14 subjects. The effect of surgery was assessed at baseline and at 6 months post-intervention.Results: The mean age of 14 subjects was 25.14± 7.70 years. The mean pre-operative hypertropia, excyclotorsion and inferior oblique muscle over-action was 18.42± 3.50 PD, 14.14± 2.65 degrees, and +3.21± 0.42 respectively. Following surgery, this was reduced to 1.57± 1.74 PD of residual hypertropia (a net correction of 16.85± 2.31 PD, p = 0.005), 3.85± 1.46 degrees of residual excyclotorsion (a net correction of 10.28± 1.72 degrees, p < 0.05), and +0.28± 0.46 of residual inferior oblique over-action (a net correction ∼+3) at the end of 6 months. Amongst fourteen patients, three patients still experienced residual/variable anti-elevation effect, and during the study period none of them experienced any adverse event and none of them required any additional surgeries.Conclusion: While anteriorizing the inferior oblique muscle to correct primary gaze hypertropia and the excyclotorsion, a novel “Y splitting” procedure can be followed to achieve the desired results with mitigated anti-elevation effect.Keywords: inferior oblique muscle surgery, anti-elevation syndrome, Y-splitting of the inferior oblique

Amar Pujari, Vinay Patil, Nidhi Chauhan, Rajeswari Thangavel, Swati Phuljhele, Rohit Saxena Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Amar Pujari, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 212, RPC-1, AIIMS, New Delhi, India, Email dramarpujari@gmail.comPurpose: To describe the clinical role of swept-source anterior segment optical coherence tomography in extraocular muscle imaging in various strabismic conditions.Study Design: Prospective observational study.Participants: A total of 1104 extraocular muscles of 150 subjects were imaged. Normal eyes (640 muscles), eyes undergoing re-operation (240 muscles), paralytic strabismic eyes (16 muscles), non-paralytic strabismic eyes (20 muscles), post-traumatic strabismic eyes (64 muscles), eyes with thyroid disease (64 muscles), and other atypical cases (60 muscles) were imaged. In all cases, up to four recti muscles were evaluated in a given eye depending on the need.Results: The mean age was 38.15 ± 16.25 years. Overall, muscle insertion was identified in over 90% of the subjects. Apart from normal muscles (n = 860, 93.68%), the location was identified in previously operated eyes (n = 54, 90%), in traumatic muscle slippage (n = 2, 11.11%), in ocular coat ectasia (n = 11, 91.66%), in thyroid muscle hypertrophy, in operated scleral fixated intraocular lens with strabismus, and other challenging cases. In all circumstances, clinically useful information was obtained from the anterior 4– 14 millimetres of the rectus muscle, which in turn helped in active surgical planning and overall management.Conclusion: The SS-ASOCT with its wider and deeper scanning abilities was able to locate the extraocular muscle insertion in a variety of strabismic conditions. Therefore, this tool can be used in the preoperative periods for optimal surgical planning and management.Keywords: swept source anterior segment imaging, extraocular muscle imaging, imaging in strabismus, ASOCT imaging of extraocular muscles

Amar Pujari, Sujeeth Modaboyina, Divya Agarwal, Gunjan Saluja, Rajeswari Thangavel, Vaishali Rakheja, Rohit Saxena, Namrata Sharma, Jeewan S Titiyal, Atul Kumar Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Amar PujariDr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room no. 212, RPC-1, AIIMS, New Delhi, India, Email dramarpujari@gmail.comAbstract: 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.Keywords: myopia, India, myopia in India, atropine therapy in myopia, genetics and myopia, retinopathy of prematurity and myopia, imaging in myopia, management of myopia

Amar Pujari Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaCorrespondence: Amar Pujari Email dramarpujari@gmail.comAbstract: Smartphone technology is advancing at a rapid pace. Their role in day-to-day life is becoming more and more intricate and irreplaceable. Of late, they have gained immense importance in different medical specialities where they possess an active ability to guide the clinician. This is particularly evident in ophthalmology, where the constantly evolving camera-illumination systems and the artificial intelligence integrated technology have unravelled many novel observations for non-contact posterior segment imaging. The scope of this review is to highlight the role of smartphones as ophthalmoscopes (direct as well as indirect). Nevertheless, their limitations and future directions are also stated here with the intention of making progress in the field of smartphone fundus imaging.Keywords: smartphones, smartphone ophthalmoscopy, smartphone fundoscopy

Amar Pujari, Sujeeth Modaboyina, Deepsekhar Das, Asmita Mahajan, Rajeswari Thangavel, Swati Phuljhele, Rohit Saxena, Namrata Sharma, Pradeep Sharma Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Amar PujariDr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 212, RPC-1, AIIMS, New Delhi, IndiaTel +91 8447226221Email dramarpujari@gmail.comBackground: To characterize the diagnostic role of swept source anterior segment optical coherence tomography (SS-ASOCT) in strabismus re-operations with lost surgical details.Methods: Patients presenting to our outpatient services for strabismus care from February 2020 to March 15th 2021 were systematically evaluated. Those willing to undergo re-operation were included in the study. A total of 30 patients were identified and out of this a total of 10 eyes of 10 patients with lost surgical details were finally included in the study. Demographic details, preoperative deviation, ocular findings, orthoptic measurements, detailed SS-ASOCT findings, intraoperative measurements, and post-operative outcomes were recorded.Results: The mean age of 10 patients was 23.7± 5.75 years. Seven were male and three were female. The mean pre-operative SS-ASOCT measured distance from angle to insertion was 8.90± 1.85 mm and the mean intraoperative distance was 9.12± 2.14 mm. A mean difference of 0.21± 1.31 mm was noted, and this difference was statistically insignificant (paired t test, p = 0.57). In addition, SS-ASOCT unraveled novel signs to differentiate operated eyes from the un-operated eyes, and recessed muscle from the resected muscle.Conclusion: In strabismus re-operation with lost surgical details, the pre-operative SS-ASOCT can provide reliable muscle details with respect to its type of surgery and amount surgery.Keywords: extraocular muscle, swept source anterior segment optical coherence tomography and strabismus re-operation

Amar Pujari, Namrata Sharma Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaCorrespondence: Amar PujariDr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), Room No. 212, RPC-1, New Delhi, IndiaTel +918447226221Email dramarpujari@gmail.comAbstract: Modern-day cataract surgery has achieved equivalence with refractive surgery, thus requiring surgeons to perform all possible pre-emptive exercises to mitigate intraoperative complications. In this direction, we possess a tremendous amount of technology to understand the preoperative status of the lens. Anterior segment optical coherence tomography (ASOCT) is one such tool, which has played a distinctive role in imaging various forms of cataracts. In this review, we critically analyse the practical role of ASOCT in the preoperative and intraoperative periods from a cataract surgeon’s perspective. After a thorough literature assessment, it was substantiated that the cross-sectional imaging ability of ASOCT can demonstrate delicate anatomical and pathological lenticular changes in a visually and clinically comprehensible way. The objective grading of immature cataracts to intralenticular and posterior capsular details in mature/white, posterior polar, traumatic and other forms of cataracts paves the way for various practical innovations as and when required. Hence, preoperative more than intraoperative ASOCT-derived lenticular knowledge is of immense help in careful surgical planning, with improved complication rates.Keywords: anterior segment optical coherence tomography and cataract, cataract, anterior segment optical coherence tomography

Amar Pujari,* Divya Agarwal,* Rohan Chawla, Atul Kumar, Namrata Sharma Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India*These authors contributed equally to this workCorrespondence: Amar PujariDr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaTel +91 8447226221Email dramarpujari@gmail.comAbstract: Intraoperative imaging of ocular tissues for diagnostic and therapeutic applications has gained immense admiration in recent years. The real time cross-sectional imaging, as well as three and four dimensional reconstruction abilities of intraoperative optical coherence tomography (iOCT), has enhanced our knowledge on many fronts in surgical maneuvers. In this review, we discuss the iOCT discovered constructive knowledge in the cornea, cataract, refractive, glaucoma, pediatric ocular, and various retinal conditions. The practical utility with decision modifying aspects along the specified ocular tissues and with respect to specific ocular entities have been narrated. Moreover, limitations and future directions have also been emphasized to make ophthalmic care more comprehensive in the future.Keywords: intraoperative optical coherence tomography, iOCT, hand-held optical coherence tomography and intraoperative microscope integrated optical coherence tomography

Amidst Covid-19, young adults have experienced major symptoms of anxiety and/or depression disorder (56%). Mental health issues have been spiking all over the world rapidly. People have taken up to social media as a platform to vent about their mental breakdowns. Twitter has seen enormous rise in depressive and anxious tweets in these times, but the downside being that majority of the population has neglected the importance of mental health issues and there are not enough resources to liberate people about it. Also, people hesitate to talk about their mental issues and seek help. So, a machine learning model using distant supervision to detect depression on Twitter is curated. Use of Sentiment140 dataset with 1.6 million records of different tweets. Our training data makes use of Twitter tweets included with emojis, which are classified as noisy labels on a dataset. Further, this paper mentions about how to use models like Support Vector Machine (SVM), Logistic Regression, Naive Bayes, Random Forest, XGBoost to distinguishing tweets between depressive or nondepressive. The purpose behind using multiple models is to achieve highest accuracy when trained with emoticon dataset. The paper’s main contribution is the idea of using tweets with emoticons for distant supervised learning.

Calcium is a ubiquitous and versatile secondary messenger that enables plant growth through various processes in response to abiotic and biotic stress factors. Plants are immobile and therefore constantly exposed to various environmental stimuli (drought, waterlogging, etc.) and microorganisms such as bacteria, fungi, and viruses resulting in large crop losses. Calmodulin (CaM) is an evolutionarily conserved calcium-binding protein and sensor that occurs in all eukaryotes and performs various functions under stress. CaM-binding proteins (CBPs) such as transcription factors, enzymes and channels are involved in responses to environmental stress. Plants have evolved a sophisticated innate immune system to fight infections, commonly referred to as pathogen-associated molecular pattern (PAMP)-triggered immunity (PTI) and effector-triggered immunity (ETI). Soybean is an economically important legume crop that is constantly confronted with various pests and pathogens, resulting in significant yield and production losses. The article highlights the functions of calmodulin in soybean during biotic (soybean-microbe pathogenesis) and abiotic (soybean-environment) interactions in the light of currently available knowledge on the subject. It also describes the new paradigms in this field, emphasising the need for further investigation and providing up-to-date information on the most plausible approaches to combat this challenge for commercial use.

Background: Although abdominal pain is common in the paediatric age group, problems of misdiagnosis and serious consequences are more particular in an emergency setting. This study examined the aetiologies of acute abdominal emergencies in children. Materials and Methods: This was a retrospective study of 100 children below the age of 12 years presenting with acute abdominal emergencies (gastrointestinal) requiring operative interventions. All patients were operated on an emergency basis and the intraoperative findings were correlated with the clinical findings. Results: Acute abdominal emergencies in the paediatric age group were heterogenous, with a myriad of aetiological factors. Overall, 73% of patients were greater than 3 years of age. Early neonatal period formed the second most common group (12%). Acute appendicitis was the most common cause except in the infancy period where congenital abnormalities predominated. Conclusion: The correct diagnosis of acute abdomen in children requires attention to clinical details and a high degree of suspicion. Early surgical intervention in doubtful cases may be necessary to solve diagnostic problems.

Abstract The rapid evolution of mass spectrometry-based single-cell proteomics now enables the cataloging of several thousand proteins from single cells. We investigated whether we could discover cellular heterogeneity beyond proteome, encompassing post-translational modifications (PTM), protein-protein interaction, and variants. By optimizing the mass spectrometry data interpretation strategy to enable the detection of PTMs and variants, we have generated a high-definition dataset of single-cell and nuclear proteomic-states. The data demonstrate the heterogeneity of cell-states and signaling dependencies at the single-cell level and reveal epigenetic drug-induced changes in single nuclei. This approach enables the exploration of previously uncharted single-cell and organellar proteomes revealing molecular characteristics that are inaccessible through RNA profiling.