039811   RAWAT P, BHANGE A, UPADHYAY V, BHAISARE V, WALIA S, KORI N (Ophthalmology Dep, Mahatma Gandhi Memorial Medical Coll, Indore, Madhya Pradesh, Email: archu9404@gmail.com) : Study of retinal nerve fiber layer analysis using optical coherence tomography in different demyelinating diseases and its correlation with the severity of visual impairment. Indian J Ophthalmol 2020, 68(6), 1115-9.

This purpose of this study was to find the association between severity of visual impairment and retinal nerve fiber layer (RNFL) thickness loss in different demyelinating diseases using optical coherence tomography (OCT) and, simultaneously, assess the fellow eye for subclinical RNFL thicknessloss. This cross‑sectional, observational study included 60 eyes of 30 patients above the age of 20 years with diagnosed cases of multiple sclerosis (MS), neuromyelitis optica (NMO), and clinically isolated syndrome (CIS) who had history of (h/o) optic neuritis (ON) attack were included. Participants included in the study group underwent best‑corrected visual acuity (BCVA) measurement, color perception, swinging flashlight test, slit‑lamp examination, and dilated fundus examination (DFE). RNFL thickness was measured using spectral domain OCT (SD‑OCT) (Optovue RTVue‑V6.11 A Fourier). Inter group analysis of RNFL thickness was done using a Chi‑square test (P < 0.05 was considered significant). Spearman’s rank correlation coefficient (Spearman’s ρ) was used for association (ρ < 0.963 was considered significant). RNFL thickness was significantly reduced in patients with NMO than MS, while all patients of CIS had the highest RNFL thickening (P = 0.00048). Lower visual function scores correlated with reduced average overall RNFL thickness, and this association was statistically significant in affected (R = 0.942) and fellow eyes (R = 0.963). The severity of visual impairment significantly correlated withthe severity of axonal loss in affected as well as the fellow eye. NMO is associated with more widespread axonal injury in the affected optic nerve. Hence, RNFL thickness is an indicator of the progression of visual impairment in demyelinating diseases and OCT can help distinguish the etiology and, therefore, may be useful as a surrogate marker of axonal involvement in demyelinating diseases.

4 illus, 5 tables, 14 ref

039810   DIVYA K, KANAGARAJU V, DEVANAND B, JEEVAMALA C, RAGHURAM A, SUNDAR D (Ophthalmology and Radiology Dep, PSG Institute of Medical Sciences and Research, Coimbatore- 641 004, Tamil Nadu, Email: vikrantmailin@gmail.com) : Evaluation of retrobulbar circulation in type 2 diabetic patients using color doppler imaging. Indian J Ophthalmol 2020, 68(6), 1108-14.

To investigate the retrobulbar circulatory parameters in type 2 diabetes mellitus patients with color Doppler imaging (CDI) and compare the results with non diabetic controls.  This prospective study included 50 type 2 diabetic patients and 50 age‑matched controls. Seven field stereo fundus photography was used to diagnose and classify diabetic retinopathy (DR). Diabetic patients were further divided into two: Group 1, consisted of patients with no DR, mild and moderate non‑proliferative DR (n = 36); Group 2,severe non proliferative and proliferative DR (n = 14). CDI was performed using Philips iU22 xMATRIX ultrasound. The peak systolic velocity (PSV), end‑diastolic velocity (EDV), resistivity index (RI) and pulsatile index (PI) of ophthalmic (OA), posterior ciliary artery (PCA), and central retinal artery (CRA) along with central retinal vein (CRV) were recorded. RI in the ophthalmic artery was significantly higher in both DR groups than the control group (P = 0.000). Diabetic Group 1 had decreased blood flow velocity (PSV and EDV) in PCA compared to controls (P = 0.046 and P = 0.010, respectively). Group 2 DR had significantly reduced EDV and increased RI in CRA compared to Group 1 (P = 0.015). Binary logistic regression analysis revealed glycosylated hemoglobin and RI of OA to be independent risk factors of DR. Significant changes in resistivity index and flow velocities were observed in the retrobulbar vessels, especially in ophthalmic artery in diabetics compared to controls. CDI with results of increased resistance or decreased flow could be useful to predict individuals at higher risk for developing severe DR.

1 illus, 4 tables, 32 ref

039809   SANE S S, ALI M H, KUPPERMANN B D, NARAYANAN R (Biostatistics Dep, L V Prasad Eye Institute, Hyderabad- 500 034, Telangana, Email: narayanan@lvpei.org) : Comparative study of pars plana vitrectomy with or without intravitreal dexamethasone implant for idiopathic epiretinal membrane. Indian J Ophthalmol 2020, 68(6), 1103-7.

To investigate if use of adjunctive intravitreal dexamethasone implant during pars planavitrectomy (PPV) leads to faster visual recovery and reduction of retinal thickness in idiopathic epiretinal membrane (ERM).  In this non‑randomized, comparative, interventional study 30 eyes (from 30 patients with idiopathic ERM) were enrolled. In the control group (n = 15), patients underwent 25‑G parsplana vitrectomy (PPV) and ERM peeling. In the study group (n = 15), each patient underwent the same procedure as those in the control group, and also received an additional dexamethasone implant. Primary outcome after treatment was mean gain in best corrected visual acuity (BCVA), and secondary outcome was reduction in central retinal thickness (CRT). Data were analyzed using Fisher’s exact test, Wilcoxon rank sum test, and two‑sample t‑test. The mean gain in BCVA (logMAR) from baseline at 1‑month follow‑up was significantly higher in the study group (median = ‑ 0.3, IQR = ‑ 0.4, ‑ 0.1) than in the control group (median = 0, IQR = ‑ 0.1, 0.3; P < 0.008). However, no significant difference in mean gain in BCVA between the two groups was detectable at the 6‑month follow‑up (P < 0.55). At 1‑month follow‑up, one and seven patients in the control and study groups gained ≥15 letters of BCVA (P < 0.05), respectively. The mean reductions in CRT at the 1‑month follow‑up were significantly higher in the study group than in the control group (Mean = ‑ 60 μm, SD = 92.1; P < 0.014; 95 % CI = 19.75–156.54). The difference in mean reduction of CRT at 6 months was not significant (P < 0.24). Adjunctive dexamethasone implant can aid faster visual recovery after PPV in idiopathic ERM, although the implants do not affect long‑term gains invisual acuity.

4 illus, 3 tables, 19 ref

039808   WASEEM S M A, ALVI A B (Integral Univ, Lucknow, Uttar Pradesh, Email: abbas14waseem5@gmail.com) : Correlation between anemia and smoking: Study of patients visiting different outpatient departments of Integral Institute of medical science and research, Lucknow. Natl J Physiol Pharm Pharmac 2020, 10(2), 149-54.

Smoking-induced hypoxia, inflammation, and oxidative stress result in impairment of hematological parameters. Contradictory evidence is found as far as the effect of smoking on blood cells and indices is concerned. Very few studies have evaluated male smokers for the presence or absence of anemia. Thus, the present study was undertaken to study the hematological parameters in male smokers and find the presence of anemia and find a correlation between the severity of smoking and hemoglobin (Hb), red blood cell (RBC), and white blood cell(WBC). The present study included 100 male smokers divided into anemic (n = 34) and nonanemic(n = 66) groups. RBC, WBC, Hb, and blood indices (mean corpuscular volume [MCV] and mean corpuscular Hb concentration [MCHC]) were compared and further evaluation was done on the basis of severity of smoking (as per the pack-years). Correlation between pack-years and RBC, Hb, and WBC was done. Data were analyzed using statistical tests such as unpaired t-test, Chi-square, ANOVA, and Pearson’s correlation. P < 0.05 was taken as statistically significant. There were significant differences (P < 0.05) in the mean age, MCV, MCHC, and WBC between the two groups and with increase in severity of smoking, the levels of Hb, RBC, MCV and MCHC, and WBC were increased significantly in smokers with anemia when compared to those without anemia. In smokers with anemia, the highest percentage was found in mild smoker category (19/34, i.e., 55.88 %) and with increase in smoking severity, the number of anemic subjects decreased. In smokers without anemia, the highest percentage was found in mild smoker category (37/66, i.e., 56.06 %).The difference in anemic and non-anemic smokers on the basis of severity of smoking was found to be insignificant(P > 0.05). The correlation of pack-years with Hb, RBC, and WBC was found to be significantly (P < 0.05) positive. RBC, Hb, MCV, and MCHC were significantly higher in anemic smokers as compared to non-anemicsmokers and with increase in the smoking severity the percentage of anemic subjects declined. It may be concluded that there appears a link between smoking and alterations in hematological parameters.

5 tables, 38 ref

039807   SUNDAR D, DAS T, CHHABLANI J, KUMAR A, SHARMA N (All India Institute of Medical Sciences, New Delhi- 110 029, Email: namrata.sharma@gmail.com) : All India ophthalmological society members' survey: Practice pattern of intravitreal anti-vascular endothelial growth factor injection. Indian J Ophthalmol 2020, 68(6), 1095-8.

The aim of this paper is to report the results of an on-line survey to evaluate the practice pattern of Indian retina specialists in administering intravitreal anti-vascular endothelial growth factor injection.  A structured questionnaire on the intravitreal injection (IVI) procedure protocols was sent online to all members of the All India Ophthalmological Society (AIOS) with a request to the retina specialists to respond. A unique link that directed to the web-based questionnaire page allowed a single response only. Participating physicians were masked from each others' responses. The responses were categorized into pre-injection patient preparation, injection aliquoting, injection administration, and post-injection care. The results were compared with similar surveys in Europe, the UK, and the USA. Response was received from 741 of 1016 (73 %) retina specialists (of 16,000 AIOS ophthalmologists). The survey showed: 43.5 % evaluated patient's cardiac risk factors, 60 % used prophylactic topical antibiotic, 90.9 % performed injection under topical anesthesia, 55 % aliquoted from the bevacizumab vial at the eye care facility, 66.2 % used a single puncture technique, 91.4 % injected in the main operating room, 98 % wore masks and sterile gloves during the procedure, 96 % used lid speculum, and 89.3 % advised topical antibiotic after the procedure. Peri procedure antibiotic use, injection in the min operating room, wearing of gloves and mask were higher than practices in other countries. Ophthalmologists in India practice asepsis in IVI procedure. There is no uniform protocol for aliquoting bevacizumab. Single use bevacizumab vial for exclusive ophthalmic use will further improve the safety of the procedure.

1 table, 32 ref

039806   TELI A, GHATNATTI R (KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi, Karnataka, Email: drravighatnatti@rediffmail.com) : Association between blood transfusion and serum creatinine as a major risk factor in patients undergoing cardiac surgeries: An observational study. Natl J Physiol Pharm Pharmac 2020, 10(1), 59-63.

Blood transfusion is associated with altered serum creatinine levels. However, there are not many studies available to substantiate the cause of acute kidney injury (AKI) in patients undergoing cardiac surgeries. The present study was aimed to assess and analyze serum creatinine levels, after blood transfusion(post-operative) in patients undergoing cardiac surgery and to assess its significance as a potential diagnostic and prognostic serum biomarker in predicting renal dysfunction. An observational study was performed after obtaining the Institution’s Ethical Committee approval. Patients (n = 162) who underwent cardiac surgeries were considered for the study and were evaluated for alterations in serum creatinine levels and creatinine clearance rate, before (pre-operative) and after blood transfusion (post-operative). Analysis of variance, paired t-test, Chi-square test, and logistic regression test were used. Statistically significant difference (P < 0.0001) in mean creatinine levels as well as creatinine clearance rate was observed in 70 patients who were at a greater risk of developing AKI (post-operative). Post-operative median creatinine level as well as creatinine clearance rate were also significantly different (P < 0.001) in AKI group, compared to non-AKI group. Mean difference between pre- and post-operative serum creatinine, for congenital procedure, was statistically significant (P < 0.001). Blood transfusion is often associated with altered serum creatinine levels, leading to unfortunate adverse effects of potentially renal dysfunction. Therefore, better blood conservation and anesthetic techniques should be studied upon to prevent excessive bleeding and avoid unnecessary blood transfusion.

5 tables, 20 ref

039805   RAMYASHRI S, RAO A, PADHY D, DAS G (L V Prasad Eye Institute, Bhubaneswar- 751 024, Odisha, Email: aparna@lvpei.org) : Small incision cataract surgery with trabeculectomy versus phacoemulsification trabeculectomy in pseudoexfoliation glaucoma. Indian J Ophthalmol 2020, 68(6), 1090-4.

This study aims to evaluate efficacy and outcomes of manual small incision cataract surgery with trabeculectomy (Group 1) and phacoemulsification with trabeculectomy (Group 2) inpseudoexfoliation glaucoma (PXG). In this retrospective comparative observational case series, All patients with PXG who underwent either small incision cataract surgery or phacoemulsification with trabeculectomy from 2011‑2015 were studied. Data compared included best corrected visual acuity (BCVA), intraocular pressure (IOP), total surgical time, and incidence of intra/postoperative complications. A total of 82 (Group 1) and 64 (Group 2) subjects were included for the study. The baseline IOP and anti‑glaucoma medications in both groups were comparable pre‑operatively (group 1 = 26 ± 10.3 mmHg, group 2 = 23 ± 13.9 mmHg, P = 0.1). The IOP at final follow up between the two groups was not statistically significant (group 1 = 12 ± 3.2 mmHg, group 2 = 14 ± 1.8 mmHg, P = 0.2). The average total time of surgery (group 1 = 40 ± 21.6 min, group 2 = 34 ± 14.8 min, P = 0.4) was not statistical significant between groups. The incidence of post‑operative complications were similar in both groups (P = 0.95). Manual small incision cataract surgery with trabeculectomy is noninferior in PXG patients with comparable surgical outcomes, when compared with phacoemulsification with trabeculectomy.

3 illus, 3 tables, 20 ref

039804   BHATTACHARJEE H, BURAGOHAIN S, JAVERI H J, DAS D (Ophthalmology Dep, Sri Sankaradeva Nethralaya, Guwahati- 781 028, Assam, Email: suklen.bgohain@gmail.com) : Scanning electron microscopic features of explanted degraded hydrophobic acrylic intraocular lenses which were in vivo for a prolonged period. Indian J Ophthalmol 2020, 68(6), 1086-9.

To study and document electron microscopic features in explanted hydrophobic microvacuoles affected acrylic intraocular lenses (IOL) which were in vivo for an average duration of 11 years. Scanning electron microscopic (SEM; Hitachi S 3000 N EXAX Genesis VP SEM) study of five explanted hydrophobic acrylic IOL which had clinically evident microvacuoles prior to explantation, was done. The IOLs were in vivo for aprolonged period and needed explantation for various indications. Only those hydrophobic acrylic IOLs which fulfilled the inclusion criteria were included. The findings were compared with control specimens.The IOLs were in vivo for an average duration of 11.6 ± 4.21 years. The cause of explantation of IOL was subluxationin four cases and low visual acuity in one case. Bulk degradation and microvacuoles on cut sections throughout the IOL optics and undulating surface patterns over both the surfaces of the IOL has been documented in all the specimens. No such findings were noted in the control specimens where the surface and texture were homogenous. SEM findings of the structural changes in explanted IOL documented in the study demonstrate that hydrophobic acrylic IOL is degradable in vivo. Microvacuoles are a clinical manifestation of the structural changes that occur at a microscopic and molecular level. These changes are not seen in IOLs which have not undergone intraocular implantation. To our knowledge, a similar study of this kind has not been done.

4 illus, 1 table, 27 ref

039803   ARUN KUMAR M, SUMA P, SUMA K V, VENKATESH D (East West Institute of Technology, Bengaluru, Karnataka, Email: sumap1994@gmail.com) : Validation of novel single spot photoplethysmography monitoring device to measure the autonomic status of the individual. Natl J Physiol Pharm Pharmac 2020, 10(1), 64-74.

In this study, the validation of electrocardiogram (ECG) and photoplethysmography (PPG) signals is performed. The pulse readings are recorded for ten healthy volunteers, and simultaneously ECG readings were recorded for the duration of 30 min. Pulse rate variability (PRV) is an approach used to assess the changes in the autonomic nervous system of an individual. The primary method of deriving the PRV is to acquire the PPG signal. The acquired PPG signal is validated with ECG signals to ensure that single spot PPG monitoring device can be used as an alternative measurement to heart rate variability (HRV). With the approval from Ethics Committee, ten healthy subjects, aged from 18 to 24, took part in this study. The ECG and PPG readings were recorded in the early morning between 7 and 9 a.m. During PPG recording process, the peak to peak interval from PPG signals was monitored. Simultaneously, the ECG readings were recorded from RMS Vagus HRV Software. The RR interval from ECG signals was monitored during the ECG recording process.  Both ECG and PPG readings were monitored, and a close accuracy with an average percentage error for beats per minute was around 7 %, and RR interval was around 5 % which was achieved. With the development of single spot PPG monitoring devices can be used as an alternative measurement to HRV even during non-stationary conditions. PPG sensors can be placed on fingertip, wrist which offers more flexibility to the users. Furthermore, with the development of wearable devices for monitoring biomedical signals suggested that it is possible to monitor pulse rate through PPG signals due to the simplicity of PPG waveforms.

6 illus, 7 tables, 8 ref

039801   NAYAK P R, VEGAD A M (GMERS Medical Coll, Junagadh, Gujarat, Email: dranupvegad@yahoo.com) : A comparative study on the effects of night shift on psychomotor vigilance and mathematical abilities of the nurses of different chronotypes. Natl J Physiol Pharm Pharmac 2020, 10(1), 75-8.

Individuals have different preference of doing certain work at certain hours. This preference is called chronotype and it can have influenced on shift workers. The work of nursing profession in demanding and the long shift work, especially the night shift work, can impact one’s vigilance and mathematical abilities which can result in increased risk of patient’s safety. The present study was undertaken to observe the effects of night shift on psychomotor vigilance and mathematical abilities of the nurses of different chronotypes. A total of 50 nurses working at various hospitals of Junagadh city were studied for their chronotype. Their psychomotor vigilance and mathematical abilities near the end of their night shift and morning shift were studied. Psychomotor vigilance and mathematical abilities of morning chronotype were highly affected by the night shift while they were at their best after the morning shift. Evening chronotype was affected by both the morning and night shift; however, their performance did not decrease drastically like morning chronotypes. Ten hours night shift and lack of conducive environment at home for the naps might have resulted in inability to cope up with the interference in circadian cycle by the night shift. Reduction in the shift length might improve the performance of morning chronotypes after the night shift and evening chronotypes after the morning shift.

2 illus, 2 tables, 22 ref

039800   CALVO-SANZ J A, BONNIN-ARIAS C, ARIAS-PUENTE A (Instituto de Ciencias Visuales, Madrid, Spain, Email: jacalvosanz@gmail.com) : Clinical application of bicylindric intraocular lens power calculation method. Indian J Ophthalmol 2020, 68(6), 1073-8.

To analyze the reliability of the refractive results prediction obtained in intraocular lens (IOL) calculation using bicylindric power calculation method, with the use of steep and flat keratometry readings compared with the classical mean keratometry calculation method. Fifty‑seven eyes of 57 subjects who underwent cataract surgery were included in this prospective study. Optical biometry was performed with IOLMaster 700 and IOL power calculation was performed using both keratometry readings and the surgically induced astigmatism. Four weeks after surgery, subjective refraction was done. Finally, results obtained with both IOL calculation methods were compared. Mean spherical equivalent using bicylindric IOL power calculation method was ‑0.082 ± 0.296D, and achieved mean spherical equivalent using classical IOL power method with Haigis formula was ‑0.088 ± 0.405D. Achieved mean spherical equivalent obtained in subjective refraction after surgery was ‑0.101 ± 0.265D. Linear correlation between bicylindric method spherical equivalent calculation and achieved spherical equivalent was statistically significant (r = 0.761,P < 0.001), also correlation between Haigis spherical equivalent calculation and achieved spherical equivalent was statistically significant (r = 0.339, P = 0.010). Emmetropia was achieved in 49 of 57 (85.86 %) subjects and bicylindric method calculated that 49 of 57 (85.86 %) of subjects would get emmetropia (P = 1.000). Classical IOL power calculation estimated that 38/57 subjects would get emmetropia (66.67 %) (P = 0.026). The IOL power calculation including both keratometry readings and surgically induced astigmatism seems to be more accurate and provides more precision in refractive prediction than classical calculation method.

5 illus, 3 tables, 25 ref

039799   SUDHA D, SUVALAKSHMI V, KANNAN N (Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Researc, Melmaruvathur, Tamil Nadu, Email: ssudha91@yahoo.com) : Clinical evaluation of pulmonary functions among the non-smoking municipal street cleaners and healthy volunteers. Natl J Physiol Pharm Pharmacol 2020, 10(1), 79-83.

In developed countries, street cleaning is done with the help of mechanical assets and precautionary measures. Hence, it has been found to have a lesser incidence of respiratory diseases. However, in developing countries like India, 90 % of street cleaning is done manually. The prolonged inhalations of foreign particles stimulate inflammatory reactions which lead to obstructive pulmonary diseases. Hence, it could be considered as one of the major occupational hazards in India. The objectives of the study were to measure the values of functional vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, forced expiratory flow (FEF) 25–75 %, and peak expiratory flow rate (PEFR) in municipal street cleaners and healthy volunteers and compare the clinical evaluation of respiratory functions of both the groups using the appropriate statistical tool. In this study, 100 subjects were taken and they are divided into two groups: 50 individuals of street cleaners and 50 healthy volunteers. Clinical examination of the respiratory system of municipal street cleaners and healthy volunteers of the same locality and measures the values of FVC, FEV1, FEV1/FVC, FEF 25–75 %, and PEFR in both the groups. Statistical analyses were done using the unpaired t-test. The results of the pulmonary function test (FVC, FEV1, FEV1/FVC, FEF 25–75 %, and PEFR) showed that the values were significantly reduced in street cleaners when compared with the healthy volunteers. The values were statistically significant. Constant exposure to the dust and other hazardous inhaling substances causes permanent damage to the lung tissue. The street cleaners should have proper protection while they work, which will reduce the damage to the lungs.

2 illus, 6 tables, 20 ref

039798   WALLACE H B, MISRA S L, MCKELVIE J (Ophthalmology Dep, Auckland Univ, Auckland, New Zealand, Email: james@mckelvie.co.nz) : Validation of Mahajan's formula for scaling ocular higher-order aberrations by pupil size. Indian J Ophthalmol 2020, 68(6), 1067-72.

Zernike polynomials for describing ocular higher order aberrations are affected by pupil aperture. The current study aimed to validate Mahajan’s formula for scaling Zernike polynomials by pupil size. Higher order aberrations for 3 intraocular lens models (AcrySof IQ IOL SN60WF, Technis ZA9003, Adapt Advanced Optics) were measured using the Zywave aberrometer and a purpose‑built physical model eye. Zernike coefficients were mathematically scaled from a 5 mm to a 3 mm pupil diameter (5:3 mm),from a 5 mm to a 2 mm pupil diameter (5:2 mm), and from a 3 mm to a 2 mm pupil diameter (3:2 mm).Agreement between the scaled coefficients and the measured coefficients at the same pupil aperture was assessed using the Bland–Altman method in R statistical software. No statistically significant mean difference (MD) occurred between the scaled and measured Zernike coefficients for 21 of 23 analyses after Holm‑Bonferroni correction (P > 0.05). Mean differences between the scaled and measured Zernikeco efficients were clinically insignificant for all aberrations up to the fourth order, and within 0.10 μm.Oblique secondary astigmatism (Z⁻²4) was significantly different in the 5:3 mm comparison (MD = ‑ 0.04μm, P < 0.01). Horizontal coma (Z¹3) was significantly different in the 3:2 mm comparison (MD = ‑ 0.07 μm,P = 0.03). There were borderline statistical differences in both vertical (Z⁻¹3) and horizontal coma (Z¹3) in the 5:3 mm comparison (MD = 0.02 μm, ‑ 0.09 μm, P = 0.05, 0.05, respectively). A formula forthe scaling of higher order aberrations by pupil size is validated as accurate. Pupil scaling enables accurate comparison of individual higher order aberrations in clinical research for situations involving different pupil sizes.

3 illus, 2 tables, 25 ref

039797   HUNG K , LU C, LIU H, HOU Y, WANG I, HU F, CHEN W (Ophthalmology Dep, National Taiwan Univ Hospital, Taipei- 10002, Taiwan, Email: chenweili@ntu.edu.tw) : Use of white light in vivo confocal microscopy for the detection of spatial changes in the corneal nerves in cases of early-stage Acanthamoeba keratitis with radial keratoneuritis. Indian J Ophthalmol 2020, 68(6), 1061-6.

Radial keratoneuritis (RK) is a common feature of Acanthamoeba keratitis (AK). In vivo confocal microscopy (IVCM) is non invasive and provides real‑time images for the diagnosis of corneal diseases by allowing the visualization of corneal structures and morphologies of living organisms at the cellular level.Images of AK with RK obtained using commercial white light IVCM devices have not been frequently evaluated. In the present study, a white light IVCM device was used to evaluate the corneal findings and describe spatial changes in the corneal nerves at different depths in cases of early‑stage AK with RK.  In this retrospective, observational study, white light IVCM images focused on RK were evaluated for Acanthamoeba cysts/trophozoites, corneal deposits, and altered corneal nerves, with special emphasison three‑dimensional spatial changes in the corneal nerves at different depths.  Seventeen eyes of 17 patients exhibiting early‑stage AK with RK were included in the study. Acanthamoeba cysts/trophozoites were observed in the corneal epithelium of 13 eyes and stroma of 7 eyes. Alterations in the corneal nerve morphology and density were observed from the basal epithelial layer to the stromal layer in 12 eyes. Acanthamoeba trophozoites were attached to the corneal stromal nerves in five eyes.These findings suggest that white light IVCM can identify consistent corneal findings, particularly spatial changes in the corneal nerves, in cases of early‑stage AK with RK.

3 illus, 2 tables, 23 ref

039796   GOGRI P, BHOMBAL F A (L V Prasad Eye Institute, Hyderabad- 500 034, Telangana, Email: pratikgogri@lvpei.org) : A new technique for fitting of tricurve rigid gas-permeable contact lens in penetrating keratoplasty eyes using Scheimpflug imaging. Indian J Ophthalmol 2020, 68(6), 1057-60.

Rigid gas‑permeable (RGP) contact lens fitting after penetrating keratoplasty (PK) is challenging due to significant irregular astigmatism.The aim of the study was to determine a guideline for selecting the initial base curve (BC) of the RGP contact lens fitting in post PK eyes.  The data of patients who had tricurve RGP contact lens fitting post PK were collected retrospectively. The following data were collected: best‑corrected visual acuity with glasses and contact lenses; contact lens parameters which included the BC and diameter; corneal topography parameters which included steep keratometry value (K), flat‑K, and mean‑K; and anterior best fit sphere (BFS) measured using Scheimpflug imaging.The median age of the 40 subjects (46 eyes) who met the inclusion criteria was 37.5 years (IQR 26.7–45.5). The spherical equivalent was –3.00 diopter (D) (–8.31 to –1.56). The median steep‑K, flat‑K, and mean‑K in them were 6.76 mm (6.28–7.07), 7.78 mm (7.37–8.14), and 7.26 mm (6.93–7.46), respectively. The median anterior BFS value of the transplanted cornea was 6.96 mm (6.6–7.37). The median BC of the final RGP lens was7.0 mm (6.7–7.23) and the median diameter was 9.8 mm (9.4–10.4). Among all the Scheimpflug imaging parameters, the BFS correlated well with the final BC of the RGP contact lens dispensed (R 0.742, P < 0.0001). The anterior corneal surface BFS value can be used as a reference in selecting the initial BC of tricurve RGP contact lens to achieve the best fitting and reducing the chair time of patients after PK.

1 illus, 4 tables, 32 ref

039793   SHEN E, FOX A, JOHNSON B, FARID M (California Univ, CA- 92697, USA, Email: elizabethpshen@gmail.com) : Comparing the effect of three descemet membrane endothelial keratoplasty injectors on endothelial damage of grafts. Indian J Ophthalmol 2020, 68(6), 1040-3.

Various injectors are commercially available for Descemet membrane endothelial keratoplasty (DMEK) but not all injectors have been studied for endothelial damage of grafts. The aim of the study was to compare endothelial damage in pre‑stripped DMEK tissue from three clinically used injector devices: the modified Jones tube, the STAAR intraocular (IOL) injector, and the Geuder glass cannula in a laboratory setting. Twenty‑four human donor corneas were used for this study, eight for each study arm. Each endothelial graft was pre‑stripped, trephined to 8.0 mm diameter, then loaded into either the modified Jones tube, the STAAR IOL injector, or the Geuder glass cannula by an eye bank technician who had no prior experience with any of the injectors. Grafts were then ejected, stained with Calceinacetoxymethyl (AM), and quantitatively analyzed using FIJI image software. The primary outcome was the percent of endothelial damage from injector loading and injection. Donor demographics were analyzed using Fisher’s exact test. The percentage of endothelial cell loss was compared across groups using the Kruskal–Wallis test.  The mean percent of endothelial damage from after injection of the graft was 37.8 % (±SD12.2 %) for the modified Jones tube, 37.0 % (±SD 13.9 %) for the STAAR IOL injector, and 23.5 % (±SD 5.1 %) for the Geuder cannula (P = 0.008). DMEK injectors contribute to intraoperative endothelial damage of transplanted grafts. The Geuder glass cannula may offer increased ease of use and less endothelial damage compared to the modified Jones tube or STAAR IOL injector for the novice user in early cases.

3 illus, 2 tables, 24 ref

039791   DOGANAY D, DOGANAY S, CANKAYA C (Ophthalmology Dep, Uluda Univ, Bursa, Turkey, Email: d3rya1983@gmail.com) : Corneal tattooing for esthetic purposes in patients with corneal opacities. Indian J Ophthalmol 2020, 68(6), 1033-6.

This study evaluated corneal tattooing for esthetic purposes in patients with corneal opacification. Eight eyes of eight patients were included in the study (four males and four females). Corneal tattooing was achieved by stromal puncture in five patients, femtosecond laser‑assisted corneal tattooing in two patients, and femtosecond laser‑assisted corneal tattooing and stromal needling (combined procedure) in one patient. In six of the patients, the entire cornea was stained black; in one patient, the center of the cornea (3 mm) was stained black and the periphery was stained dark brown; and in the last patient, the corneal periphery was stained dark brown. Patient satisfaction was evaluated on the first day after surgery and at the last visit as follows: Very satisfied (4), satisfied (3), moderately satisfied (3), and not satisfied (1). The patients ranged in age from 11–80 years. The mean satisfaction score of the patients was 4 and 3.5 on the first postoperative day and at the last visit, respectively. No complication occurred during or after surgery.  Corneal tattooing for esthetic purposes was successful in both blind eyes and seeing eyes.

4 illus, 2 tables, 16 ref

039789   WATTS P, SAHAI A, KUMAR P R, SHAMSHAD M A, TRIVEDI G K, TYAGI L (Ophthalmology Dep, Sahai Hospital and Research Centre, Jaipur- 302 004, Rajasthan, Email: research@sahaihospital.com) : A prospective study to assess the role of vitamin D individually and in combination with cyclosporine in the treatment of dry eye in patients with deficient serum 25(OH)D levels. Indian J Ophthalmol 2020, 68(6), 1020-6.

To study the efficiency of vitamin D3 (buccal spray) alone and combination of vitamin D3 with cyclosporine in the treatment of dry eye disease (DED) in patients with deficient serum 25(OH)D levels. Around 90 patients with DED with deficient serum 25(OH)D levels were included and randomized into three groups and were given treatment for dry eye (Group A‑ 0.5 % carboxymethylcellulose (CMC), Group B‑ 0.5 % CMC + 2000 IU vitamin D through buccal spray, Group C‑ 0.5 % CMC + 2000 IU vitamin D through buccal spray + 0.05 % cyclosporine). The patients were followed at day‑15, day‑30, and day‑90 for improvement in tear breakup time (TBUT) and Schirmer’s, and ocular surface disease index (OSDI) score. Improvement in serum vitamin D level was assessed at day‑90. One way ANOVA test, paired t‑test,and Chi‑square test were used for analysis. Group B and Group C had significantly higher in Schirmer’s test‑I values as compared to Group A (P = 0.001, P < 0.001, P < 0.001 at day‑15, day‑30, and day‑90,respectively). Significantly higher values of TBUT and mean serum vitamin D levels were obtained in Group B and Group C as compared to Group A at day‑90 (P < 0.05). OSDI scores of patients significantly decreased in all three groups at all follow‑up visits (P < 0.05). Overall, Group C and Group B were found statistically better than Group A. Group C showed better results than Group B but they were non significant. Vitamin D supplementation leads to earlier and significant improvement in TBUT, Schirmer’s, and OSDI score in patients with vitamin D deficient DED.

5 tables, 31 ref

039788   KUMAR K, PRAKASH A A, GANGASAGARA S B, RATHOD SBL, RAVI K, RANGAIAH A, SHANKAR S M, BASAWARAJAPPA S G, BHUSHAN S, NEERAJA T G, KHANDENAHALLI S, SWETHA M, GUPTA P, SAMPRITHA U C, PRASAD G N S, JAYANTHI C R (Ophthalmology Dep, Bangalore Medical Coll and Research Institute, Bengaluru- 560 002, Karnataka, Email: dockiran2011@gmail.com) : Presence of viral RNA of SARS-CoV-2 in conjunctival swab specimens of COVID-19 patients. Indian J Ophthalmol 2020, 68(6), 1015-7.

To detect the presence of viral RNA of severe acute respiratory syndrome coronavirus‑2(SARS‑CoV‑2) in conjunctival swab specimens of coronavirus disease‑19 (COVID‑19) patients. Forty‑five COVID‑19 patients positive for real‑time reverse transcription‑polymerase chain reaction (RT‑PCR) for SARS‑CoV‑2 in nasopharyngeal swab with or without ocular manifestations were included in the study. The conjunctival swab of each patient was collected by an ophthalmologist posted for COVID duty. Out of 45 patients, 35 (77.77 %) were males and the rest were females. The mean age was 31.26 ± 12.81 years. None of the patients had any ocular manifestations. One (2.23 %) out of 45 patients was positive for RT‑PCR SARS‑CoV‑2 in the conjunctival swab. This study shows that SARS‑CoV‑2 can be detected in conjunctival swabs of confirmed cases of COVID‑19 patients. Though the positivity rate of detecting SARS‑CoV‑2 in conjunctival swabs is very less, care should be exercised during the ocular examination of patients of COVID‑19.

1 table, 13 ref

039783   BARANWAL V K, SHYAMSUNDAR K, KABUYAYA V, BISWAS J, VANNADIL H (Ophthalmology Dep, Command Hospital, Pune- 411 040, Maharashtra, Email: shyam3110@yahoo.co.in) : Study of onchocerciasis-related visual impairment in North Kivu province of the Democratic Republic of Congo in Africa. Indian J Ophthalmol 2020, 68(5), 890-4.

The Objective of this study is to determine baseline data regarding onchocercal eye lesions and associated visual loss in the Nord Kivu province, an onchocerciasis hyperendemic tropical rain forest area in the Democratic Republic of Congo (DRC).  A cross‑sectional study was conducted in the Nord Kivu province of the DRC during which 2150 subjects were examined ophthalmologically.The eye examination included visual acuity (VA), slit‑lamp examination, ophthalmoscopy, intraocular pressure, and visual field assessment by the confrontation test. Patients with suspicion of glaucoma were further evaluated by Humphreys automated perimeter. 39 (1.81 %) out of 2150 subjects had onchocerciasis‑related eye lesions and 4 (0.19 %) were blind (VA <3/60). Chorioretinitis (0.88 %) was the most frequent onchocerciasis lesion followed by keratitis (0.46 %), microfilaria in the anterior chamber (0.28 %), iridocyclitis (0.28 %), secondary glaucoma (0.19 %), complicated cataract (0.19 %), and optic atrophy (0.19 %).Visual impairment was discovered in 114 (5.3 %) out of 2150 subjects, of whom 39 (0.19 %) had blindness and75 (3.4 %) had low vision. Visual impairment was mostly caused by nononchocerciasis‑related diseases like cataract (27.2 %), retinal diseases (19.3 %), glaucoma (15.8 %), and iridocyclitis (15.8 %) rather than because of onchocerciasis (9.6 %) among all causes of visual impairment. Features of ocular onchocerciasis usually described in forest and savanna areas were relatively less common than expected in and around Goma, the capital of the Nord Kivu province of the DRC.

6 illus, 4 tables, 15 ref

039782   GOPALAKRISHNAN S, VELU S, RAMAN R (Sankara Nethralaya, Chennai- 600 006, Tamil Nadu, Email: rajivpgraman@gmail.com) : Low-vision intervention in individuals with age-related macular degeneration. Indian J Ophthalmol 2020, 68(5), 886-9.

The objective of this study was to estimate the level of visual impairment in patients diagnosed to have age‑related macular degeneration (ARMD) who presented to low‑vision care (LVC) clinic at a tertiary eye care center in India, to analyze the type of distant and near devices prescribed to them and to compare the visual benefit in different age groups among patients with ARMD. A retrospective review was done for 91 patients with low‑vision secondary to ARMD who were referred to the LVC clinic from 2016 to 2017. Demographic profile: age, gender, occupation, ocular history, visual acuity status, and type of low‑vision device (LVD) preferred were documented. The details of LVDs and subsequent improvements were noted. Of the 91 patients, 64 (70.3 %) were men and 27 (29.7 %) were women. Of the cases which were referred, 36.26 % had a severe visual impairment (VI), 32.96 % had moderate VI, 28.57 % had mild VI,and 5.49 % had profound VI. The majority of the patients had myopia 57 (62.63 %), followed by hyperopiain 25 (27.47 %) subjects. The subjects were divided into three groups based on age 40–65 years, 66–75 years, and above 75 years for the analysis of VI. There was a statistically significant improvement (P < 0.01) innear vision with the help of LVDs in all three groups. SEE TV binocular telescope was the most commonly prescribed LVD for viewing distant objects. The most commonly preferred magnifier for near work was half‑eye spectacle (56 %) followed by stand magnifier (9.9 %) and portable video magnifier (9.9 %). The use of LVDs can help these patients with ARMD in cases where medical and surgical treatment have no or a limited role in restoring useful vision.

3 tables, 15 ref

039780   KOSHY S P, VARGHESE L M, THOMAS S, THOMAS P (Ophthalmolgy Dep, Believers Church Medical Coll Hospital, Thiruvalla- 689 103, Kerala, Email: leenalincy.varghese@gmail.com) : An innovative and simple method, clinically comparable to high-definition optical coherence tomography in quantifying posterior segment lesions in the retina. Indian J Ophthalmol 2020, 68(5), 875-9.

To introduce a simple and inexpensive method using a fundus contact lens and a reticle, to measure retinal lesions comparing it with values obtained with high-definition optical coherencetomography (HD-OCT). This study considers optic disc as the object for comparison. Patients underwent routine ophthalmologic examination and their horizontal optic disc diameter was measured, both with the reticle and OCT. For measurement with reticle a simple equation was deduced, x = 0.7y, where x corresponds to the actual image size and y to the reticle scale reading in millimeters. Anaggregate of 127 eyes of 75 patients were dilated and examined. The calculated mean diameter according to OCT was 1.639 mm (standard deviation = 0.179) and that assenting to reticle was 1.713 mm (standarddeviation = 0.175), with a difference in mean being 0.089 mm.  Values obtained by this new method was found to be comparable with the OCT values for retinal measurements, useful for ophthalmologists who cannot afford expensive and sophisticated machines.

6 illus, 1 table, 27 ref

039779   KOCAYIGIT I, ATUM M, SAHINKUS S, AKSOY M, CAN Y (Cardiology Dep, Sakarya Education and Research Hospital, Sokak– 54100, Sakarya, Email: ikocayigit@ gmail.com) : Increased cardio-ankle vascular index values in patients with acute branch retinal vein occlusion. Indian J Ophthalmol 2020, 68(5), 868-71.

Patients with retinal vein occlusions (RVOs) are at increased risk of cardiovascular disease. Arterial stiffness is an independent risk factor for cardiovascular events. Our aim is to evaluate the arterial stiffness in patients with acute branch retinal vein occlusion (BRVO) by using cardio‑ankle vascular index (CAVI). This prospective study included 42 patients (18 male, mean age 57.5 ± 11.3) with acute BRVO and a matched control group (by age, sex, and presence of hypertension) with 70 (26 male, mean age 54.4 ± 9.4) patients. All patients and control subjects underwent complete ocular examination and CAVI measurement.BRVO was diagnosed based on clinical examination. There were no significant differences between baseline clinical and demographic characteristics, echocardiographic measurements of left ventricula rejection fraction, systolic and diastolic blood pressure, and body mass index of the BRVO and control group.Both right and left CAVI values were found significantly higher in BRVO group (7.94 ± 1.53 vs 7.28 ± 1.25,P < 0.05 and 8.06 ± 1.41 vs 7.30 ± 1.26, P < 0.05, respectively). There were no significant difference in right and left ankle‑brachial index values between the groups (1.05 ± 0.10 vs 1.06 ± 0.08, P = 0.46 and 1.04 ± 0.12 vs1.05 ± 0.08, P = 0.46, respectively). Arterial stiffness is an important mediator of cardiovascular diseases. We found that CAVI which is a novel marker of the arterial stiffness is increased in patients with acute BRVO compared to controls.

2 tables, 29 ref

039778   ANANDKUMAR M H, CHANDRASHEKHAR D M, JAYALAKSHMI M K, PRASHANTH BABU G (Gadag Institute of Medical Sciences, Gadag, Karnataka, Email: chandrashekardm3@gmail.com) : Anthropometric measures of obesity as correlates of atherogenic index of plasma in young adult females. Natn J Physiol Pharm Pharmac 2020, 10(1), 84-8.

Cardiovascular diseases (CVDs) are the leading cause of death globally, accounting to one-third of all global deaths. The first step toward dealing with the epidemic of CVD is to come up with reliable and feasible screening methods, that when applied to the general population, can identify people with high CVD risk. Atherogenic index of plasma (AIP), defined as logarithm of the ratio of plasma concentration of serum triglycerides to high-density lipoprotein cholesterol, is a strong marker to predict the risk of atherosclerosis and a novel predictive indicator for CVD. We have undertaken the present study to find the correlation between the commonly used anthropometric measures of obesity and AIP.  The objective of the study was to evaluate the extent of correlation between anthropometric measures of obesity and AIP. This cross-sectional study was conducted on sixty apparently healthy young females. After recording the anthropometric measures of obesity in the subjects, lipid profile was evaluated and AIP was calculated. Correlation between anthropometric measures of obesity and AIP was tested by Pearson’s correlation coefficient. All anthropometric measures of obesity showed a significant correlation with AIP; however, waist circumference (WC) showed the strongest correlation (r = 0.369) followed by waist-to-hip ratio (WHR) (r = 0.298) and lastly body mass index (r = 0.277). Central measures of obesity such as WC and WHR are more accurate in predicting AIP, and hence, they can be used as handy screening tools to assess CVD risk in the general population.

3 illus, 2 tables, 17 ref

039775   SRINIVASAGOPALANE B, ABEETHA S, SUREKA V, GANESH M, POOVARAGHAVAN J (Dr. MGR Educational and Research Institute, Chennai, Tamil Nadu, Email: brindmbbs22@gmail.com) : Learning style predilection among health professional learners - A comparative study among varied course groups in a medical college. Natn J Physiol Pharm Pharmac 2020, 10(1), 89-93.

The learning behavior of an individual is attributed to one’s learning style. With varied learning styles been evident, identification of the best learning modality is a must to upgrade the student’s knowledge. This study pertains to seven sensory modalities of learning such as visual, verbal, aural, physical, logical, social, and solitary.  The aim of the study was to identification and comparison of learning style preferences among three categories of undergraduate health learners and gender differences in their learning styles. The study participants were 444– 1st-year students of both the genders from Medicine, Physiotherapy, and Nursing course groups studying in ACS. The medical College was included in the study. The Memletics questionnaire containing 70 questions was distributed and the students were encouraged to choose their best-preferred answer. Student identity, gender, and the course assigned were noted. Statistical analysis was done using SPSS software version 23. One way analysis of variance (ANOVA) showed medicine, Physiotherapy and Nursing group of students preferred multimodal learning. Further analysis with multiple linear regression model to compare the learning modality between the three groups showed visual, social and solitary modalities of learning were the best preferred learning style in common among all the three groups of students. Both the gender groups preferred social modality of learning in common. One way ANOVA results showed a significant difference between male and female students with regard to visual (P = 0.023), verbal (P = 0.000), and logical (P = 0.002) modalities of learning. With multimodal learning behavior been evident, implementation of appropriate teaching modalities to cater the students need, as well, exposing them to newer learning modalities will strengthen the teaching-learning process, their academic performance, and educative outcome to make the individual a complete professional.

2 illus, 3 tables, 16 ref

039774   DESWAL J, NARANG S, GUPTA N, JINAGAL J, SINDHU M (Ophthalmology and Psychiatry Dep, Government Medical Coll Hospital, Chandigarh, Email: subina_navya@yahoo.com) : To study the impact of diabetic retinopathy on quality of life in Indian diabetic patients. Indian J Ophthalmol 2020, 68(5), 848-53.

To study the impact of diabetic retinopathy (DR) on the quality of life (QoL) of Indian patients with diabetes. This cross-sectional tertiary health care institution-based study involved 250 patients of DR. They were interviewed using four questionnaires, namely, the General Health Questionnaire (GHQ), Final Quality of Life Instrument for Indian Diabetic Patients (QoLID) questionnaire for diabetes and questionnaire modified for DR, retinopathy dependent quality of life (RetDQoL), and coping strategy checklist (CSCL). The mean GHQ score was 1.12, indicating the absence of psychological morbidity. Mean QoLID score for financial worries and treatment satisfaction scores were 15 each for DR compared with 17 and 16, respectively, for diabetes mellitus (DM). The mean RetDQoL score was −27.94 (±2.14),showing the negative impact of DR on QoL. The mean CSCL score was 1.22 (±0.14), indicating infrequent use of coping strategies. Scores achieved by all four questionnaires correlated to each other. On subgroup analysis, proliferative DR (PDR) patients had a significantly higher GHQ score, lower treatment satisfaction,and more financial worries, with a poorer QoL than nonproliferative DR (NPDR). The severity of the diseasehad a negative impact on the QoL. The treatment satisfaction and psychological impact on the patients undergoing all types of eye treatments were comparable.  DR has a significantly detrimental impact on the QoL, which increases with increasing severity of the disease.

7 tables, 30 ref

039771   PILLAI G S, REMADEVI K K, ANILKUMAR V, RADHAKRISHNAN N, RASHEED R, RAVINDRAN G C (Ophthalmology Dep, Amrita Institute of Medical Sciences, Kochi- 682 041, Kerala, Email: drkirankrishnan@gmail.com) : Clinical profile and outcome of endogenous endophthalmitis at a quaternary referral centre in South India. Indian J Ophthalmol 2020, 68(5), 827-33.

The purpose of this study is to evaluate the clinical profile, visual, anatomical and survival outcome of patients with endogenous endophthalmitis. Retrospective chart review of consecutive cases with endogenous endophthalmitis presenting from 2009‑2016.  In our study, 41 eyes of 34 patients were included. Most common co‑morbidity associated with endogenous endophthalmitis was Diabetes Mellitus (70.7 %) and most common infective foci was UTI (73.2 %). Among the culture positive cases, fungi and bacteria were evenly distributed, 76.93 % were Gram positive bacteria and 23.07 % were Gram negative. Fungal endogenous endophthalmitis was more commonly seen in immuno suppressed state (72.7 %) and bilateral cases (66.7 %). The mean presenting vision (log MAR) of patients who diedduring the study were poor compared to those who survived (P = 0.014) Poor mean visual acuity at presentation was associated with more death (P = 0.014). Eyes with poor presenting vision, fungal isolates,culture positivity and immune suppression had poor visual and survival outcome. Poor visual outcome was observed more frequently in eyes with Aspergillus infection (85.7 %) compared to Candida (75 %) and bacteria (58.3 %). Evisceration was done for 5 out of 41 eyes (12.2 %). Vitrectomy rate was 53.7 % in our study,with 40 % of them showing overall improvement in vision.  Endogenous endophthalmitis is asight threatening condition associated with high mortality particularly when caused by Aspergillus spp. inimmuno compromised patients. Contrary to the prior published reports of endogenous endophthalmitis outside India, we found an equal distribution of fungal and bacterial organisms among our cases, with predominance of Aspergillus among fungal isolates and Gram‑positive organism among bacteria. Fungal infections, especially with Aspergillus spp., resulted in poor visual and survival outcome.

6 tables, 34 ref

039770   RATHI V M, SHARMA S, DAS T, KHANNA R C (L V Prasad Eye Institute, Hyderabad- 500 034, Telangana, Email: varsharathi@lvpei.org) : Endophthalmitis prophylaxis study. Report 1: Intracameral cefuroxime and moxifloxacin prophylaxis for the prevention of postcataract endophthalmitis in rural India. Indian J Ophthalmol 2020, 68(5), 819-24.

Intracameral antibiotics are known to reduce the incidence of acute endophthalmitis. Various drugs are available for intracameral use. This prospective study was carried out to compare the efficacies of intracameral cefuroxime and moxifloxacin prophylaxis in reducing the incidence of acute endophthalmitis after cataract surgery in rural India. This was a prospective, non randomized, comparative,interventional study. Between October 2016 and March 2018, 15 eye care facilities spread over four Indian states were preselected to use either of the intracameral antibiotics, cefuroxime or moxifloxacin, following cataract surgery (phacoemulsification or manual small incision cataract surgery, SICS). The main outcome measure was the occurrence of acute clinical endophthalmitis within six weeks of the surgery. This was compared with the earlier rate of endophthalmitis in the same locations. The study was done in 42,466 eyes. Of the total, 42.2 % received intracameral cefuroxime and 57.8 % received intracameral moxifloxacin.SICS was performed more often. Clinical acute endophthalmitis occurred in 15 eyes. This accounted to a 72.22 % reduction, from the earlier 0.126 % to 0.035 %, of post cataract surgery acute endophthalmitis. There duction in the incidence of endophthalmitis after intracameral cefuroxime was 0.017 % and that afterintracameral moxifloxacin was 0.049%. With either intracameral antibiotics, the reduction in incidence was statistically significant (P < 0.001), but not between the molecules. Intracameral cefuroxime showed 66.67 % reduction and intracameral moxifloxacin showed 74.74 % reduction. A 3.6‑fold decrease in postcataract surgery endophthalmitis was observed upon the use of intracameral antibiotics in rural India.Both intracameral cefuroxime and moxifloxacin proved efficacious.

2 illus, 2 tables, 34 ref

039769   RAMALINGAM L, VEERARAGHAVAN A (Shri Sathya Sai Medical Coll and Research Institute, Kanchipuram, Tamil Nadu, Email: lathura@gmail.com) : A cross-sectional study on the age of onset of menarche in females among rural and urban areas of Kanchipuram district in the past 5 years, since 2014. Natn J Physiol Pharm Pharmac 2020, 10(1), 94-8.

Hormonal imbalance, obesity, altered food habits, chemicals in cosmetics, and sedentary life have been the main causes of early onset of menarche. There has been a secular trend in the age of menarche of females at the rate of decrease of 1 month per decade since 1995. The objective of the study is to find out the trend of age of the onset of menarche in females of rural and urban areas in the past 5 years, from 2014 to 2018. A cross-sectional study was conducted among 378 females (196 rural and 182 urban) of the age group of 7–15 years in the rural and urban population of Kanchipuram district. After obtaining written consent, a questionnaire was administered to know their current age and age of menarche and noted. Majority of the females had the age of menarche between 12 and 13 years in the rural and urban population, but the number of females who attained menarche at 13 years was comparatively more in the rural population (n = 96) when compared with the urban (n = 37), though there was no statistical difference between the both. Furthermore, we observed that the early age of onset starts in early 2015 in the urban population, compared with the trend establishing in the rural population in the recent 2017 and 2018. There is a trend of early age of menarche among the females of the urban population when compared with the rural population.

3 tables, 30 ref

039768   VALAMBATH S, RAMAKRISHNAN P (Kannur Medical Coll, Kannur, Kerala, Email: smruthi8@gmail.com) : Morphological assessment of the soft palate and a possible corelation with obstructive sleep apnea - A digital cephalometric study. Natn J Physiol Pharm Pharmac 2020, 10(1), 21-6.

The available literature on the different morphologies of the soft palate is extremely scarce and has never been classified in an Indian population. We aim to study a corelation between different velar morphologies and probe variations with age, gender, and morphometric assessment based on the length and width. The present study also explores a possible link between snoring and particular velar morphologies as an indicator for the early diagnosis of obstructive sleep apnea syndrome (OSAS). (1) To assess the various velar morphological varieties in an Indian population,(2) most prevalent velar patterns according to gender predilection, (3) most prevalent velar patterns according to the age(adult >18 years and pre-adult <18 years), (4) assessment of the length and width of the soft palate, and (5) assessment of predilection for sleep apnea by comparing snoring with particular morphological variants.  Lateral cephalograms were obtained from 299 normal individuals whose age ranged from 5 to 85 years after obtaining clearance from the Institutional Ethical Committee. The velar morphology was classified, and the possibility of a corelation to gender, age, and the length and width of the soft palate was assessed. A snoring questionnaire was given to the relatives of the patients to assess the corelation between it and any particular velar morphology. Velar morphology was classified into six types, and we propose an indeterminate type as Type 7 in the classification. The results showed no corelation between particular velar morphologies and age or gender but showed a positive corelation between snoring and Type 6, Type 5, and Type 1 palates. The study corroborates the classification suggested by earlier investigators. No significant association was noted with particular velar morphology and age/gender. However, a significant increase in length with respect to Type 5 was noted. The present study for the 1st time in literature derived a positive corelation between snoring and particular velar morphologies (Type 6, Type 5, and Type 1 palates) which may be of use as an early indicator for the early diagnosis of OSAS.

7 tables, 12 ref

039767   PILLAI G S, VARKEY R, UNNIKRISHNAN U G, RADHAKRISHNAN N (Ophthalmology Dep, Amrita Vishwa Vidyapeetham Univ, Tiruvalla, Kerala, Email: rebecca.miss@gmail.com) : Incidence and risk factors for intraocular pressure rise after transconjunctival vitrectomy. Indian J Ophthalmol 2020, 68(5), 812-7.

To study the incidence and risk factors of raised intraocular pressures (IOPs) in the follow‑up of transconjunctival sutureless vitrectomy (TSV).  A retrospective observational study was performed on 635 patients who underwent TSV under a single surgeon. The IOPs were recorded using acalibrated non‑contact tonometer at seven postoperative visits, viz., day 1, 7 and 1, 3, 6 months, and 1 day and 1 month following silicone oil removal. IOP rise was seen in 24.25 % (154) out of the 635 eyes studied. Among patients under 50 years of age, 37.73 % had an IOP rise, compared to 21.55 % above 50 years (Odds Ratio 2.206). Among males, 30.32 % had an IOP rise, as compared to 15.98 % females (OR 2.287). In eyes with retinal detachment, 49.16 % had raised IOP (OR 5.435), and 24.05 % with proliferative diabeticretinopathy (OR 1.780), as opposed to 15.38 % with macular hole and 12.32 % with epiretinal membrane.This was statistically significant (P < 0.001). In eyes with silicone oil, 34.9 % developed a rise in IOP(OR 2.738) as compared to 11.94 % of other surgeries (OR 0.697). This was statistically significant (P < 0.001). We observed an increase in IOP postoperatively, more in those under 50 years, males and patients undergoing surgery for RD and PDR.

4 illus, 1 table, 11 ref

039766   SNEHA J A N, MURARAIAH S, KUMAR V (Bangalore Medical Coll and Research Institute, Bengaluru, Karnataka, Email: sushmamurari@yahoo.co.in) : Hemodynamic response to administration of vasopressors among patients with septic shock. Natn J Physiol Pharm Pharmac 2020, 10(1), 27-31.

Septic shock is characterized by refractory hypotension with a mortality of >50 %. Early fluid resuscitation,if failed, vasopressors are recommended to maintain mean arterial pressure (MAP) of 65 mmHg to restore organ perfusion. Noradrenaline (NA) is the vasopressor of choice but can be associated with adrenergic hyposensitivity and adverse effects on prolonged high-dose treatment. Hence, the addition of arginine vasopressin (AVP) to reduce the dose of NA is recommended. In view of the paucity of data in our setup, the present observational study was undertaken. The present study was conducted to analyze the hemodynamic response to vasopressors among patients in septic shock and to compare the same among patients receiving NA alone or NA + AVP. All consenting adult patients >18 years with septic shock receiving vasopressors were included in the study. Hemodynamic variables such as systolic and diastolic blood pressure and MAP were noted at baseline, 30 min, 1, 6, 24, and 48 h and the same was compared between patients receiving either NA alone or NA + AVP. The median age was 45 years with male preponderance. At admission, median MAP was 63 mmHg. On administration of vasopressors, target MAP was achieved by 1-h and maintained in both the groups of patients receiving NA or NA + AVP. No significant differences were noted in terms of hemodynamic parameters among patients receiving NA alone or NA + AVP.  As per the surviving sepsis guidelines 2018, vasopressor administration was initiated and the target MAP of >65 mmHg was achieved by 1 h, sustained over 48 h. No significant differences were noted among the patients receiving NA alone or NA + AVP in terms of hemodynamic variables.

4 tables, 15 ref

039765   KARACA U, DAGLI O, OZGE G, MUMCUOGLU T, BAYER A (Ophthalmology Dep , Suleyman Demirel Univ, Turkey, Email: drumutkaraca@gmail.com) : Comparison of structural and functional tests in primary open angle glaucoma. Indian J Ophthalmol 2020, 68(5), 805-11.

To comparatively analyze the structural and functional tests used in the diagnosis and follow‑up of glaucoma. Eighty eyes of 40 patients with primary open angle glaucoma (POAG) and 46 eyes of 23 healthy individuals were included in the study. Transient pattern electroretinography (PERG), steady‑state PERG (ssPERG), computerized visual field (VF) screening, and examination of retinal nerve fiber layer (RNFL) and macular thickness on optical coherence tomography (OCT) were undertaken. The results were compared between the groups.  80 eyes belonging to 40 patients with a diagnosis of POAG (23 female, 17 male) (18 mild 22 moderate POAG) with a mean of 57.37 (±8.6) years, and 46 eyes of 23 healthy individuals (14 female, 9 male) with a mean age of 55.30 (±8.09) years were included in the study. PERG P50 and N95 and ssPERG latency revealed a significant delay in the POAG group. When the wave amplitudes were examined, they were found to be significantly lower in both PERG and sSPERG tests for the POAG group, but the results were more pronounced in ssPERG. The latency values of PERG and ssPERG tests were not significantly correlated with any of the parameters of the remaining tests. However,the amplitude values of these tests had a positive correlation with the mean deviation value and negative correlation with the pattern standard deviation value of VF. All associated parameters were significant for the amplitude value of the ssPERG test. For the proper management of glaucoma, rather than approaching damage simply as the loss of retinal ganglion cells or the neuroretinal rim, it is necessary to focus on the ongoing anatomical and functional relationship and evaluate structural and functional tests together. In addition, ssPERG test, which is not widely adopted in routine practice, provides valuable information and is significantly correlated with OCT parameters.

1 illus, 5 tables, 41 ref

039764   RAO A, RAJ N, PADHY D, SARANGI S P (L V Prasad Eye Institute, Bhubaneswar- 751 024, Odisha, Email: vinodini10375@yahoo.com) : Perspectives and impediment to eye care in caregivers of children with childhood glaucoma. Indian J Ophthalmol 2020, 68(5), 798-804.

To study the perceptions, attitude, knowledge of the disease, and impediments to seeking early eyecare in caregivers of children with childhood glaucoma. The study included new and old children diagnosed with childhood glaucoma (which included congenital glaucoma and developmental glaucoma) at a tertiary hospital of east India. The caregivers were administered a video‑based questionnaire through open‑ended questions intended to collect demographic and other personal details such as caregiver’s socioeconomic status, knowledge, attitude towards eye health, and other social barriers. The responses were analyzed using thematic analysis technique into different buckets such as social status, knowledge/attitude,and socio cultural beliefs while individual responses in each bucket were analyzed.  Of a total of 43 patients included, >75 % of patients came from places >200 km from the eye care centre with >50 % coming from >300 km. Most patients presented either <1 year (42 %, n = 18) or >3 years (52 %, n = 22) with only 2 % (n = 3) presenting between 1–3 years of age. The mother was the first person of contact to diagnose the eye abnormality in >45 % of patients. Comparing differences among children who presented within1 year of first diagnosis and those that presented later, caregivers hailing from long‑distance >200 km from an eye care center, monthly income <5000 INR, and those with social/cultural taboos (like children’s eyes should not be operated) were more likely to seek delayed eye care for congenital glaucoma, P < 0.001. Impediments in seeking early eye care for blinding diseases in children (including distance from the nearest hospital, low socio economic constraints, and sociocultural beliefs/taboos) mandate serious policies towards improving education about eye disease and eye health among caregivers.

4 illus, 5 tables, 23 ref

039763   ASGARI S, HASHEMI H, FOTOUHI A, MEHRAVARAN S (Noor Eye Hospital, Tehran, Iran, Email: research@norc.ac.ir) : Anterior chamber dimensions, angles and pupil diameter in patients with down syndrome: A comparative population-based study. Indian J Ophthalmol 2020, 68(5), 793-7.

To study the anterior chamber (AC) dimensions, angles and pupil diameter (PD) in patients with Down syndrome compared to normal controls. Prospective study is comparing the AC parameters in patients with Down syndrome aged 10‑30 years and age‑matched controls. Extracted indices included average anterior chamber depth on the 2‑mm ring (ACD‑2 mm), 4‑mm ring (ACD‑4 mm), at the corneal apex from the endothelium (endo‑ACD), at the corneal apex from the epithelium (epi‑ACD), anterior chamber volume (ACV), mean anterior chamber angle (ACA), and PD measured by Pentacam. Data from 202 patients with Down syndrome (age 17.2 ± 4.8 years) were compared with 190 normal controls (age 17.2 ± 4.5 years). In Down and normal groups, mean ± SD were 2.51 ± 0.31 and 2.83 ± 0.34 mm for ACD‑2 mm, 1.65 ± 0.30 and 1.93 ± 0.31 mm for ACD‑4 mm, and 3.03 ± 0.29 and 3.24 ± 0.26 mm for endo‑ACD, 3.54 ± 0.29 and 3.80 ± 0.26 mm for epi‑ACD, mean 169.31 ± 30.38 and 200.17 ± 33.20 mm3 for ACV, 40.69 ± 4.50 and 39.97 ± 4.12° for ACA, and 2.79 ± 0.62 and 3.59 ± 0.80 mm for PD, respectively (all P < 0.001). None of the studied indices significantly correlated with age, except for ACA (P = 0.011). All parameters, except for PD, were significantly higher in males compared to females (all P < 0.001). Temporal ACA was significantly wider in male subjects (44.61 ± 6.52 vs. 42.24 ± 6.52°; P < 0.001). The AC in patients with Down syndrome is smaller than normal individuals. AC in females with Down syndromeis smaller than males, and the narrower ACA is attributable to the difference in the temporal angle and not the ACA in other meridians.

1 illus, 1 table, 26 ref

039760   KHOKHAR S, GUPTA Y, DHULL C, SINGH V (All India Institute of Medical Sciences, New Delhi- 110 029, Email: dryogita.aiims@gmail.com) : Intraoperative aberrometry in cataract surgery with topical versus peribulbar anesthesia. Indian J Ophthalmol 2020, 68(5), 776-9.

To study the effect of choice of anesthesia on the refractive outcomes of intraoperative aberrometry(IA) for intraocular lens power calculation in cataract surgeries. This prospective, interventional nonrandomized cohort study was conducted at a tertiary care hospital between March and August 2018. A total of 178 patients with age-related cataract were allocated into two groups. Group 1 received peribulbar anesthesia using a mixture of xylocaine 2 % + adrenaline 0.125 mg/ml + hyaluronidase 15 IU/ml with a 23G,32 mm needle, while Group 2 received topical anesthesia with proparacaine hydrochloride 0.05 % drops.Intraoperative aphakic measurements and IOL power calculations were obtained in all patients with the optiwave refractive analysis (ORA) system. Analysis was performed to compare the baseline parameters and postoperative manifest refraction at month 1. A total of 89 patients were included in group 1 and 89 in group 2. At baseline, the axial lengths (P = 0.66) and mean keratometry (P = 0.91) were comparable.The quality measure of captured wave front data was comparable (0.25) between the groups. Also, the postoperative mean refractive spherical equivalents were comparable between the two groups (P = 0.98) at one month. IA can be utilized well for cataract surgeries performed under local anesthesia with good quality of captured wave front, provided the eye can be aligned in centre with the fixation light of ORA.

2 illus, 1 table, 11 ref

039759   DASGUPTA S, SHAKEEL T, ROY R C (Ophthalmology Dep, SGRR- Institute of Medical and Health Sciences, Dehradun- 248 001, Uttarakhand, Email: tarannumshakeel9@gmail.com) : ToRCH-screening in pediatric cataract revisited: A North Indian tertiary care centre study. Indian J Ophthalmol 2020, 68(5), 769-75.

To analyze and report ToRCH‑serology screening profile (Toxoplasma gondii [TOX], rubella [RV], cytomegalovirus [CMV], and herpes simplex virus [HSV‑I/II]) in pediatric cataract.  In this prospective analytical study, 1,026 consecutive children were screened, of which 46 children with clinically diagnosed congenital (n = 26) and developmental cataract (n = 20) were included. Post‑traumatic and familial cataracts were excluded. Sera of all children were tested both qualitatively and quantitatively for IgG/IgM‑antibodies against ToRCH agents in a sequential manner. Overall, IgM/IgG‑seropositivity against ≥1 ToRCH agent was reported in 91.3 % (42/46) children. IgM (±IgG) positivity against ≥1 To RCH agent was reported in 26.08 % (12/46) children (nine congenital and three developmental cataract; P = 0.18),which included 8.7 % (4/46) children reported positive against ≥2 agents. Finally, 13 % (6/46) children were reported to be sero‑clinical‑positive (three were infants and three were >1 year age, P = 0.55; five congenital and one developmental cataract, P = 0.21). Either alone or combined, RV attributed to the majority (50 %; 6/12) of the IgM (±IgG) and sero‑clinical‑positive (50 %; 3/6) children. None of the children were HSV‑II IgM‑positive. Laboratory‑confirmed congenital rubella syndrome was reported in 4.3 % (2/46) children. One sero‑clinical‑positive infant with rare coexisting bilateral persistent fetal vasculature was also reported. IgG‑alone positivity was reported highest with CMV in 67.4 % (31/46) children, whereas 43.4 % (20/46) children were found non immune to RV. The current study emphasizes the need to interpret ToRCH‑screening in pediatric cataract with caution. Interpretation should include both serial qualitative and quantitative assays in tandem with clinical correlation to minimize the diagnostic errors.Clinicians should remain vigilant regarding sero‑clinical‑positivity in older children too who might pose a threat to the spread of infection.

6 tables, 34 ref

039758   KANAVI M R, CHAMANI T, KHEIRI B, JAVADI M A (Shahid Beheshti Univ, Tehran, Iran, Email: mrezaie47@yahoo.com) : Preparation of endothelial keratoplasty lenticules with gebauer SLC original versus moria cbm carriazo-barraquer and moria one-use plus microkeratomes. Indian J Ophthalmol 2020, 68(5), 762-8.

To investigate endothelial keratoplasty lenticules prepared from fresh whole eyes via Gebauer SLc Original (SLc) versus Moria CBm Carriazo‑Barraquer (CBm), and those prepared from corneoscleral buttons via SLc versus Moria One‑Use Plus (OUP) in terms of eye bank preparation criteria. Fresh whole eyes‑dissected endothelial keratoplasty lenticules with SLc were compared with CBm in terms of thickness profile measurements, over/under dissection values, endothelial cell loss, and postoperative graft failures. A similar comparison was made between corneoscleral buttons‑dissected endothelial keratoplastylenticules with SLc and OUP. Means of central thicknesses and increase of thickness toward periphery were not significantly different between 33 fresh whole eyes‑dissected endothelial keratoplastylenticules with SLc and 33 fresh whole eyes‑dissected ones with CBm. There was no significant difference between 19 corneoscleral buttons‑dissected endothelial keratoplasty lenticules with SLc and 19 corneoscleral buttons‑dissected ones with OUP in terms of mean central thickness and post‑cut endothelial cell loss.However, in the corneoscleral buttons‑dissected endothelial keratoplasty lenticules, a mean increase of thickness was significantly different from central to two pericentral locations with OUP (P = 0.001) and from central to two peripheral parts with SLc (P = 0.011). Both CBm and OUP systems showed deeper dissection depths than head descriptions as compared to SLc (P < 0.001). Unlike fresh whole eyes‑dissected endothelial keratoplasty lenticules with SLc or CBm, thickness profiles of corneoscleral buttons‑dissected endothelial keratoplasty lenticules with both SLc and OUP systems showed a partial asymmetric increase of thickness toward the periphery. A high agreement was observed between endothelial keratoplasty lenticules thicknesses and SLc nomograms.

2 illus, 4 tables, 25 ref

039757   PUROHIT P, MANTRI S, NAYAK J, MAHAPATRA B (Maharaja Krishna Chandra Gajapati Medical Coll, Berhampur, Odisha, Email: bibhupadam@gmail.com) : Factors responsible for mortality in patients with sickle cell disease: A hospital-based study. Natn J Physiol Pharm Pharmac 2020, 10(1), 32-6.

Sickle cell disease is the most common hemoglobin disorders in the state of Odisha with a significant morbidity and mortality. Various factors are responsible for the mortality in patients with sickle cell disease. This study was undertaken to explicate the possible cause of mortality in patients with sickle cell disease hospitalized in a tertiary health-care facility. From June 2017 to December 2018, 22 hospitalized sickle cell disease patients had died. All the demographic, hematological, and clinical investigations of the deceased patients were compared with age- and gender-matched hospitalized sickle cell disease patients who survived and were discharged during this study period. All the demographic features, hematological, and clinical investigations were compared in both the deceased and survived patients. The Statistical Package for the Social Sciences version 16.0 software was used for all possible statistical analyses and P < 0.05 was considered as statistically significant. Majority of the deceased patients were belonging to rural area (90.19 %) which was significantly high (P = 0.0271) compared to survived patients (61.36 %). Further, 77.27 % of deceased patients were referred from primary health centers compared to 29.55 % of patients in survived group (P = 0.0007). All the hematological and clinical parameters were comparable in both the groups. There was a high risk of mortality in patients with sickle cell disease who either referred from other primary health centers and/or belonging to the rural area. An early diagnosis of sickle cell disease, choose of suitable antibiotics, and other therapeutic strategies in hospitalized sickle cell disease patients may combat the disease severity as well as mortality.

3 tables, 14 ref

039756   PRASHANTH P, ARUN KUMAR H P (Travancore Medical Coll, Kollam, Kerala, Email: muktha900@gmail.com) : Effect of cardiovascular fitness on cognitive functions among male medical students of south kerala. Natn J physiol pharm Pharmac 2020, 10(1), 37-41.

Cardiovascular fitness has a beneficial effect on cognition and brain function in children. However, due to conflicting results in relationship between acute exercise and cognitive function in young adults, the data remain unknown. Hence, the present study is aimed to assess the effect of cardiovascular fitness on cognitive functions in healthy young adults. The aims of the study were as follows: (1) To assess the cardiovascular fitness among male medical students using Harvard step test, (2) to study the audiovisual reaction time and critical flicker-fusion frequency(CFFF) among male medical students, and (3) to study the correlation between cardiovascular fitness and cognitive functions. A comparative study was conducted among 100 male medical students of the age group of 18–25 years and they were randomly chosen into the study and control group. All were subjected to cognitive function tests such as visual reaction time (VRT), auditory reaction time (ART), and CFFF and pre-scores were recorded. Each subject from the study group underwent Harvard step test at a rate of 22/min for 5 min or until exhaustion for which fitness index was calculated. Cognitive tests were repeated within 5 min after exercise and post-exercise values were also recorded. The same cognitive tests were assessed in the control group after resting for 10 min. The pre-values and post-exercise values of the study group showed a significant difference in cognitive functions. The pre-values and post rest values of the control group had no significant difference. The pre-values of the study group and control group had no significant difference. The post-values of the study group and control group had significant difference. There was also a correlation between the fitness index and some cognitive function tests such as VRT and CFFF in the study group. There was a decrease in VRT and ART and increase in CFFF after exercise in the study group, which suggests that there was a positive influence of acute moderate exercise on cognitive functions.

6 tables, 19 ref

039755   THOMAS E, GEETHADEVI M (Government Medical Coll, Kottayam, Kerala, Email: evelynphysiology@gmail.com) : Prevalence and determinants of overweight and obesity among medical students. Natn J Physiol Pharm Pharmac 2020, 10(1), 42-8.

Obesity is one of the major lifestyle disorders in India and its incidence has rapidly increased during recent decades. Medical students are more prone for obesity, due to, their sedentary lifestyle, lack of exercise, disordered eating habits, increased stress, and vast topics to learn. The objectives of the present study were to find the prevalence of overweight/obesity among medical students, identify the contributing/associated factors, and assess the risk of comorbidities in them. A cross-sectional study was done among 330 medical students aged 18–25 years. Height, weight, and waist circumference were measured. Body mass index (BMI) was calculated. International physical activity questionnaire was used to assess physical activity. Dietary habits such as regular/irregular diet, vegetarian/non-vegetarian, eating speed, frequency of consumption of fried snacks, and fast food and sleep duration were also assessed. Based on waist circumference, the risk of comorbidities was also assessed. Increased prevalence of overweight/obesity (30.6 %) was obtained among medical students. Statistically significant increase in the prevalence of generalized obesity was noted in males compared to females. However, waist circumference showed a statistically significant increase in females. There was no significant association between dietary factors, sleep, and physical activity with BMI. Medical students have a high prevalence of obesity and are thus more prone for obesity-related risks. This study might create a self-awareness among the medical students to adopt healthy lifestyles such as regular exercise, less frequent consumption of fast food, and thus assure that they have reduced cardiovascular risks.

7 tables, 21 ref

039754   SINHA S, ALI M A (Physiology Dep, Sharda Univ, Greater Noida, Uttar Pradesh, Email: drsmritisinha@gmail.com) : A comparative study of age of menarche in private and government school-going girls. Natn J Physiol Pharm Pharmac 2020, 10(1), 49-53.

The menarche is known to assess the integrity of a woman’s circuitry from brain to ovary to the uterus and its timing is determined by multiple factors, one of which is attainment of a particular waist-to-hip (W/H) ratio, suggesting that leptin conveys information about the fat distribution to hypothalamus to initiate the process of menarche. This study aims to assess the mean age of menarche in this region (AOM) and to find if there is any difference between the AOM of government and private school-going girls and to find the relationship between AOM and various anthropometric measurements. A total of 250 randomly selected adolescent girls were asked to fill a pretested pre-structured questionnaire regarding anthropometric measurements, socio demographic profile, and menstrual history. The mean AOM was found to be 12.94 ± 0.74 years and the difference between the AOM of government and private schools is highly significant (P < 0.001) and W/H ratio is the single best predictor of the AOM. As childhood obesity and mental stress are on a rise worldwide, both these puberty accelerators are producing a new generation of girls who are sexually mature at a very tender age and this pubertal maturity should be matched by social maturity.

5 tables, 11 ref

039751   VYAS N, JADHAV P, SANE R (MGM Medical Coll and Hospital, Navi Mumbai, Maharashtra, Email: noopur1192@gmail.com) : Knowledge, attitude, and practices regarding informed consent for research purposes among postgraduate resident doctors. Natn J Physiol Pharm Pharmac 2020, 10(1), 54-8.

Informed consent is an ethical and legal requirement for research involving human participants. Postgraduate(PG) residents are budding doctors who are in their interim phase of education and are engaged in thesis/research work, which mandates adequate knowledge of informed consent and regulatory guidelines. There exists paucity of data in literature on the informed consent process with regard to PG residents; therefore, this study was conducted to assess the knowledge, attitude, and practices (KAP) of informed consent among PG residents. The aim of the study was to assess the level of knowledge and attitude about the informed consent process and assess practices adopted by PG residents for research purposes. It was a cross-sectional, observational and questionnaire-based study conducted from January 2018 to March 2018 at a tertiary care teaching hospital, Navi Mumbai. The study included PG residents of either sex pursuing specialty MD/MS courses. A validated KAP questionnaire was used to assess KAP of the informed consent process. Responses from the eligible participants were obtained and analyzed. A total of 100PG residents participated; 39 % of males and 61 % of females. Overall, the knowledge score was high and attitude toward informed consent was average. However, 34 % participants felt that witness is not necessary, 20 % felt that once the patient participates, they should not be allowed to withdraw and few felt that on voluntary withdrawal, participants are not liable for further standard care and compensation. In practice, few participants failed to explain consent in the local language and neglected to take the signature of an impartial witness. Overall, the KAP of informed consent among PG residents were adequate. Structured continuing medical education/workshops are necessary to advance informed consent practices.

2 illus, 3 tables, 15 ref

039750   KAMLEKAR S K, AGARWAL A, Aasha Latha P, GUPTA S (Geetanjali Medical Coll and Hospital, Udaipur, Rajasthan, Email: sandeep.k.kamlekar@gmail.com) : Evaluation of drug utilization pattern of anticancer drugs in oncology department of a tertiary care teaching hospital of southern Rajasthan. Natn J Physiol Pharm Pharmac 2020, 10(1), 15-20.

Cancer becomes major health burden on society, increased mortality rate in developing and developed countries. Chemotherapy plays a key role in the management of cancer. Drug utilization studies give an idea about the prescribing practice and characterize the early signals of irrational drug use. The present study was designed to investigate the utilization pattern of anticancer drugs and incidence of cancer types at Oncology Department, Geetanjali Medical College and Hospital, Udaipur, Rajasthan. One ninety two prescriptions of cancer effected patients were screened for anticancer drugs and supportive medications from February 1, 2019, to September 30, 2019, according to disease type, respectively. In our study, maximum cancer encountering age in both males and females was above 50 years, females are more predominant over males (female 53.64 % vs. 46.35 % males)with carcinoma of breast 15 % followed by carcinoma of ovary 13 % with carcinoma of lung 10 % in males. Carboplatin 52.08 % was the most commonly prescribed drug, followed by paclitaxel 45.31 % and gemcitabine 33.85 % along with adjuvants dexamethasone 100 %, ranitidine 100 %, and pantoprazole 35.93 % successfully. Carboplatin with other anticancer drugs was a safer combination for treating above-mentioned carcinomas.

3 illus, 5 tables, 28 ref

039748   NALINI G K, DEEPAK P, NEELAMMA P, SAHANA G N, NAGARAL J V (Hassan Institute of Medical Sciences, Karnataka, Email: drpdee@gmail.com) : Effectiveness of digital learning versus traditional learning among undergraduate students - prescription writing. Natn J Physiol Pharm Pharmac 2020, 10(1), 9-14.

Researchers of education constantly explore the impact of learning environment in relation to learning outcome. The social and communicative interaction between teacher and student has been an important part of classroom teaching. Now, there has been a change in electronic education due to favorable online environment due to increased internet connectivity, speed, and accessibility. The aim of the study was to know the difference in outcome between traditional and online learning among medical undergraduate students. After the Institutional Ethical Committee clearance, this study was done on 2nd year MBBS students. A total of 102 students were participated in the study. In a pre-test, a case scenario was given to all the students and they were asked to write the prescription for that case within 15 min. Then, the students were divided into two groups of 51 each. The first group (traditional learning) was provided with textbooks and the second group (online learning) was provided Internet facility. 45 min time was given to each group to use the respective facility and then was asked to write the prescription. The prescription written was analyzed using the suitable checklist. The study result shows that there was a significant improvement in both online learning and traditional learning methods. The improvement noted in the post-test was more in online learning when compared to traditional learning method and this was found to be statistically significant. It was observed that online learning was better than traditional text book-based learning. The nature of teaching and learning by incorporating new technology will redefine and oppose the superficial learning. Digital learning supports deeper and self-directed learning.

4 illus, 4 tables, 11 ref

039747   RAMADOSS G, YADALLA D (Aravind Eye Hospital and Post graduate Institute of Ophthalmology, Puducherry, Email: drdayakaryadalla@gmail.com) : A scientometric analysis of literature published in Indian Journal of Ophthalmology from 2005 to 2017. Indian J Ophthalmol 2020, 68(5), 738-44.

To perform an analysis of ophthalmic literature published by the Indian journal of ophthalmology (IJO) between 2005 and 2017 using scientometric techniques. The bibliographic records of all the literature published in the study period were collected from PubMed and exported as XML into Microsoft access for scientometric analysis. Subspecialty wise distribution across time, type of articles published (original articles, case reports, review articles, editorials, and letter to editor), reference analysis, author productivity analysis and citation analysis were performed as per well‑established scientometric methodology.  A total of 2,633 papers were published in the IJO during the study period. Articles related to vitreoretinal diseases contributed 23 % of all the articles published (n = 598) followed by corneal diseases (n = 313, 12 %), and cataract (n = 293, 11 %). There were equal numbers of case reports (n = 894, 34 %) and original articles (n = 862, 33 %) though case reports reduced over time. A total of 5490 unique authors from 64 countries published in the IJO with majority authors (63 %) from India. Less than 80 % of articles published in the IJO were cited (n = 2051, 78 %) by 24,592 articles with retina‑related papers contributing 20 % of all citations. Original articles had three times more likelihood of being cited compared to case reports.The IJO showed a steady increase in the number of publications from year to year. Papers from the vitreoretinal domain were the commonest and were cited most often. Original articles and case reports contributed equally to the published content though the former were cited much more frequently than the latter.

3 illus, 6 tables, 14 ref

039746   DAS A V, BASU S (EyeSmart EMR and AEye Dep, L V Prasad Eye Institute, Hyderabad- 500 034, Telangana, Email: sayanbasu@lvpei.org) : Epidemic keratoconjunctivitis in India: Trend analysis and implications for viral outbreaks. Indian J Ophthalmol 2020, 68(5), 732-6.

To describe the correlation between the temporal pattern of presentation of acute epidemic keratoconjunctivitis (EKC) of presumed adenoviral etiology with meteorological parameters such as environmental temperature, rainfall, humidity, and wind speed.This cross‑sectional hospital‑based study included 2,408,819 patients presenting between August 2010 and February 2020. Patients with a clinical diagnosis of EKC in at least one eye were included as cases. A smaller cohort of patients with acute (≤1 week) presentation hailing from the district of Hyderabad during the calendar years 2016–2019 was used to perform correlation analysis with the local environmental temperature, rainfall, humidity, and wind speed (data obtained from the Telangana State Development and Planning Society). Overall, 21,196 (0.87 %) patients were diagnosed with EKC, of which 19,203 (90.6 %) patients had acute onset; among which the cohort from the district of Hyderabad included 1,635 (8.51 %) patients.The mean monthly prevalence in this cohort was 0.89 % with a peak prevalence in April (1.09 %). The environmental parameters of rainfall (r2 = 0.47/P = 0.0131), humidity (r2 = 0.65/P = 0.0014), and windspeed (r2 = 0.56/P = 0.0047) were significantly negatively correlated with the temporal pattern of EKC in the population. There was no visible trend or significant correlation seen with temperature (r2 = 0.08/P = 0.3793). Contrary to popular belief, epidemic viral infections like EKC may not be affected by temperature, but rather by a complex interplay of other environmental factors such as humidity, rainfall, and wind speed. An increase in rainfall, wind speed, and humidity contributes to a lower prevalence of EKC cases during the year.

2 illus, 16 ref

039745   SHARMA S K, MUDGAL S K, THAKUR K, GAUR R (Nursing Dep, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, Email: peehupari05@gmail.com) : How to calculate sample size for observational and experimental nursing research studies. Natn J Physiol Pharm Pharmac 2020, 10(1), 1-8.

Sample size estimation for a research study is the most crucial part of the research process because it helps to produce reliable results which improve generalizability of study results. A researcher must have understanding about significance level, effect size, study’s power, and effect size; margin of error and ratio in event among population and design effect touse sample size calculation formulas efficiently. There are different formulas of sample size calculation for different types of variables measured in distinct study designs, namely descriptive, epidemiological, comparative, and interventional research studies which are covered in this article. Review authors searched online and grey literature related to sample size and read extensively. There were two authors who extracted and complied information related to topic.

1 table, 23 ref

039744   NAIR A G, GANDHI R A, NATARAJAN S (Aditya Jyot Eye Hospital, Mumbai- 400 031, Maharashtra, Email: akshaygn@gmail.com) : Effect of COVID-19 related lockdown on ophthalmic practice and patient care in India: Results of a survey. Indian J Ophthalmol 2020, 68(5), 725-30.

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.  An online survey was sent across to practicing Indian ophthalmologists across through various social media platforms. All valid responses were tabulated and analyzed. 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 there sumption 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. 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 tele medicine 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.

5 illus, 24 ref

039727   PAN U, JAIN A, GUBERT J, KUMARI B, SINDAL M D (Aravind Eye Hospital, Pondicherry- 605 007, Email: mdsindal@gmail.com) : Antibiotic sensitivity trends of pseudomonas endophthalmitis in a tertiary eye care center in South India: A 12-year retrospective study. Indian J Ophthalmol 2020, 68(4), 627-31.

To assess trends in antibiotic sensitivity of pseudomonas and compare multidrug resistance (MDR) between Pseudomonas endophthalmitis cases presenting in two consecutive 6‑year time frames in a tertiary center in South India. This is a retrospective comparative series of all Pseudomonas endophthalmitis cases treated from June 2004 to May 2016. Microbiological culture results in all endophthalmitis patients were screened for pseudomonas. Positive cases in the initial 6 and final 6 years were compared for sensitivity to antibiotics and the proportion of MDR. MDR was defined as resistance to at least two different classes of antibiotics. Pseudomonas accounted for 74 of 389 endophthalmitis cases (19 %), 42 in initial 6 and 32 in final 6 years. Sensitivity to ciprofloxacin, ofloxacin,gatifloxacin, moxifloxacin, and ceftazidime was 85.7 %, 82.9 %, 76.5 %, 76.9 %, 88.1 % up to 2010 which reduced to 75 %, 59.4 %, 68.8 %, 56.3 %, 56.3 %, respectively, after 2010, being significant for ofloxacin (P = 0.0349) and ceftazidime (P = 0.0028). Susceptibility to amikacin, gentamicin, and tobramycin changed non‑significantly from 83.3 %, 43.9 %, 47.6 % to 71.9 %, 61.3 %, 61.3 %, respectively. Twenty of 74 cases (27 %) were MDR with 16.7 % in first 6 years versus 40.6 % in final 6 years. Postoperative MDR cases rose from 10.3 % to 50 %(P = 0.0048).  This study shows rising resistance of Pseudomonas to fluoroquinolones, amikacin,and ceftazidime in endophthalmitis. MDR also showed an upward trend, particularly in postsurgical cases.

1 illus, 3 tables, 15 ref