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Introduction: Venous Thromboembolism (VTE) and Pulmonary Embolism (PE) are more common following orthopaedic surgeries around the hip than other surgeries. However, there is still a dilemma among orthopaedic surgeons regarding whether routine thromboprophylaxis is justified in patients. Aim: To describe current practices among orthopaedic surgeons regarding routine thromboprophylaxis among patients with proximal femur fractures. Materials and Methods: A cross-sectional exploratory study was conducted at Department of Orthopaedics, Saveetha Medical College, Chennai, Tamil Nadu, India between March 2022 and May 2022 among orthopaedic surgeons. A Google survey form, containing 10 prevalidated multiple-choice questions, was shared on social media and medical groups. Descriptive analysis was undertaken, and statistical analysis was done with International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 28.0. Results: Among the 141 respondents, 72% were from private sector institutions/hospitals. Over 90.78% of the respondents indicated that there was a role for anticoagulation therapy in proximal femur fractures, and 92% used low molecular weight heparin. The responses varied slightly depending on whether anticoagulant treatment was used preoperatively (51%) or postoperatively (48%), and if there was a waiting time of less than 24 hours to 3-5 days before surgery. Most orthopaedic surgeons opted for anticoagulation therapy in the presence of a previous history of Deep Vein Thrombosis (DVT)/PE (79%), age greater than 70 years (61%), and use of hormone replacement therapy (64%), or if the surgery lasted more than two hours (61%). Conclusion: The present study concludes that 9.2% of orthopaedic surgeons do not use anticoagulation therapy and nearly half (48%) do not administer anticoagulation therapy preoperatively. As the proportion of elderly patients increases, consensus building will enable the formulation of practice guidelines based on evidence generated through such surveys. [ABSTRACT FROM AUTHOR]

In India, post economic liberalisation period starting from early 1990s opened up new vistas for rapid development of Indian stock markets accompanied by high volatility in stock exchanges. The volume of trade increased rapidly with more number of retail investors beginning to invest in equity shares of listed companies in specific industry sectors. This brought to the fore the importance of analysis of business and financial risks associated with such investment decisions. Every rational investor will do well to analyse the risk and return before investing in any stock or security. The investment process must be considered in terms of both risk and return. The present study deals with the estimation of business risk and financial risk of the selected companies in selected industries, based on empirical analysis. For the study, six industries such as Automobile, Cement, Paint, Paper, Pharmaceuticals and Personal Care(FMCG) have been selected from the Indian industries from April 1996 to March 2020. The findings of the study revealed the extent of the relationship between business and financial risk and return in specific sectors of industry in India. [ABSTRACT FROM AUTHOR]

Introduction: Despite several ongoing efforts in biomedicine and traditional medicine, there are no drugs or vaccines for coronavirus disease 2019 (COVID-19) as of May 2020; Kabasura Kudineer (KSK), a polyherbal formulation from India's Siddha system of medicine, has been traditionally used for clinical presentations similar to that of COVID-19. We explored the efficacy of KSK in reducing viral load and preventing the disease progression in asymptomatic, COVID-19 cases.Methods: A prospective, single-center, open-labeled, randomized, controlled trial was conducted in a COVID Care Centre in Chennai, India. We recruited reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 of 18 to 55 years of age, without clinical symptoms and co-morbidities. They were randomized (1:1 ratio) to KSK (60 mL twice daily for 7 days) or standard of care (7 days supplementation of vitamin C 60,000 IU morning daily and zinc 100 mg evening daily) groups. The primary outcomes were reduction in the SARS-CoV-2 load [as measured by cyclic threshold (CT) value of RT-PCR], prevention of progression of asymptomatic to symptomatic state, and changes in the immunity markers including interleukins (IL-6, IL-10, IL-2), interferon gamma (IFNγ), and tumor necrosis factor (TNF α). Siddha clinical assessment and the occurrence of adverse effects were documented as secondary outcomes. Paired t-test was used in statistical analysis.Results: Viral load in terms of the CT value (RdRp: 95% CI = 1.89 to 5.74) declined significantly on the seventh day in the KSK group and that of the control group, more pronounced in the study group. None progressed to the symptomatic state. There was no significant difference in the biochemical parameters. We did not observe any changes in the Siddha-based clinical examination and adverse events in both groups.Conclusion: KSK significantly reduced SARS-CoV-2 viral load among asymptomatic COVID-19 cases and did not record any adverse effect, indicating the use of KSK in the strategy against COVID-19. Larger, multi-centric trials can strengthen the current findings.Trial Registration: Clinical Trial Registry of India CTRI2020/05/025215 . Registered on 16 May 2020. [ABSTRACT FROM AUTHOR]

The demand for high speed rail networks is rapidly increasing in developing countries like India. One of the major constraints in the design and implementation of high speed train is the braking efficiency with minimum friction losses. Recently, the aerodynamic braking concept has received good attention and it has been incorporated for high speed bullet trains as a testing phase. The braking performance is extremely important to ensure the passenger safety specifically for the trains moving at more than 120 km/h. In this paper, an Indian train configuration WAP7 (wide gauge AC electric passenger, Class 7) has been assumed with the locomotive and one passenger car. Aerodynamic braking system design is done by opening a spoiler over the train to amplify the aerodynamic drag at high speeds. The magnitude of braking force depends on the position and orientation of the braking spoiler. It creates differential drag forces at various deflection angles to decelerate the trains instantaneously in proportion to the running speeds. Drag created by the braking spoiler is observed numerically with the help of CFD simulation tools for further validation through wind tunnel experiments. Striking aerodynamic results are obtained with and without braking spoilers on the passenger cars and the spoiler at 4 0 ∘ − − 5 0 ∘ orientation makes greater drag coefficient as compared to the other angles. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is an emerging preventable cause of blindness in India. All India Ophthalmology Society (AIOS) and Vitreo-Retinal Society of India (VRSI) have initiated several measures to improve of DR screening in India. This article is a consensus statement of the AIOS DR task force and VRSI on practical guidelines of DR screening in India. Although there are regional variations in the prevalence of diabetes in India at present, all the States in India should screen their population for diabetes and its complications. The purpose of DR screening is to identify people with sight-threatening DR (STDR) so that they are treated promptly to prevent blindness. This statement provides strategies for the identification of people with diabetes for DR screening, recommends screening intervals in people with diabetes with and without DR, and describes screening models that are feasible in India. The logistics of DR screening emphasizes the need for dynamic referral pathways with feedback mechanisms. It provides the clinical standards required for DR screening and treatment of STDR and addresses the governance and quality assurance (QA) standards for DR screening in Indian settings. Other aspects incorporate education and training, recommendations on Information technology (IT) infrastructure, potential use of artificial intelligence for grading, data capture, and requirements for maintenance of a DR registry. Finally, the recommendations include public awareness and the need to work with diabetologists to control the risk factors so as to have a long-term impact on prevention of diabetes blindness in India. [ABSTRACT FROM AUTHOR]

Background and Objective: One of the public health hazards has been the Snake bites in the agrarian society of India. Such bites were found to have seasonal pattern during harvesting time. The toxicity of viper venom affects the functions of kidneys and leads to symptoms of cellulites, Disseminated Intra Vascular Coagulation (DIVC), cerebral sign. Serum based polyvalent Anti Snake venom (ASV) vials are commonly injected as antidotes accompanied by dialysis procedure to save life and avoid complications. This paper statistically attempted to predict the number of ASVs for conserving the scarce resource and on the frequency of dialysis. Such sudden snake bites cause debacle in family life of patient socially, economically and therefore prediction of management of procedures would facilitate to counsel patients and their relatives on the cost of treatment and the length of hospital stay as it is unknown, unexpected expenditure in the family. Material and methods: This was retrospective study. The sample size was decided on the effect up to 2 vials using the Poisson model for prediction per patient. Accordingly, 45 cases were studied against a required sample of 37 cases. Statistical techniques such as Stratified control charts, ANOVA, Matrix plot and Regression were carried out in order to predict the number of vials and frequency of dialysis. Results: Average number of vials increased from 18 vials (10 to 26) to 30 (19 to 40) significantly per patient when the DIVC symptoms were noticed (67%). Same was the case with cerebral sign increasing the ASV from 22 (12 to 31) to 35 (23 to 47) that increased by of 60% per patient. It was also noticed that, number of vials did not increase due to delay in admission from the time of bite, and as a contrary, the study group revealed the declining trend from 15 to 5 from the same date of admission to delayed by 3 days. The average predicted ASV was determined by the equation considering only 5 terms among 10 terms (Age, BP Sys, BP diastolic, no of admission days, DIVC, Cerebral sign, Gender, CT Minutes, Total dialysis, age x no. of days) as significant predictors and was used for prediction. Conclusion: BP diastolic increase of 10 mm Hg increased an average by 17 vials. Presence of cerebral sign increases by 13 vials followed by DIVC at 10 vials. As the age and no of days increase there was declining trend in injection of vials. The correlation between no of ASV and no of dialysis was not established and they do not complement each other. [ABSTRACT FROM AUTHOR]

Background: In India, about 1 million people are bitten by snakes more in the rural area and they get admitted to hospitals. About 50,000, people die of snake bites every year in India. The patients admitted with poisonous snake bites were treated with polyvalent anti snake venom serum. Aim: To determine the significant difference and outcome between High Dose and Low dose Polyvalent Anti Snake Venom Serum (PVASVS), with regards to age gender and severity of coagulation abnormalities. The cost of ASV has an economic impact and if low dose ASV saves the scarce resource. Materials and Methods: 45 patients bitten by snake admitted and treated which included both males and females were taken up for this study based on Poisson model of sampling. All the patients had cellulitis, renal failure and varying degree of coagulation abnormalities. They were classified into LDG and HDG depending on the number of PVASVS they received which was ≤25 vials or >25 vials respectively. This was decided based on the treatment of ASV analyzed using chi-square contingency statistically for its significance. Results: The age and clotting time as such do not have association to distinguish HDG or LDG. It was revealed that Gender has an effect that female HDG are 26.3% (5 out of 19) as compared to male 73.7% (14 out of 19). In each group, 2 patients died out of 18, LDG (11%) 27 in HDG (7.4%) 62.9% of patients in LDG and 38.8% in HDG required hospital stay more than 10 days. Conclusions: The female gender falls in low dose conserving ASV. The LD ASV demands higher duration of stay (more than 10 days) in the hospital. The age, coagulation abnormality did not establish the significant results in the LDG and HDG. [ABSTRACT FROM AUTHOR]

The article presents a commentary on COVID-19-specific clinical research using traditional medicine with lessons from traditional Chinese medicine for India's Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) systems. Topics include tabilized blood oxygen saturation and reduced respiratory support and antibiotic use; and health systems are well-recognized and wellsupported by the Government of India (GoI) through various plans and policies.

Background: The incidence of fatty liver in India is estimated to be around 9-32% with higher incidence in diabetics, obese and dyslipidemic patients. The incidence is increasing with the noninvasive investigation of ultra-sound abdomen and greater awareness of patients opting for Master Health Checkups. Aim of the study: The aim of the study was to analyze the causative factor of fatty liver and their relative incidence in the patients who reported to out-patient clinic with Master Health Checkup details. Materials and Methods: The analysis was performed as an out-patient procedure by scrutinizing the master health checkup results. Interview technique was used to collect information on a predesigned protocol. The patients with ultrasound abdomen report revealing fatty liver were all taken up for the study which included both male and female patients. Results: The main cause for alcoholic fatty liver was consumption of alcohol. There was a positive history of alcohol intake in 43 patients out of 122 patients studied (35%). The remaining percentage comes under Non Alcoholic Fatty Liver Disease (NAFLD) and the various causes include obesity (91%) Dydlipidemia (96%), Diabetes Mellitus (47.5%). Hypothyroidism was present in 3 patients and 5 patients had no other specific risk factors probably belonging to idiopathic group. Conclusions: Males constitute 71% and females 29%, out of 122 patients studied with fatty liver. The causes are alcohol (35%), obesity (91%), dyslipidaemia (96%), diabetes mellitus (47.5%) were found in this study. [ABSTRACT FROM AUTHOR]

Background: Globally, depression and depressive disorder are common amongst people of all ages, especially amongst 15–29 years old. The prevalence of depression amongst medical students was studied on the World Health Day 2017 using the Brief Patient Health Questionnaire. Objective: The objective was to study the prevalence of depression and depressive symptoms amongst students of a class of MBBS based on responses collected anonymously in the year 2017. Materials and Methods: A class of students in a medical college was administered the questionnaire consisting of nine items, and 81 students participated in this study. Each item was explained, and the students were given time to think and mark their respective responses. The results of responses of 79 students who answered all questions are reported. Based on the cumulative score of their responses, depression was graded as minimal, mild, moderate, moderately severe and severe depression. Results and Discussion: Twenty‑four male students and 55 female students constituted the study population. Overall, 91% of the students reported some degree of depression in the previous 2 weeks. Nearly 8.9% of the students did not have any depressive symptoms over the previous 2‑week period. Almost 12.7% and 5.1% of the students reported moderately severe and severe depression, respectively. Minimal, mild and moderate depression were reported by 21.5%, 32.9% and 22.8% of the students, respectively. Students with depression were informed to consult with a psychiatrist for formal evaluation. Conclusion: The prevalence of depressive symptoms is very high amongst medical students, and a formal study with intervention is the need of the hour. [ABSTRACT FROM AUTHOR]

A study was conducted in different agroclimatic zones of Tamil Nadu with the objective of assessment of Soil Organic Carbon (SOC) stock and its changes overtime, prediction of SOC stock under existing and alternate cropping pattern using Roth C model. Fifteen benchmark soils were selected in different agroclimatic zones of Tamil Nadu based on their land use and areal extent to assess SOC level and its changes overtime. Results revealed that, during 1997 and 2007 SOC was higher in forest ecosystem of pedon 15 (Ooty series) and in pedon 14 (Pechiparai series) of horticultural land use. Among seven agroclimatic zones of Tamil Nadu soil series in five agroclimatic zones viz., Periyanaickenpalayam series (Western zone), Peelamedu series (Southern zone), Vallam series (North eastern zone), Vannappatti series (North western zone) and Padugai series (Cauvery delta zone) were selected to predict SOC stock for the year 2025 and 2050 except hilly and high rainfall zone due to high organic carbon content in these agroclimatic zones. Results showed that, among the soil series selected for the study, Vannappatti and Padugai series registered the highest Total Organic Carbon (TOC), Biomass Carbon (BIO) and Humified Organic Carbon (HUM) under existing cropping pattern while Periyanaickenpalayam, Peelamedu and Vallam series had high TOC, BIO and HUM under alternate cropping pattern. Among five selected soil series, Periyanaickenpalayam, Peelamedu and Padugai series recorded 7.5 g kg-1 TOC during 2025 and 2018, 2100 and 2035, 2013 and 2014 under existing and alternate cropping pattern respectively. [ABSTRACT FROM AUTHOR]

As a part of SEFI protocol, blood cultures are performed for children with fever lasting for >=3 days, and thereby 24 children with jaundice received a blood culture during the same episode of illness when they presented with jaundice. B Conclusion: b Our findings highlight that Hepatitis A infection can present as sporadic outbreaks in communities with sub-standard water and sewage systems, along with the co-infection of other enteric infections such as invasive Salmonellosis. B Background: b Outbreaks of Hepatitis A virus (HAV) infection continue to be reported from India, that have transitioned from hyper-to-intermediate endemicity. [Extracted from the article]

Drought is an insidious hazard of nature and is considered to be the most complex but least understood of all natural hazards. Large historical datasets are required to study drought and these involve complex interrelationships between climatological and meteorological data. Rainfall is an important meteorological parameter; the amount and distribution influence the type of vegetation in a region. To analyse the changes in vegetation cover due to variation in rainfall and identify the land-use areas facing drought risk, rainfall data from 1981 to 2003 were categorized into excess, normal, deficit and drought years. The Advanced Very High Resolution Radiometer (AVHRR) sensor's composite dataset was used for analysing the temporal and interannual behaviour of surface vegetation. The various land-use classes - crop land (annual, perennial crops), scrub land, barren land, forest land, degraded pasture and grassland - were identified using satellite data for excess, normal, deficit and drought years. Normalized Difference Vegetation Indices (NDVIs) were derived from satellite data for each land-use class and the highest NDVI mean values were 0.515, 0.436 and 0.385 for the tapioca crop in excess, normal and deficit years, respectively, whereas in the drought year, the groundnut crop (0.267) showed the maximum. Grassland recorded the lowest value of NDVI in all years except for the excess year. Annual crops, such as groundnut (0.398), pulses (0.313), sorghum (0.120), tapioca (0.436) and horse gram (0.259), registered comparatively higher NDVI values than the perennial crops for the normal year. The Vegetation Condition Index (VCI) was used to estimate vegetation health and monitor drought. Among land-use classes, the maximum VCI value of 92.1% was observed in onions for the excess year, whereas groundnut witnessed the maximum values of 78.2, 64.5 and 55.2% for normal, deficit and drought years, respectively. Based on the VCI classification, all land-use classes fall into the optimal or normal vegetation category in excess and normal years, whereas in drought years most of the land-use classes fall into the drought category except for sorghum, groundnut, pulses and grasses. These crops (sorghum 39.7%, groundnut 55.2%, pulses 38.5% and grassland 38.6%) registered maximum VCI values, revealing that they were sustained under drought conditions. It is suggested that the existing crop pattern be modified in drought periods by selecting the suitable crops of sorghum, groundnut and pulses and avoiding the cultivation of onion, rice and tapioca. [ABSTRACT FROM AUTHOR]

Objectives: The primary objectives of this study are to determine efficacy of Siddha medicine, Kabasura kudineer in reduction of SARS-CoV-2 viral load and reducing the onset of symptoms in asymptomatic COVID-19 when compared to Vitamin C and Zinc (CZ) supplementation. In addition, the trial will examine the changes in the immunological markers of the Siddha medicine against control. The secondary objectives of the trial are to evaluate the safety of the Siddha medicine and to document clinical profile of asymptomatic COVID-19 as per principles of Siddha system of Medicine.Trial Design: A single centre, open-label, parallel group (1:1 allocation ratio), exploratory randomized controlled trial.Participants: Cases admitted at non-hospital settings designated as COVID Care Centre and managed by the State Government Stanley Medical College, Chennai, Tamil Nadu, India will be recruited. Eligible participants will be those tested positive for COVID-19 by Reverse Transcriptase Polymerase Chain reaction (RT-PCR) aged 18 to 55 years without any symptoms and co-morbidities like diabetes mellitus, hypertension and bronchial asthma. Those pregnant or lactating, with severe respiratory disease, already participating in COVID trials and with severe illness like malignancy will be excluded.Intervention and Comparator: Adopting traditional methods, decoction of Kabasura kudineer will be prepared by boiling 5g of KSK powder in 240 ml water and reduced to one-fourth (60ml) and filtered. The KSK group will receive a dose of 60ml decoction, orally in the morning and evening after food for 14 days. The control group will receive Vitamin C (60000 IU) and Zinc tablets (100mg) orally in the morning and evening respectively for 14 days.Main Outcomes: The primary outcomes are the reduction in the SARS-CoV-2 load [as measured by cyclic threshold (CT) value of RT-PCR] from the baseline to that of seventh day of the treatment, prevention of progression of asymptomatic to symptomatic state (clinical symptoms like fever, cough and breathlessness) and changes in the immunity markers [Interleukins (IL) 6, IL10, IL2, Interferon gamma (IFNγ) and Tumor Necrosis Factor (TNF) alpha]. Clinical assessment of COVID-19 as per standard Siddha system of medicine principles and the occurrence of adverse effects will be documented as secondary outcomes.Randomisation: The assignment to the study or control group will be allocated in equal numbers through randomization using random number generation in Microsoft Excel by a statistician who is not involved in the trial. The allocation scheme will be made by an independent statistician using a sealed envelope. The participants will be allocated immediately after the eligibility assessment and informed consent procedures.Blinding (masking): This study is unblinded. The investigators will be blinded to data analysis, which will be carried out by a statistician who is not involved in the trial.Numbers To Be Randomised (sample Size): Sample size could not be calculated, as there is no prior trial on KSK. This trial will be a pilot trial. Hence, we intend to recruit 60 participants in total using a 1:1 allocation ratio, with 30 participants randomised into each arm.Trial Status: Protocol version 2.0 dated 16th May 2020. Recruitment is completed. The trial started recruitment on the 25th May 2020. We anticipate study including data analysis will finish on November 2020. We also stated that protocol was submitted before the end of data collection TRIAL REGISTRATION: The study protocol was registered with clinical trial registry of India (CTRI) with CTRI/2020/05/025215 on 16 May 2020.Full Protocol: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2). [ABSTRACT FROM AUTHOR]

In this study, we estimated the causes for hospitalization, risk-factors and the direct costs incurred towards hospitalization in the Surveillance for Enteric Fever in India (SEFI) cohort established at Vellore. B Background: b Understanding trends in hospitalization among children from low-and middle-income countries (LMIC), especially in settings with a high burden of infectious diseases is essential to understand healthcare needs of the population as well as to prioritize interventions, given the resource-constrained background. [Extracted from the article]

The author reflects on the accomplishments achieved by blindness prevention programs in India. He says that India was the first country in the world to launch a national program to prevent blindness in 1976. He believes that there is a need for a holistic and comprehensive approach to tackle blindness which should begin from ophthalmic education. According to a study, cataract, glaucoma, refractive errors, and corneal opacity are leading causes of blindness in India.

Development of F1 hybrids through intervarietal hybridization has been a very promising line of economic production along with shoot and fruit borer resistance and improved quality. Based on this background, present studies were taken up to know the organoleptic quality of borer resistant hybrids. The hybrid EP 65 x Pusa Uttam ranked first for flavour both in bajji and poriyal and also for taste in poriyal. The next best scorer was EP 104 x APAU Bagmathi. The preparations made from the check variety CO 2 got the lowest score for all the characteristics except overall acceptability for poriyal, where it ranked third. The results indicated that these hybrids do not have negative quality such as bitter taste as compared to the standard variety CO 2. This is an added advantage for these hybrids. [ABSTRACT FROM AUTHOR]

Background: Selfies have been defined as "a photograph that one has taken of oneself, and are a continuing growing trend among Millennials and Gen Z". Narcissism refers to a personality trait of an extraordinary self-awareness and adoration. Studies have shown a close relationship between selfie-taking behavior, narcissism and oral health. Hence, a study was conducted with aim of assessing correlations between perceived health, perceived oral health, selfie-taking behavior, narcissism and oral health behavior in an adolescent population., Methods: An analytical cross-sectional questionnaire study was designed using relevant literature for collating information on sociodemographic characteristics, frequency of dental visits, selfie-taking behavior and perceived oral health. Oral health examination was performed to assess decay and plaque using DMFT index and Plaque index. Narcissism was assessed using The Five-Factor Narcissism Inventory Short Form., Results: The study included a sample of 163 participants. The associations between selfies taken per day and perceived oral health was statistically significant (p value 0.047*). Binary logistic regression models were constructed, which were significant for perceived oral health and grandiose fantasy. Plaque Scores showed significant corelations between indifference, manipulativeness, thrill seeking and age. Step forward binary regression demonstrated a significant odds ratio for grandiose narcissism followed by selfie-taking behavior., Conclusion: This study revealed a correlation between perceived oral health and selfie-taking behaviour. Further studies are required to assess selfie-taking behaviour and oral health., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Prabhu P et al.)

Background: In India, a significant scarcity of published data exists regarding chronic limb-threatening ischemia (CLTI) and its management, especially among the elderly population. CLTI, often accompanied by frailty poses a significant healthcare challenge. While endovascular interventions offer hope, there remains a dearth of outcome data for this age group. This study seeks to address this critical gap by investigating the impact of frailty on outcomes, emphasizing amputation-free survival (AFS), wound healing, and health-related quality of life (HRQoL)., Methods: Our study included 131 elderly CLTI patients aged ≥70 years who underwent infrainguinal endovascular interventions between April 2018 and August 2021, with a follow-up period of 2 years. Among the patients, 93.9% had diabetes mellitus and 82.4% had hypertension. Clinical frailty was assessed using the clinical frailty scale (CFS). Patients were categorized into group 1 (CFS 1-5) and group 2 (CFS 6-9). Primary outcomes were AFS, wound healing, HRQoL, and their association with frailty. Secondary outcomes included technical success, procedure-related complications, major adverse limb events, major adverse cardiac events, vessel patency, re-intervention rates, and mortality rates including periprocedural and overall mortality., Results: Technical success was achieved in 86.3% of patients, with frailty significantly influencing this outcome. Group 2 exhibited reduced technical success (80.8%) compared to group 1 (93.1%). The major amputation rate was 9.2%, with higher rates in group 2 [univariate hazard ratio: 5.20; P = 0.033]. Similarly, group 2 showed elevated overall mortality [univariate hazard ratio: 5.18; P < 0.001]. AFS at 1 and 2 years were 67.9% and 55%, respectively, with higher rates in group 1. Wound healing was achieved in 76.1% of patients (83/109), with frailty significantly associated with delayed wound healing (P < 0.001). Vessel patency at 1 year was observed in 88.8% of patients. HRQoL significantly improved postintervention, with vascular quality of life questionnaire-6 (VascuQol-6) scores increasing from an average of 9 of 24 at baseline to 20 of 24 at 2 years. Frailty score significantly correlated with VascuQol-6 scores at 1 and 2 years (P < 0.0012). Group 1 exhibited higher VascuQol-6 scores than group 2, indicating improved HRQoL during follow-up., Conclusions: Successful endovascular treatments in high-risk CLTI patients promote improved wound healing and post-treatment quality of life. Frailty should be assessed before endovascular interventions as it correlates with adverse outcomes, including amputations and mortality. While revascularization holds promise, caution is advised for frailer patients, emphasizing the importance of personalized care and tailored treatments for elderly CLTI patients., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: This study aims to evaluate the accuracy rate of foramen magnum dimensions in determining sex among the South Indian population using discriminant functional analysis., Methods: An observational study in which CBCT images from 200 full field of view (FOV) scans were analysed. The dimensions of the foramen magnum were measured. Intra- and interobserver reliability were calculated. Independent t -tests were used to compare the various parameters between sexes. Stepwise discriminant function analysis was used to determine sex., Results: A total of 200 CBCT scans were included in the study. The mean age (±SD) was 25.66 (±7.11) years among males and 24.64 (±5.12) years among females. The measurements and the circumference of the foramen magnum were significantly ( p < 0.001) greater in males than in females. The univariate analysis of foramen magnum measurements reached an accuracy rate of 73.5% in sex determination. The discriminant function analysis combining the foramen magnum measurements and circumference yielded an overall predictability rate of 66.5% for determining sex., Conclusion: Taking into account the predictability rate of sex based on foramen measurement in the present population, it can be concluded that its applicability should be limited to cases associated with fragmentary skull bases., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2024 Junaid Ahmed et al.)

Background & objectives Tuberculosis (TB) remains a persistent public health challenge in India. The country also has high proportions of malnutrition in different areas, making the population susceptible to TB. Among vulnerable populations, such as tribal communities, TB and malnutrition pose significant threats. Tribal populations exhibit disproportionately higher TB prevalence rates compared to non-tribal groups. Also, malnutrition prevalence among tribal communities far exceeds national averages in India. Amidst fragmented data, a systematic review of nutritional status among tribal populations with TB in India is imperative to inform comprehensive intervention strategies. Methods Cross-sectional, case-control, cohort and interventional studies reporting the nutritional status of active TB affected individuals among tribal populations in India were specifically included if terms such as "malnutrition" or "low BMI" were used. This systematic review followed PRISMA guidelines and was registered with PROSPERO (CRD42020168328). The data was assessed using a random-effects model and standardized mean with 95% confidence interval (CI). The I2 statistics indicated heterogeneity. Publication bias was evaluated using funnel plots. Results Out of 124 studies, 20 were selected for initial screening, 15 were excluded due to a lack of appropriate data, and five were included for the final analysis. The pooled prevalence estimates of malnutrition among Indian tribes living with TB was 514 per 1000 people, with 95% CI: 232-791. The sensitivity analysis showed that no individual study influenced the estimation of pooled prevalence. Interpretation & conclusions In the background of India, contributing considerably to the burden of TB-related morbidity and mortality alongside undernutrition, reviews have underscored undernutrition as the predominant risk factor for TB, affecting over 50 per cent of the population in some States. This situation is exacerbated among the tribal communities in India due to the dual burdens of undernutrition and TB being more pronounced. Our systematic review consolidates evidence from five studies, revealing the prevalence of malnutrition among tribal TB patients. Conducting well-planned implementation research to address this dual burden among the underprivileged population would help achieve the ambitious goal of a TB-free India 2025.

Background: Online education has emerged as a crucial tool for imparting knowledge and skills to students in the twenty-first century, especially in developing nations like India, which previously relied heavily on traditional teaching methods., Methods: This study delved into the perceptions and challenges experienced by students and teachers in the context of online education during the COVID-19 pandemic. Data were collected from a sample of 491 dental students and 132 teachers utilizing a cross-sectional research design and an online-validated survey questionnaire., Results: The study's findings revealed significant insights. Internet accessibility emerged as a major impediment for students, with online instruction proving more effective for theoretical subjects compared to practical ones. Although most teachers expressed comfort with online teaching, they highlighted the absence of classroom interaction as a significant challenge., Conclusion: This study comprehensively examines the perspectives of both students and teachers regarding online education during the pandemic. The results carry substantial implications for the academic community, underscoring the need to address internet access issues and explore ways to enhance engagement and interaction in online learning environments., (© 2024. The Author(s).)

Cystic fibrosis (CF) is a life-threatening monogenic disease affecting thousands of people worldwide. Cystic fibrosis transmembrane conductance regulator (CFTR) is an ion channel that facilitates transportation of water and salts across epithelial cell membranes through the conductance of Cl - and other anions. A dysfunctional CFTR due to abnormalities in the cftr gene causes CF, which is believed to be a rare disease in India mainly due to mis/underdiagnosis. Although numerous diagnostic methods and treatment options are available for CF globally, most of these are unaffordable for developing countries like India. Currently, CF symptoms are managed with mucolytics, antibiotics, anti-inflammatory drugs, and various CFTR modulators based on the type of defect. While a definitive cure for CF remains elusive, advancements in stem cell and gene therapies hold promise for permanent cure in the near future. In this review, we discuss the prevalence of CF cases in India, affordable diagnostic methods, and treatment options amenable for developing countries. We further emphasize the scope for the universal newborn screening programme.

Purpose: Exposures to volatile organic compounds (VOCs) cause respiratory symptoms among children, a known vulnerable group. Reports on exposures to VOCs and respiratory symptoms among South Indian children living in biomass-using households are not available thus far., Methods: A cross-sectional study was conducted among 313 rural children to assess the influence of emitted VOCs on their respiratory health. Standard analytical procedures for VOCs and Pulmonary Function Test (PFT), allied questionnaires, and all ethical considerations were fulfilled in the study., Results: The increase in VOC concentrations was observed proportional to the amount of burnt biomass fuel in two selected sites in Tamil Nadu (TN) and Andhra Pradesh (AP). Houses cooked for more than 60 min showed a remarkable increase in VOC concentrations and was observed as statistically significant (p < 0.01) in AP households. Among the younger children, the peak expiratory flow rate (PEFR) values were found significantly higher than comparatively older children in both the sites, TN and AP. However, the trend with respect to FEV1 is statistically significant (p < 0.01) among AP children., Conclusions: This study reports reduced lung function for a considerable proportion of the VOC-exposed selected children. Based on PFT, the children who were interpreted to be normal were found to be exposed to lesser indoor TVOC concentrations in comparison with the children of the households having restrictive or obstructive impairments. Diagnostic ratios with Benzene/Toluene (B/T) and Xylene/Ethyl benzene (X/E) confirmed the presence of VOCs-emissions from adjacent cooking fuels only. The observed results of this study recommends cleaner cooking fuel-use for better respiratory health among the citizens across the country, which in turn, in line with the Pradhan Mantri Ujjwala Yojana (PMUY), Government of India., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: To examine the effectiveness of a computer-assisted device (CAD) for diabetic retinopathy (DR) screening from retinal photographs at a vitreoretinal outpatient department (VR OPD), telecamps, and diabetes outpatient clinic by an ophthalmologist. In particular, the effectiveness of CAD in gradable and ungradable retinal images was examined. Methods: A total of 848 eyes of 485 patients underwent 45° retinal photographs at the VR OPD of a tertiary care hospital in southern India. A total of 939 eyes of 472 patients with diabetes were examined in the telecamps conducted in remote villages in Tamil Nadu, a state in southern India. A total of 2,526 eyes of 1,263 patients were examined in a diabetes clinic using 45° field retinal photographs. The algorithm was validated under physiological dilatation (without pharmacological dilatation) in all three arms. Results: Seventy-one percent of 848 eyes in VR OPD, 13% of 939 eyes in telecamps, and 7% of 2,526 eyes in diabetes clinic were diagnosed to have DR. The algorithm showed 78.3% sensitivity and 55.1% specificity for all images and 78.9% sensitivity and 56.8% specificity for gradable images in the VR OPD; 80.1% sensitivity and 79.2% specificity for all images and 84.8% sensitivity and 80.0% sensitivity for gradable images in telecamps; 63.0% sensitivity and 79.6% specificity for all images and 63.2% sensitivity and 78.1% specificity for gradable images in the diabetes clinic. The algorithm had an overall accuracy of 76.4%. The ungradable rate was variable. Conclusion: The algorithm performs equally well in identifying DR from gradable and ungradable photographs and may be used for DR screening in a rural setting with limited or no access to eye care.

Polycyclic aromatic hydrocarbons (PAHs) are well-known hazardous substances; nevertheless, research on their exposure and health concerns associated with kerosene fuel emissions is limited. In this study, PAH (combined gaseous and particle phase) monitoring was carried out in the kitchen and living room in selected households. Personal exposure and cooking time monitoring were also carried out, simultaneously. The study's findings revealed that BaP, BA, BbF, and Nap were the most prevalent PAHs in both the summer and winter seasons, regardless of urban or rural households. The estimated values of average incremental lifetime cancer risks were found to be greater than the USEPA level, i.e., 1 × 10 -6 , in both urban and rural households, regardless of seasonal fluctuation. In both seasons, the non-carcinogenic risk for developmental and reproductive effects was higher in rural women than in urban women, and in case of developmental risk it showed greater than unity (rural: 1.11 and urban 1.03) in the winter season. On the other hand, Monte Carlo simulation model revealed that concentrations of PAHs (97.1% and 97.5%) and exposure duration (51.7% and 56.7%) were the most sensitive factors contributed for health risk estimations for urban and rural area in both seasons, respectively. Furthermore, the results clearly showed that women who were using kerosene for cooking were at a greater risk of acquiring both carcinogenic and non-carcinogenic health consequences from PAH exposure from kerosene cookstoves. It was recommended that they should utilize clean fuel, either by using LPG under the PMUY scheme or by using electricity/solar power to reduce health risks for better health., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: To describe the epidemiology of cancer in sites associated with tobacco use in India, according to recent findings from the National Cancer Registry Programme., Methods: The data on cancers in sites associated with tobacco use has been sourced from 28 population-based and 58 hospital-based cancer registries of the National Cancer Registry Programme in India. The data covering a period of 5 years (2012-2016) was taken up for analysis., Results: The highest age-adjusted incidence rate (AAR) among males was reported in the Aizawl district in Mizoram (197.3 per 100 000). The AAR was the highest (121.1 per 100 000) in the Papumpare district in females. The top five leading sites were cancers of the lung (10.7%), mouth (8.7%), oesophagus (6%), tongue (6%) and stomach (5%) among males and cancer of the cervix (10.3%), lung (4.3%), oesophagus (3.3%), mouth (3.3%) and tongue (2.7%) in females. The highest significant increase in AAR, indicated by the annual percentage change was seen among males in Aurangabad (3.4) and females in Kamrup urban (2.4). Except for lung cancer, most patients with other cancer types among both genders presented to the health facility with a locoregional (spread to nearby lymph nodes) disease spread. It is projected that in 2025, there will be 694367 cases of cancers in the sites associated with tobacco use., Conclusion: Tobacco uses in either form and cancer in sites associated with tobacco use are an important matter of public health concern in India. Cancer registries play a crucial role in identifying populations with high cancer incidence in sites associated with tobacco use, monitoring the trends over time, and evaluating the impact of tobacco control measures., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Baseline knowledge and attitudes regarding diabetic retinopathy (DR) have not been previously reported for type 2 diabetes mellitus adults (T2DM) in Dharavi, one of the largest slums in Mumbai. Furthermore, a pre- and post-intervention survey study regarding this topic has not been conducted to date in Dharavi. This pre- and post-intervention survey study analyzes the impacts of DR counseling sessions administered individually on the knowledge and attitudes of T2DM participants recruited from Dharavi., Methods: Potential subjects (>30 years old) from Dharavi were enrolled by community workers and screened for T2DM. Those with confirmed T2DM were each registered for an individual DR counseling session. A survey was distributed to participants before the counseling session to determine their baseline knowledge and attitudes. The same survey was distributed after the counseling session, and changes in pre- and post-survey responses were analyzed., Results: Exactly 1718 T2DM study participants were given pre- and post-surveys. Before the counseling, T2DM participants showed low baseline knowledge and attitudes regarding DR, with only 30.8% (530/1718) participants being aware that diabetes can affect the eye. Participants showed significant improvements after the counseling session, with more participants showing willingness to attend DR screenings (pre: 38.3.%, post: 56.8%; P < 0.0001) and more becoming aware that diabetes can affect the eye (90.4%, 1553/1718; P < 0.0001)., Conclusion: Targeted educational interventions for T2DM individuals from the slums of western India, such as Dharavi, can lead to significant improvements in knowledge and attitudes, representing a promising avenue in tackling the burden of avoidable blindness caused by DR in India., Competing Interests: None

Background: The study aimed to analyze frequency and severity of adverse events (AEs) and other reasons for interruption of treatment and loss to follow up (LTFU) during first six months of treatment among tuberculosis patients on bedaquiline containing regimens., Methods: This pilot exploratory observational study included 275 patients enrolled consecutively over two years who received bedaquiline containing regimen under programmatic conditions in India., Results: Among 275 patients with median age of 25 years, 86 (31.3%) patients had at least one interruption with 122 total episodes of interruption. Among these 70 were temporary, 35 were permanent interruptions and 17 were LTFU. The AEs due to drugs were the commonest reason for interruption observed in 81.4% of temporary interruption group and 97.1% of permanent interruption group. Among a total 192 adverse event episodes, (49.5%) were minor (grade 1-2) and (50.5%) were serious (grade 3-5). Personal factors were the commonest reason for interruption observed in LTFU (94.1%) group. The most common temporarily interrupted drug was bedaquiline in 8.7% and permanently stopped drug was linezolid in 5% of patients., Conclusions: Our study observed that drug related AEs are important risk factors associated with treatment interruptions in bedaquiline containing regimens. Bedaquiline is the most common temporarily interrupted drug due to AEs., (Copyright © 2020 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.)

Competing Interests: None

Diabetic macular edema (DME) is a common cause of moderate visual impairment among people with diabetes. Due to the rising number of people with diabetes in India, the absolute numbers of people with DME are significant. There are several treatment options for DME, and the choice of treatment is based on the availability of retinal specialists and infrastructure for the delivery of treatment. A major challenge is the out-of-pocket expenditure incurred by patients as most treatment options are costly. Treatment also varies based on the associated ocular and systemic conditions. The All India Ophthalmology Society (AIOS) and the Vitreo-Retinal Society of India (VRSI) have developed this consensus statement of the AIOS DR task force and VRSI on practice points of DME management in India. The objective is to describe the preferred practice patterns for the management of DME considering the different presentations of DME in different clinical scenarios., Competing Interests: None

Aim: The novel coronavirus disease-2019 (COVID-19) is a major health problem and has affected innumerable people around the world. The current online-based study was conducted to assess the knowledge, attitude and practice (KAP) of dental students and professionals during the early days of lockdown in India from 2 April to 1 May 2020., Methodology: An online-based cross-sectional study was undertaken through WhatsApp messenger and e-mail groups among dental students and professionals. The KAP on COVID-19 was ascertained using an investigator designed and validated questionnaire. The results were stratified based on student vs professionals. The data were expressed as frequency and percentage analysed using the chi-square/Fishers exact test using IBM version 17. A probability value of <.05 was considered significant., Results: A total of 287 complete responses from the dental students and professionals were received. The results indicated that the knowledge of both dental students and professionals were good and that the attitude and practice were in accordance with good clinical practice. No significant differences were found within the domains of KAP scores among the dental students and practitioners indicating that the study participants were abreast with the recent advances., Conclusion: The results of this study conducted during the early stage of the lockdown indicated that the dental students and professionals who had filled the questionnaire had very good knowledge of coronavirus and COVID-19., Clinical Implications: The results of the study indicate that the volunteers had good knowledge, attitude and self-care practice, which are necessary in preventing the spread of COVID-19. It is anticipated that detailed hands-on training in practical aspects of good clinical practice with protective gears will help students and professionals perform the necessary dental procedures in accordance with the guidelines set by Centers for Disease Control and Prevention and World Health Organization., (© 2021 John Wiley & Sons Ltd.)

Purpose: The aim of this study was to determine the prevalence of diabetic retinopathy (DR) and its risk factors among diabetic patients in rural and urban West Bengal (WB)., Methods: Patients were screened in the physician's clinic by a team of ophthalmologist, optometrist and counsellor. Demographic details, diabetic control, compliance to eye checkup, awareness regarding diabetic blindness, and visual acuity were recorded using a questionnaire. DR was graded both by indirect ophthalmoscopy and fundus photo taken with a portable fundus camera., Results: A total of 1553 subjects were screened over 39 camps across 14 districts of WB over 17 months. The prevalence of DR was 21.51%, with a significant difference between rural (26.55%) and urban (13.89%) areas (P < 0.01). No significant difference with gender was seen (P = 0.99). Presence and grade of DR were related to age, loss of vision, diabetic age, diabetic control, awareness of diabetic blindness and last eye checkup., Conclusion: This study provides the first major prevalence data from WB, and gives valuable insight regarding modifiable risk factors for DR. It is also the first DR study in India to be conducted in the physician's clinic. The study results emphasise the need to "fix the missing link" between ophthalmologists and treating physicians to win the battle against DR., Competing Interests: None

Hypertension (HTN) is a globally prevalent non-communicable disease contributing significantly to cardiovascular (CV) morbidity and mortality. In achieving control of HTN, therapeutic adherence plays a crucial role. Studies from India identify varying rates of adherence to antihypertensive medications. Multiple factors determine treatment adherence in HTN. In India, factors such as lower socioeconomic status, health literacy, asymptomatic nature of disease, forgetfulness, cost of medications, and duration of HTN determine the adherence. An excellent physician-patient relationship incorporating adequate counseling along with the use of other methods can identify poor adherence. Improving adherence necessitates incorporating a multipronged approach with strategies directed at physicians, patients, and health systems. With innovation in therapeutics, the pharmaceutical sector can contribute significantly to improve adherence. Furthermore, increasing adherence to lifestyle interventions can help achieve better HTN control and improve CV outcomes. In the Indian context, more emphasis is necessary on patient education, enhanced physician-patient relationship and communication, increased access to health care, and affordability in improving therapeutic adherence in HTN., (Copyright © 2021 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Purpose: The aim of this study was to study the perception of residency trainers about an optimum residency program., Methods: A survey, using a pre-validated questionnaire, was conducted by the Academic and Research Committee of the All India Ophthalmological Society, in 2019-20 with questions directed to teachers in medical colleges and national board of examination's ophthalmology residency programs on demography, teaching experience, imparting clinical and surgical skills, ideal academic schedule and dissertation in the post-graduate residency program., Results: The response rate in the survey was 47.6%. Valid responses were obtained from 309 residency trainers. Of these, 132 of 309 (42.7%) were females. The mean age was 45.3 ± 9.5 years, range 26-68 years. The trainers believed that on a scale of 0-10, clinical skills teaching should be taught, mean ± SD: slit lamp 9.8 ± 0.7; indirect ophthalmoscopy 9.3 ± 1.3; gonioscopy 9.2 ± 1.5; perimetry 8.9 ± 1.5; OCT 8.4 ± 1.9; applanation tonometry 9.5 ± 1.2 and orthoptic evaluation 8.1 (±1.9). A resident should ideally perform independently surgeries (median, inter-quartile range IQR): SICS 50 (IQR 40-100); phaco 50 (20-60); pterygium excision 20 (10-40); DCR 10 (5-20); chalazion 20 (10-50), trabeculectomy 7 (5-15); strabismus 5 (2-10), LASIK and retinal detachment 0. Ideally there should be four lectures, four seminars, four case presentations, five journal clubs and four wet labs every month., Conclusion: Teachers expected their wards to become competent professionals. There was near unanimity about the content of clinical skills training, non-medical skills and academics, but there was a significant variation on extent of surgical training that should be imparted to the residents., Competing Interests: None

Introduction: To report the 10-year rate of vitrectomies and the associated factors in people with proliferative diabetic retinopathy (PDR) from a multicentric cohort of people with diabetes mellitus., Methods: Ten centres in India with established vitreoretinal (VR) services for over 10 years were invited to provide long-term data on PDR. People with Type 1 or 2 diabetes with a clinical diagnosis of active PDR in 1 or both eyes were included. Baseline data collected included age, sex, duration of diabetes, source of referral and best-corrected visual acuity, and diabetic retinopathy status in both eyes. Available follow-up data included the numbers of panretinal photocoagulation (PRP) sessions, cataract surgery, treatment of diabetic macular oedema, use of anti-vascular endothelial growth factor (VEGF) therapy, vitrectomy with or without retinal surgeries over 10 years., Results: Over 10 years, 89% needed supplemental PRP after initial complete PRP. One-third required retinal surgery, 16% needed intravitreal injection. Men (74.5%) had significant higher risk for vitreous (VR) surgery. Of the group with low-risk PDR, 56.8% did not require VR surgery, p < 0.001. Of the patients who underwent cataract surgery and had intravitreal anti-VEGF injections, 78.5 and 28.2% needed subsequent vitreous (VR) surgery, p = 0.006 and <0.0001, respectively. Independent predictors of need for vitreoretinal surgery included those who underwent cataract surgery and those with poor baseline visual acuity (logMAR). Eyes at lower risk for VR surgery included the eyes previously treated with PRP and low-risk PDR at baseline., Conclusion: Despite initial "complete" PRP, one-third of our study cohort needed vitrectomies over 10 years, highlighting that these patients require regular follow-up for a long period of time., (© 2020 S. Karger AG, Basel.)

Background: Lysyl oxidase (LOX) is a copper amine oxidase which belongs to the LOX multigene family and is normally involved in cross-linking of stromal collagen fibers. LOX expression has been found to be associated with increased episodes of recurrence, metastasis and overall poor prognosis in renal cell carcinomas and melanomas. This study aimed to assess the effects of LOX on the prognosis of oral squamous cell carcinoma (OSCC), which is one of the most common cancers in India., Methods: The immunohistochemical expression of lysyl oxidase using LOX2 primary antibody was assessed at the tumor proper, invasive tumor front and peritumoral stroma in tissue sections from 40 cases of histologically proven OSCC., Results: LOX expression was elevated in OSCC patients who had lymph node metastasis and in those who died of disease. No significant variation was seen with histological grade., Conclusions: LOX has a 'pro-neoplastic' effect as it modulates the host stroma to favor increasing tumor mass and worsening prognosis. Increased expression of LOX causes increased collagen fiber cross-linkage that stiffens the stromal matrix. This increases compressive stresses contributing to tissue hypoxia that elevates Rho GTPase-dependent cytoskeletal tension leading to erratic tumor cell morphogenesis that in turn confers motility to these cells resulting in metastasis. Inhibitors of LOX can potentially down-regulate LOX levels in the tumor micro-environment by controlling tissue hypoxia and curtailing the production of hypoxic LOX molecules.

Background: Mutations in CERKL gene has been reported to cause Retinitis pigmentosa (RP) and clinically appears discrete from other commonly encountered phenotypes. We report 14 patients who were seen to have CERKL mutation of the 152 patients of RP from Indian population who underwent genetic testing., Materials and Methods: A retrospective analysis was performed in 28 eyes of the 14 unrelated patients to establish genotype phenotype correlation. Targeted next generation sequencing was performed using the STRAND® NGS v2.5 software. Validation was done using PCR-based bidirectional Sanger sequencing. Clinical data was collected along with imaging such as fundus photo, autofluorescence(AF), Optical coherence tomography and Electroretinogram wherever available., Results: Three variants c.1045&#95;1046delAT, c.847 C > T and a novel c.899-IG>A were identified. Retinal morphological features were typically bilaterally symmetrical with mild to moderate disc pallor and arteriolar attenuation in all cases, while sparse peripheral pigmentation was noted in seven patients indicating paucipigmentary character. Early macular involvement in all cases was a characteristic finding with central hypo-autofluorescence and surrounding hyper-autofluorescence. Peripheral scalloped chorioretinal atrophic patches were seen in five patients particularly in older patients., Conclusions: Phenotype associated with CERKL mutation appears clinically discrete from other commonly encountered phenotypes of inherited retinal dystrophies. Recognizing this typical genotype phenotype correlation will help clinicians to identify this form of RP, prognosticate the disease and segregate candidates for futures gene therapy.

As the COVID-19 pandemic rages on, India is recording a very high number of new cases daily; even as the country prepares to gradually "unlock", after months of lockdown. While elective eye surgeries such as uncomplicated cataract surgeries, blepharoplasty and eyelid procedures and refractive surgeries can be planned at a later date; emergency cases pertaining to ocular trauma cannot be deferred. This manuscript gives a brief overview of the general guidelines for the management of ocular trauma during the COVID-19 pandemic., Competing Interests: None

Flooding in urban basins is a major natural catastrophe that leads to many causalities of life and property. The semi-urbanized Koraiyar River basin in Tamil Nadu has important cities like Tiruchirappalli and many towns located in it. The basin unfailingly experiences a flood event in almost every decade. It is anticipated that the basin will undergo rapid unplanned urbanization in the years to come. Such fast and erratic urban developments will only increase the risk of urban floods ultimately resulting in loss of human lives and extensive damages to property and infrastructure. The effects of urbanization can be quantified in the form of land use land cover (LULC) changes. The LULC change and its impacts on urban runoff are studied for the continuous 30-year present time period of (1986-2016) to reliably predict the anticipated impact in the future time period of (2026-2036). The analysis of land cover patterns over the years shows that urbanization is more prevalent in the northern part of the basin of the chosen study area when compared with the other regions. The extreme rainfall events that occurred in the past, and the probable future LULC changes, as well as their influence on urban runoff, are studied together in the current study. In order to minimize flood damages due to these changing land use conditions, certain preventive and protective measures have to be adopted at the earliest. There are some inevitable limitations while applying traditional measures in flood modeling studies. This investigative work considers a case study on the ungauged Koraiyar floodplains. The spatial scale risk assessment is assessed by coupling geographic information systems, remote sensing, hydrologic, and hydraulic modeling, to estimate the flood hazard probabilities in the Koraiyar basin. The maximum flood flow is generated from the Hydrologic Engineering Centre-Hydrologic Modeling System (HEC-HMS), the hydrologic model adopted in the present study. The maximum flood flow is given as input to the Hydrologic Engineering Centre-River Analysis System (HEC-RAS), an effective hydraulic model that generates water depth and flood spread area in the basin. The flood depth and hazard maps are derived for 2, 5, 10, 50, and 100-year return periods. From the analysis, it is observed that the minimum flood depth is less than 1.2 m to a maximum of 4.7 m for the 100-year return period of past to predicted future years. The simulated results show that the maximum flood depth of 4.7 m with flood hazard area of 4.32% is identified as high hazard zones from the years 1986-2036, located in the center of the basin in Tiruchirappalli city. The very high hazard flood-affected zone in the Koraiyar basin during this period is about 198.85 km 2 . It is noticed that the very low hazard zone occupies more area in the basin for the present and future simulations of flood hazard maps. The results show that the increase in peak runoff and runoff volume is marginally varied.

Women are underrepresented in groups of patients seeking hypertension care in India. The present paper reports trends in office and ambulatory blood pressure measurement (OBPM, ABPM) and 24-h heart rate (HR) with sex in 14,977 subjects untreated for hypertension (aged 47.3 ± 13.9 years, males 69.4%) visiting primary care physicians. Results showed that, for systolic blood pressure (SBP), females had lower daytime ABPM (131 ± 16 vs. 133 ± 14 mm Hg, P < .001) but higher nighttime ABPM (122 ± 18 vs. 121 ± 16 mm Hg, P < .001) than males. Females had higher HR than men at daytime (80 ± 11 vs 79 ± 11.5 bpm) and nighttime (71 ± 11 vs 69 ± 11), respectively (all P < .001). Dipping percentages for SBP (7.4 ± 7.3 vs 9.3 ± 7.4%), DBP (10.1 ± 8.6 vs. 12.3 ± 8.9%), and HR (10.7 ± 7.9 vs. 12.8 ± 9.2%) were lower (P < .001) for females than for males, respectively. Females more often had isolated nighttime hypertension as compared to males (14.9%, n = 684% vs 10.6%, n = 1105; P < .001). BP patterns and HR showed clear differences in sex, particularly at nighttime. As females were more often affected by non-dipping and elevated nighttime SBP and HR than males, they should receive ABPM, at least, as frequently as men to document higher risk necessitating treatment., (© 2020 Wiley Periodicals LLC.)

To provide the real-world outcomes of people with proliferative diabetic retinopathy (PDR) in India and highlight opportunities for improvement of their disease status and to evaluate their visual acuity (VA) status. A multicenter retrospective study in which ten centers in India with established vitreoretinal services for over 10 years were invited to provide long-term data on PDR. This study population were of Indian nationality. Patients with a diagnosis of type 1 or 2 diabetes with a clinical diagnosis of active PDR in any or both eyes, who had long term follow-up for up to 10 years were included. Baseline data collected included age, sex, duration of diabetes, source of referral and best-corrected visual acuity, diabetic retinopathy status in both eyes. Available follow-up data on VA were collected at 6 months post baseline, 5 years and 10 years within a ± 3 months window. Evaluating the presenting VA of people with PDR, short-term outcomes at 6 months and the incidence of visual impairment (VI) at 5 and 10 years are the main outcome of the study. Data was available for 516, 424 and 455 patients at baseline, 5 years and 10 years respectively. Gender and duration of diabetes did not have statistically significant effect on VI outcomes. Eyes receiving treatment early in the disease course (i.e. baseline VA ≥ 6/12) had significantly better VA outcomes at 10 years versus eyes treated at a later stage (i.e. baseline VA < 6/12) (p = <0.0001). On comparing eyes with stable treated PDR and persistent PDR at end of 10 year follow up, a significantly higher percentage of eyes in the stable treated group maintained VA of ≥ 6/12 (55.1% vs. 24.2%) (p = < 0.0001), indicating persistent disease activity due to inadequate treatment results in worse VA outcomes. We found no trend in VI or blindness with increasing levels of age at both 5- and 10-year time points (p > 0.05). The age standardized incidence for VI was 11.10% (95% CI 8.1, 14.2) and for blindness was found to be 7.7% (95% CI 5.2, 10.3). Our results suggest that despite robust recent clinical trial results showing that pan retinal photocoagulation is an excellent treatment for PDR, people with diabetes in India need to be made aware of annual screening and treatment of their eyes to avoid vision impairment and blindness.

Telepathology is in its nascent stages in India. Video calling applications in mobile phones can be efficiently used to transmit static and live field microscopic images hastening low cost telepathology. To evaluate the efficiency of WhatsApp® Video Calling for dynamic microscopy in distant diagnosis. Thirty haematoxylin and eosin stained slides of common pathologies were retrieved from the archives of Department of Oral Pathology and Microbiology, coded with relevant history and given to three untrained investigators. The investigators then connected a mobile phone with VOIP facility to a microscope using a custom adaptor. Dynamic fields were transferred to three independent pathologists via WhatsApp® video call. The pathologists attempted to diagnose the lesion based on the live field video over their display screen (phone). Audio quality was found to be better than that of video. In 70% of the cases, pathologists could render a diagnosis (13% gave a confirmed diagnosis, 57.7% gave a probable diagnosis). The average time taken for connecting the adaptor, connecting the call to the pathologist and then receiving the diagnosis was 9:30 min. In addition, proper history taking and staining of the tissue slides were critical to arrive at the diagnosis. WhatsApp® free VOIP facility helped untrained investigators to send the live-field pathologic fields to a specialist rendering histopathological diagnosis. The factors affecting the diagnosis included network stability, clarity of images transmitted, staining quality and contrast of nuclear details of the stain. The history, clinico-pathologic correlation, transmission of static images, training of the person transmitting the images plays a vital role in rendering accurate diagnosis. Telepathology over WhatsApp® video calling could be used as an efficient screening tool to identify suspicious lesions and follow-up critical cases.

The COVID-19 pandemic has taken tragic proportions and has disrupted lives globally. In the wake of governmental lockdowns, ophthalmologists need practical and actionable guidelines based on advisories from national health departments on how to conduct their duties during nationwide lockdowns and after these are lifted. In this paper, we present a preferred practice pattern (PPP) based on consensus discussions between leading ophthalmologists and health care professionals in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. In this document, the expert panel clearly defines the range of activities for Indian ophthalmologists during the ongoing lockdown phase and precautions to be taken once the lockdown is lifted. Guidelines for triage, governmental guidelines for use of personal protective equipment from ophthalmologists' point of view, precautions to be taken in the OPD and operating room as well as care of various ophthalmic equipment have been described in detail. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics and should help Indian ophthalmologists in performing their professional responsibilities without being foci of disease transmission., Competing Interests: None

Purpose: In early 2020, the World Health Organization declared the outbreak of the disease COVID-19, caused by a new variant of coronavirus 2019-nCoV as a global pandemic. The government of India ordered a nationwide lockdown for 21 days, limiting movement of people as a preventive measure. This survey was designed and conducted during the lockdown period to assess its effect on ophthalmic practice and patient care in India., Methods: An online survey was sent across to practicing Indian ophthalmologists across through various social media platforms. All valid responses were tabulated and analyzed., Results: A total of 1260 ophthalmologists responded to the survey. Most of the respondents (775/1260; 61.5%) were in private practice and 14.8% (187/1260) were affiliated to ophthalmic institutes. At the time of taking the survey, 72.5% of the respondents (913/1260) were not seeing any patients due to the lockdown. Of those who were still examining patients, 82.9% (287/347) were only seeing emergency cases, based on their own clinical judgement. The proportion of ophthalmologists in ophthalmic institutes, government and municipal hospitals (126/253;49.8%) who were still seeing patients was significantly higher (P < 0.0001) than those in private practice (174/775;22.4%). Apart from emergencies such as trauma, retinal detachment, and endophthalmitis (81.8%), other surgeries that were still being performed included intravitreal injections (9.1%) and cataract surgeries (5.9%). Approximately, 77.5% (976/1260) of the respondents had begun telephonic/e-mail/video consultations or consultations over social media applications since the lockdown began. In addition, 59.1% (745/1260) felt that ophthalmologists were potentially at a higher risk of contracting COVID-19 compared to other specialties while examining patients. When asked about the resumption of practice upon easing off of the restrictions, 57.8% (728/1260) of the respondents said they were unsure of when to resume elective surgeries; furthermore, 62.8% (791/1260) were unsure about the preferred screening strategy or precautionary approach prior to resuming surgeries and were awaiting guidelines., Conclusion: Our survey shows that majority of ophthalmologists in India were not seeing patients during the COVID-19 lockdown, with near-total cessation of elective surgeries. Emergency services were still being attended to by 27.5% of ophthalmologists who responded. A large proportions of ophthalmologists had switched over to telephonic advice or other forms of telemedicine to assist patients. Most of the responding ophthalmologists were unclear about when and how to resume surgeries upon easing off of the COVID-19 related restrictions. Regulatory bodies should take note of this and issue appropriate guidelines regarding the same., Competing Interests: None

Testicular germ cell tumor (TGCT) development may involve a series of modification at epigenetic and genetic level which may act synergistically and transform the primordial gonocyte. This study evaluated the frequency and distribution pattern of RASSF1A/MGMT gene methylation and KRAS, BRAF and cKIT gene mutation in Indian TGCT patient, and their correlation with clinicopathological features. Forty-one TGCT tumors were used to investigate hypermethylation of RASSF1A and MGMT gene and mutations of KRAS codon 12/13, BRAF V600E and cKIT exon 17 mutations. RASSF1A and MGMT methylation was noted in 58.5% and 10% of the TGCTs. A higher frequency of RASSF1A methylation was noted in seminomas (71%, 17/24), while MGMT methylation was frequent in mixed tumors (23%, 3/13). Interestingly, 3 of 41 cases showed concurrent methylation of both the genes. The absence of tumor necrosis was significantly associated with increased frequency of MGMT hypermethylation (30% vs. 3%, p = 0.03). KRAS mutation was identified in 17% (7/41), while none showed BRAF and cKIT mutation. KRAS mutations were predominantly found in codon 12 with G12V as the most recurrent mutations. Mixed germ tumors tends to show increased frequency of KRAS mutation (31%, 4/13), followed by pure seminomas (4%, 1/24). Interestingly, KRAS mutation rate was significantly higher in metastatic tumors in comparison to primary tumors (100% vs. 13%, p = 0.02). No other association of RASSF1A/MGMT/KRAS alterations with other clinicopathological features was noted. In conclusion, these data support the notion that the cancer-associated alterations in the RASSF1, MGMT and KRAS gene may significantly contribute to TGCT pathogenesis., Competing Interests: Declaration of competing interest None., (Copyright © 2019. Published by Elsevier Inc.)

Competing Interests: None

Purpose: To document whether the residency training in management of retinal diseases has improved in 2000s to meet the increasing demand of retina care in India., Methods: A survey, using a prevalidated questionnaire, was conducted by Academic and Research Committee (ARC) of the All India Ophthalmological Society (AIOS) in 2014-2016 among ophthalmologists to document teaching of retina-related clinical and surgical skills in the postgraduate residency program., Results: The 144-item questionnaire was mailed to 4512 practicing ophthalmologists with residency training in two different periods, between 1967 and 2000 (group 1; 20 th -century trained) and between 2003 and 2012 (group 2; 21 st -century trained). Response was received from 320 (19.1%) of group 1 ophthalmologists and 531 (18.7%) of group 2 ophthalmologists. The average age was 49.2 ± 8.7 and 32.6 ± 4 years, respectively. Group 2 residents had received superior training in indirect ophthalmoscopy, slit lamp biomicroscopy using + 78 and + 90D lens, optical coherence tomography, fundus photography, and fluorescein angiography (all P < 0.001), but there was large variation between the training institutions. The residents were not taught vitreous and retinal detachment surgeries in either period of training., Conclusion: Teaching of retina-related clinical skills have improved in Indian residency program, but there are variations across programs. This information might help redesign the ophthalmology residency programs to meet the demands of comprehensive eye care and universal health coverage of increasing retinal diseases in India., Competing Interests: There are no conflicts of interest.

Heat waves are one of the deadliest of natural hazards and their frequency and intensity will likely increase as the climate continues to warm. A challenge in studying these phenomena is the lack of a universally accepted quantitative definition that captures both temperature anomalies and associated mortality. We test the hypothesis that social media mining can be used to identify heat wave mortality. Applying the approach to India, we find that the number of heat-related tweets correlates with heat-related mortality much better than traditional climate-based indicators, especially at larger scales, which identify many heat wave days that do not lead to excess mortality. We conclude that social media based heat wave identification can complement climatic data and can be used to: (1) study heat wave impacts at large scales or in developing countries, where mortality data are difficult to obtain and uncertain, and (2) to track dangerous heat wave events in real time.