Comparison of cognitive workload and surgical outcomes between a three-dimensional and conventional microscope macular hole surgery

BACKGROUND

Performing a surgical task subjects the surgeon to multitudinal stressors, especially with the newer 3D technology. The quantum of cognitive workload using this modern surgical system in comparison to the Conventional microscope system remains unexplored. We evaluate the surgeon's cognitive workload and the surgical outcomes of macular hole(MH) surgery performed on a 3D versus a Conventional microscope operating system.

METHODS

50 eyes of 50 patients with MH undergoing surgery using the 3D or Conventional microscope visualization system. Cognitive workload assessment was done by real-time tools(Surgeons' heart rate [HR] and oxygen saturation[SPO2]) and self-report tool(Surgery Task Load Index[SURG-TLX] questionnaire) of three Vitreoretinal surgeons. Based on the SURG-TLX questionnaire, an assessment of the workload was performed.

RESULTS

Of the 50 eyes, 30 eyes and 20 eyes underwent surgery with the Conventional microscope and the 3D system, respectively. No difference was noted in the MH basal-diameter(p = 0.128), total surgical-duration(p = 0.299), internal-limiting membrane(ILM) peel time(p = 0.682), and the final visual acuity (VA; p = 0.515) between the two groups. Both groups showed significant improvement in VA(p < 0.001) with a 90% closure rate at one-month post-surgery. Cognitive workload comparison, the intraoperative HR(p = 0.024), total workload score(P = 0.005), and temporal-demand dimension(p = 0.004) were significantly more in Conventional microscope group as compared to 3D group. In both the groups, the HR increased significantly from the baseline while performing ILM peeling and at the end.

CONCLUSION

The surgeon's cognitive workload is markedly reduced while performing macular hole surgery with a 3D viewing system. Moreover, duration of surgery including ILM peel time, MH closure rates, and visual outcomes remains unaffected irrespective of the operating microscope system.

Optimising peak energy reduction in networks of buildings

Buildings are amongst the world's largest energy consumers and simultaneous peaks in demand from networks of buildings can decrease electricity system stability. Current mitigation measures either entail wasteful supply-side over-specification or complex centralised demand-side control. Hence, a simple schema is developed for decentralised, self-organising building-to-building load coordination that requires very little information exchange and no top-down management-analogous to other complex systems with short range interactions, such as coordination between flocks of birds or synchronisation in fireflies. Numerical and experimental results reveal that a high degree of peak flattening can be achieved using surprisingly small load-coordination networks. The optimum reductions achieved by the simple schema can outperform existing techniques, giving substantial peak-reductions as well as being remarkably robust to changes in other system parameters such as the interaction network topology. This not only demonstrates that significant reductions in network peaks are achievable using remarkably simple control systems but also reveals interesting theoretical results and new insights which will be of great interest to the complexity and network science communities.

Surface characteristics of 3D printed PEEK polymer using atomic force microscopy

High-performance polymer three-dimensional printing is becoming more popular for producing unique parts suitable for different applications. It has been utilized extensively in biomedical applications such as dental prosthetics, surgical equipment, and implants. However, the performance of the material is significantly influenced by its surface qualities, particularly in aspects of its adhesion and biocompatibility. This study involves the fabrication of PEEK specimens S1, S2, S3, and S4 with different printing parameters such as layer height of 0.10 and 0.15 mm and printing speed of 20 and 25 mm/s using a fused deposition modeling process. The surface roughness of the fabricated specimens is measured using atomic force microscopy. The results showed that the printing parameters significantly impact the surface roughness of the PEEK specimens. The surface roughness of specimen S3, printed at a layer height of 0.15 mm and a speed of 20 mm/s, has a low roughness value of 0.017 μm, which is considerable in comparison to the other specimens. In addition to the measurement of surface roughness from roughness profile, the force curve separation graph was plotted and the adhesion force values were calculated for all the specimens to determine the interlayer bonding strength.

A data-driven reduced-order surrogate model for entire elastoplastic simulations applied to representative volume elements

This contribution discusses surrogate models that emulate the solution field(s) in the entire simulation domain. The surrogate uses the most characteristic modes of the solution field(s), in combination with neural networks to emulate the coefficients of each mode. This type of surrogate is well known to rapidly emulate flow simulations, but rather new for simulations of elastoplastic solids. The surrogate avoids the iterative process of constructing and solving the linearized governing equations of rate-independent elastoplasticity, as necessary for direct numerical simulations or (hyper-)reduced-order-models. Instead, the new plastic variables are computed only once per increment, resulting in substantial time savings. The surrogate uses a recurrent neural network to treat the path dependency of rate-independent elastoplasticity within the neural network itself. Because only a few of these surrogates have been developed for elastoplastic simulations, their potential and limitations are not yet well studied. The aim of this contribution is to shed more light on their numerical capabilities in the context of elastoplasticity. Although more widely applicable, the investigation focuses on a representative volume element, because these surrogates have the ability to both emulate the macroscale stress-deformation relation (which drives the multiscale simulation), as well as to recover all microstructural quantities within each representative volume element.

Type III Monteggia Fracture-dislocation with Radial Nerve Injury in Adults - A Case Report of two Cases

Introduction

Uncommon complication of Monteggia fracture is associated PIN palsy. The PIN palsy following Monteggia fracture-dislocation is neuropraxias and will recover spontaneously.

Case Report

Two cases who were diagnosed as Monteggia fracture-dislocation with PIN palsy and associated superficial branch of radial nerve injury - Power 0/5 and sensations 0/2 were taken up for surgery (open reduction internal fixation of fracture of ulna + closed reduction of radial head). By the end of 7 weeks, both sensory and motor power were fully recovered spontaneously in both the cases.

Discussion

Most of the PIN injuries following Monteggia fracture-dislocation are neuropraxias and will recover spontaneously after closed reduction of radial head without any intervention to the nerve. The nerve needs to be intervened if there are no signs of recovery by 3 months. The time frame for the nerve to be intervened remains controversial.

Conclusion

In both of our cases, the injury is probably proximal to the terminal division of radial nerve and the injuries were neuropraxias and have recovered spontaneously. Hence, we suggest not exploring the nerve in all cases with Monteggia fracture-dislocation immediately even when there is associated sensory deficit.

Highly Selective MOF-Based Turn-Off Luminescence Detection of Hg2+ Ions in an Aqueous Medium and Its Dual Functional Catalytic Activity toward Aldol Condensation and β-Enamination Reactions

A new organic ligand, 5-(carboxyformamido)isophthalic acid (5-CFIA), was prepared and employed for the synthesis of two compounds [M₃(C₁₀H₄O₇N₁)₂(8H₂O)]·H₂O (M = Cd, Mn). The compounds have three-dimensionally extended structures. Both the compounds were found to be luminescent at room temperature. The luminescence nature was exploited for the detection of Hg²⁺ ions in an aqueous medium with good selectivity. The interactions between Hg²⁺ ions and the compounds quench the luminescence intensity and act as a turn-off sensor. Both the compounds exhibited low limits for the detection of Hg²⁺ ions and in the range mandated by the WHO. The interactions between Hg²⁺ ions and the compound involve the -NH group, which was probed using Raman and IR spectroscopic techniques. These studies provide important pointers toward the mechanism of this turn-off luminescence behavior. The compounds were explored for base-catalyzed aldol condensation and Lewis acid-promoted β-enaminoester formation reactions. The aldol condensation reaction uses the -NH functionality as a base. The studies indicate that the electron-withdrawing group produces products with higher yields. The β-enaminoester reaction uses the Lewis acid centers, and the studies reveal that the electron-withdrawing groups produce lesser yields of the products. The catalytic nature of the reaction and recyclability of the catalysts were also established. The catalytic reactions employ ethanol (aldol condensation) and no solvent (β-enaminoester), which suggests that the reactions are green and environmentally friendly. The Mn compound was observed to be anti-ferromagnetic.

Post market surveillance registry (PIONEER) of the Yukon Choice PC-Elite Coronary Stent System for percutaneous coronary intervention in Indian acute coronary syndrome population

AIM

The aim of this study was to assess the safety and efficacy profile of a newer generation biodegradable DES, the Yukon Choice PC Elite with a temperature controlling mechanism, in patients with acute coronary syndrome (ACS).

METHODS

This prospective multi-center study (PIONEER Registry) was conducted in an Indian ACS population, therefore providing data in real world clinical practice. Patients with ACS underwent DES implantation in de novo native-vessel coronary lesions with the Yukon Choice PC Elite biodegradable polymer DES and were followed up for a year.

RESULTS

A total 999 patients were evaluated. The majority of patients were male (79.2%). A total of 6.7% of the patients had a history of prior myocardial infarction (MI) and 2.7% of patients had a history of previous coronary artery bypass graft. The clinical presentations of the patients included: unstable angina pectoris (UA) (46.4%), ST-segment elevation MI (STEMI) (38.1%), and Non-ST-segment elevation MI (NSTEMI) (15.4%). Implantation of the device was successful in 99.9% of cases. The median stent length and stent size were 21.0 mm (Range: 8.0-40.0 mm) and 2.8 mm (Range 2.0-4.0 mm), respectively. Through to one-year clinical follow-up after percutaneous coronary intervention, all-cause death occurred in 4 of 999 patients (Crude Percentage: 0.4%). Cardiac death, MI, TLR, and stent thrombosis were occurred in 1 (0.1%), 8 (0.8%), 12 (1.2%) and 1 (0.1%) patients, respectively.

CONCLUSION

The results of this post marketing surveillance registry suggest favorable safety and efficacy outcomes associated with the Yukon Choice PC Elite biodegradable DES in a real world Indian ACS population.

Awareness and perception of an Indian dental professional in context to the process and their role in disaster victim identification as a taskmaster

Forensic odontology is a young area in India. However, it has been used as an integral component in a various medicolegal cases in India. However, the involvement of a dentist in mass disasters still needs to be well recognized. The role of the dentists in any unforeseen circumstances is to contribute as an adjunct hand in Disaster Victim Identification (DVI) which is in an emergent stage in India. This study aimed to assess an Indian dental professional's knowledge and awareness of their role in DVI. A pre-tested, self-administered anonymous questionnaire consisting of 6 open-ended and 14 close-ended questions was mailed to the participants. A total of 441 responses were recorded. The study indicated adequate knowledge and awareness among dental practitioners. Conversely, only a handful of people had first-hand autopsy experience. Thus, to supplement the skills needed to work at ground zero, it is recommended to develop hands-on training programs for dentists in each state of India. Also, creating a pool of experts in each state of India can strengthen the task force.

A novel application of a bioactive material as a pit and fissure sealant: in vitro pilot study evaluating the sealing ability and penetration

PURPOSE

To compare the sealing ability and penetration of a bioactive material used as pit and fissure sealant to those of glass ionomer sealant.

METHODS

This was an in vitro experimental study conducted on 20 permanent teeth. For Group I of ten teeth, ACTIVA BioACTIVE-Base/Liner was applied as a sealant on pits and fissures, and the remaining ten teeth of Group II were sealed using glass ionomer cement. After thermocycling, the apex of the teeth was sealed using composite resin and they were immersed in 1% methylene blue solution, buffered at pH 7 for 24 h. Longitudinal sections were obtained from each tooth for evaluating the sealing ability and penetration, using a binocular light microscope at 4 × magnification. The obtained data were subjected to analysis using the Chi-square test and independent t test.

RESULTS

The comparison of the sealing ability and sealant penetration, between the two groups, showed statistically no significant difference (p = 0.104 and p = 1.0, respectively).

CONCLUSION

Bioactive material as a pit and fissure sealant, performed on par with glass ionomer sealant in terms of tested properties like sealing ability and penetration.

216 Improving Patient Education About Pre-Diabetes in the Community

Aim

Pre-diabetes is a common condition and although its development is linked to lifestyle factors, many patients are unaware of interventions that can improve their condition. One-to-one consultations between patients and GPs focused on reducing carbohydrate consumption are known to be effective at improving pre-diabetes. This QIP aimed to improve patients' understanding of pre-diabetes and reduce carbohydrate intake.

Method

Patients were included if they had 2 HbA1c measurements between 42 – 48mmol/mol and the ability to make dietary changes independently. A questionnaire based on the UK Diabetes and Diet Questionnaire was constructed and used to ask patients about their concern about pre-diabetes, knowledge of foods that contribute to the condition and the frequency at which they consumed various carbohydrates. Advice about reducing carbohydrate intake was given verbally and patients were provided with a diet sheet produced by Unwin et al. Patients were called again after 7 – 14 days to assess dietary changes and the impact of the advice.

Results and Conclusions

31 patients responded to the initial telephone call of which 58.1% were concerned about pre-diabetes and 38.7% mentioned foods high in carbohydrate as a cause of pre-diabetes. 90.3% of patients consumed food high in carbohydrate on 4 or more days per week. 22 patients responded to the follow up telephone call of which 63.6% reported a reduction in carbohydrate intake, 95.5% knew more about pre-diabetes and 90.9% found the dietary advice helpful. These results suggest that pre-diabetic patients should be given verbal and written information about lowering carbohydrate intake at GP consultations.

The Impact of the First Wave of Covid 19 on Orthopaedic Surgeries in a Tertiary Care Teaching Hospital

Background: The Covid 19 was declared a global pandemic that had a sizeable impact on the health care services in the surgical field including the orthopaedic department. There was additionally a decreased accessibility to healthcare personnel and facilities reallocated to manage the Covid patients. The study was mainly conducted to find out the impact of the first wave of COVID-19 on the orthopaedic surgeries. Aim: The main aim of the study is to find out the alteration in the number, type of surgeries, financial implications, duration of hospital stay, delay in surgery during the first wave of the COVID-19 pandemic. Study Design: Retrospective crossectional study. Methods: All the surgeries conducted in the orthopaedic department in the year 2019 and 2020 following first peak in March including pre-op and post-op COVID cases are included in the study. The procedure conducted, date of admission, date of surgery, date of discharge, investigations done and the cost expenses are the various parameters that are taken into consideration. The results are analysed for each year and comparisons are made using statistical methods. Results: The comparative analysis of the data collected from the years 2019 and 2020 showed an increase in the duration of hospital stay, delay in surgery, additional expenditure, back log in the number of elective surgeries done during the Pandemic.

Powder Metallurgical Processing and Characterization of Molybdenum Addition to Tungsten Heavy Alloys by Spark Plasma Sintering

The effect of adding molybdenum to the heavy tungsten alloy of W-Ni-Fe on its material characteristics was examined in the current study. The elemental powders of tungsten, iron, nickel, and molybdenum, with a composition analogous to W-3Fe-7Ni-xMo (x = 0, 22.5, 45, 67.5 wt.%), were fabricated using the spark plasma sintering (SPS) technique at a sintering temperature of 1400 °C and under pressure of 50 MPa. The sintered samples were subjected to microstructural characterization and tested for mechanical strength. The smallest grain size of 9.99 microns was observed for the 45W-45Mo alloy. This alloy also gave the highest tensile and yield strengths of 1140 MPa and 763 MPa, respectively. The hardness increased with the increased addition of molybdenum. The high level of hardness was observed for 67.5Mo with a 10.8% increase in the base alloy’s hardness. The investigation resulted in the alloy of 45W-7Ni-3Fe-45Mo, observed to provide optimum mechanical properties among all the analyzed samples.

Kabasura Kudineer (KSK), a poly-herbal Siddha medicine, reduced SARS-CoV-2 viral load in asymptomatic COVID-19 individuals as compared to vitamin C and zinc supplementation: findings from a prospective, exploratory, open-labeled, comparative, randomized controlled trial, Tamil Nadu, India

INTRODUCTION

Despite several ongoing efforts in biomedicine and traditional medicine, there are no drugs or vaccines for coronavirus disease 2019 (COVID-19) as of May 2020; Kabasura Kudineer (KSK), a polyherbal formulation from India's Siddha system of medicine, has been traditionally used for clinical presentations similar to that of COVID-19. We explored the efficacy of KSK in reducing viral load and preventing the disease progression in asymptomatic, COVID-19 cases.

METHODS

A prospective, single-center, open-labeled, randomized, controlled trial was conducted in a COVID Care Centre in Chennai, India. We recruited reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 of 18 to 55 years of age, without clinical symptoms and co-morbidities. They were randomized (1:1 ratio) to KSK (60 mL twice daily for 7 days) or standard of care (7 days supplementation of vitamin C 60,000 IU morning daily and zinc 100 mg evening daily) groups. The primary outcomes were reduction in the SARS-CoV-2 load [as measured by cyclic threshold (CT) value of RT-PCR], prevention of progression of asymptomatic to symptomatic state, and changes in the immunity markers including interleukins (IL-6, IL-10, IL-2), interferon gamma (IFNγ), and tumor necrosis factor (TNF α). Siddha clinical assessment and the occurrence of adverse effects were documented as secondary outcomes. Paired t-test was used in statistical analysis.

RESULTS

Viral load in terms of the CT value (RdRp: 95% CI = 1.89 to 5.74) declined significantly on the seventh day in the KSK group and that of the control group, more pronounced in the study group. None progressed to the symptomatic state. There was no significant difference in the biochemical parameters. We did not observe any changes in the Siddha-based clinical examination and adverse events in both groups.

CONCLUSION

KSK significantly reduced SARS-CoV-2 viral load among asymptomatic COVID-19 cases and did not record any adverse effect, indicating the use of KSK in the strategy against COVID-19. Larger, multi-centric trials can strengthen the current findings.

TRIAL REGISTRATION

Clinical Trial Registry of India CTRI2020/05/025215 . Registered on 16 May 2020.

Analysis of Surface Morphology and Elemental Composition on Zirconia Implants Before and After Photofunctionalization by Scanning Electron Microscopy and Energy Dispersive X ray Spectroscopy - An In vitro Study

Background:

The purpose of this study is to analyze the surface morphology and elemental composition of zirconia implants before and after photofunctionalization.

Materials and Methods:

Ten zirconia implants (white sky implant system– Bredent Company) five each in the study group and control group was taken. Study group samples were treated with ultraviolet light for 48 h. Microstructured surface of the study and control group blanks at abutment and thread regions were documented by Scanning Electron Microscope The semi-quantitative element composition was analyzed using Energy-dispersive X-ray (EDX) spectrum.

Results:

SEM images of the study and control group divulged a varied array of topographical configuration of the abutment area and thread region at different magnifications. At low magnification, both study and control group revealed plain compact surface and wavy porous area, whereas higher magnification showed dense grainy regions of various sizes and intensities disrupted by pores. EDX spectrum analysis for elemental composition showed increased oxygen concentration in the study group (42.8%) than the control group (29.09%), whereas carbon concentration was lower in photofunctionalized group (34.34%) than in the control group (45.41%).

Conclusion:

In zirconia implants, photofunctionalization is a viable method to effectively enhance the surface topography and hydrophilicity of bone-implant interface.

Biomechanical design framework for prosthetic feet: Experimentally validated non-linear finite element procedure

Performance evaluation of prosthetic feet during their design is typically performed experimentally, which may be time and cost intensive. This work presents a first-of-its-kind application of a numerical procedure for the a priori determination of various stance phase biomechanical parameters of a prosthetic foot, such as its roll-over characteristics, centre of pressure trajectory, ankle flexion moment arm and ankle range of motion, to aid in its design. The numerical procedure is based on finite element analysis, which includes geometric, material and contact non-linearity. Boundary conditions emulating the rocker-based inverted pendulum model were employed to evaluate the biomechanical parameters. The finite element model was validated by employing an inverted pendulum-based apparatus using the structurally complex Ottobock Solid Ankle Cushioned Heel (SACH) prosthetic foot as the test device. A comparison of the numerical and experimental results showed low magnitude of errors. For example, the percentage error of the radius of curvature of the roll-over shape was ~0.1%. The differences found appear to be clinically insignificant, which substantiates the reliability of the model. The proposed numerical model can be employed to obtain detailed a priori insights into the biomechanical parameters influencing a prosthetic foot's characteristics during gait, which can better inform the design, analysis and prescription of prosthetic feet.

Siddha Varmam and Thokkanam therapy in the treatment of adhesive capsulitis-A case report

A 60 year married female from Chennai presented with pain and restricted abduction, adduction, external rotation and flexion of right shoulder both in active and passive movements for 2 months. She was diagnosed to be affected by adhesive capsulitis which is equated to Kumbavatham, one of the vatha diseases mentioned in Siddha system of medicine. She was treated with Siddha Varmam therapy and thokkanam with Vathakesari thylam. After 15 days of hospital stay the patient was discharged and was followed for 6 months. There were no adverse reactions/events observed during the course of treatment. The combination therapy has provided the reduction in pain and restricted movements which was measured using goniometer and SPADI index.

Effect of Rare Earth Metals (Y, La) and Refractory Metals (Mo, Ta, Re) to Improve the Mechanical Properties of W-Ni-Fe Alloy-A Review

Tungsten heavy alloys are two-phase metal matrix composites that include W–Ni–Fe and W–Ni–Cu. The significant feature of these alloys is their ability to acquire both strength and ductility. In order to improve the mechanical properties of the basic alloy and to limit or avoid the need for post-processing techniques, other elements are doped with the alloy and performance studies are carried out. This work focuses on the developments through the years in improving the performance of the classical tungsten heavy alloy of W–Ni–Fe through doping of other elements. The influence of the percentage addition of rare earth elements of yttrium, lanthanum, and their oxides and refractory metals such as rhenium, tantalum, and molybdenum on the mechanical properties of the heavy alloy is critically analyzed. Based on the microstructural and property evaluation, the effects of adding the elements at various proportions are discussed. The addition of molybdenum and rhenium to the heavy alloy gives good strength and ductility. The oxides of yttrium, when added in a small quantity, help to reduce the tungsten’s grain size and obtain good tensile and compressive strengths at high temperatures.

Diabetic retinopathy screening guidelines in India: All India Ophthalmological Society diabetic retinopathy task force and Vitreoretinal Society of India Consensus Statement

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

Analysis of Surface Roughness and 3D Scanning Topography of Zirconia Implants Before and After Photofunctionalisation by 3D Optical Profilometry- An Invitro Study

Introduction: Zirconia is considered as an alternative material for the fabrication of implants. Surface roughness of the implant plays a fundamental role in the initial bone formation. The rationale of using 3D optical profilometry in this study was to evaluate the surface roughness of the zirconia implants before and after Ultraviolet (UV) photofunctionalisation. Also, Moreso 3D optical instruments have a better resolution than the mechanical ones like Atomic Force Microscopy (AFM). Aim: To analyse the surface roughness and topography of zirconia implants after photofunctionalisation using optical profilometry. Materials and Methods: This is an in-vitro study conducted over a period of six months from March 2020 to August 2020. Ten commercially machined Zirconia implants, five each in study and control group, were micro analysed at three different regions (abutment, thread and crest) by optical profilometry. Study group was surface treated by UV radiation for 48 hours. Quantitative morphometric analysis was done between two groups and p-value less than 0.05 was considered statistically significant. The statistical test applied in this study was independent t-test. Results: Scanning micrographs of the study group revealed highest density of summits contributing to increased surface area in the study group. Quantitative analysis of surface roughness showed statistically significant higher mean roughness parameter for photofunctionalised implants in abutment, crest and thread region (p<0.05). Conclusion: Photofunctionalisation is a potentially synergistic technique in producing textured zirconia implants.

The efficacy of Siddha Medicine, Kabasura Kudineer (KSK) compared to Vitamin C & Zinc (CZ) supplementation in the management of asymptomatic COVID-19 cases: A structured summary of a study protocol for a randomised controlled trial

OBJECTIVES

The primary objectives of this study are to determine efficacy of Siddha medicine, Kabasura kudineer in reduction of SARS-CoV-2 viral load and reducing the onset of symptoms in asymptomatic COVID-19 when compared to Vitamin C and Zinc (CZ) supplementation. In addition, the trial will examine the changes in the immunological markers of the Siddha medicine against control. The secondary objectives of the trial are to evaluate the safety of the Siddha medicine and to document clinical profile of asymptomatic COVID-19 as per principles of Siddha system of Medicine.

TRIAL DESIGN

A single centre, open-label, parallel group (1:1 allocation ratio), exploratory randomized controlled trial.

PARTICIPANTS

Cases admitted at non-hospital settings designated as COVID Care Centre and managed by the State Government Stanley Medical College, Chennai, Tamil Nadu, India will be recruited. Eligible participants will be those tested positive for COVID-19 by Reverse Transcriptase Polymerase Chain reaction (RT-PCR) aged 18 to 55 years without any symptoms and co-morbidities like diabetes mellitus, hypertension and bronchial asthma. Those pregnant or lactating, with severe respiratory disease, already participating in COVID trials and with severe illness like malignancy will be excluded.

INTERVENTION AND COMPARATOR

Adopting traditional methods, decoction of Kabasura kudineer will be prepared by boiling 5g of KSK powder in 240 ml water and reduced to one-fourth (60ml) and filtered. The KSK group will receive a dose of 60ml decoction, orally in the morning and evening after food for 14 days. The control group will receive Vitamin C (60000 IU) and Zinc tablets (100mg) orally in the morning and evening respectively for 14 days.

MAIN OUTCOMES

The primary outcomes are the reduction in the SARS-CoV-2 load [as measured by cyclic threshold (CT) value of RT-PCR] from the baseline to that of seventh day of the treatment, prevention of progression of asymptomatic to symptomatic state (clinical symptoms like fever, cough and breathlessness) and changes in the immunity markers [Interleukins (IL) 6, IL10, IL2, Interferon gamma (IFNγ) and Tumor Necrosis Factor (TNF) alpha]. Clinical assessment of COVID-19 as per standard Siddha system of medicine principles and the occurrence of adverse effects will be documented as secondary outcomes.

RANDOMISATION

The assignment to the study or control group will be allocated in equal numbers through randomization using random number generation in Microsoft Excel by a statistician who is not involved in the trial. The allocation scheme will be made by an independent statistician using a sealed envelope. The participants will be allocated immediately after the eligibility assessment and informed consent procedures.

BLINDING (MASKING)

This study is unblinded. The investigators will be blinded to data analysis, which will be carried out by a statistician who is not involved in the trial.

NUMBERS TO BE RANDOMISED (SAMPLE SIZE)

Sample size could not be calculated, as there is no prior trial on KSK. This trial will be a pilot trial. Hence, we intend to recruit 60 participants in total using a 1:1 allocation ratio, with 30 participants randomised into each arm.

TRIAL STATUS

Protocol version 2.0 dated 16^th May 2020. Recruitment is completed. The trial started recruitment on the 25^th May 2020. We anticipate study including data analysis will finish on November 2020. We also stated that protocol was submitted before the end of data collection TRIAL REGISTRATION: The study protocol was registered with clinical trial registry of India (CTRI) with CTRI/2020/05/025215 on 16 May 2020.

FULL PROTOCOL

The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).

Evolving consensus on managing vitreo-retina and uvea practice in post-COVID-19 pandemic era

The COVID-19 pandemic has brought new challenges to the health care community. Many of the super-speciality practices are planning to re-open after the lockdown is lifted. However there is lot of apprehension in everyone's mind about conforming practices that would safeguard the patients, ophthalmologists, healthcare workers as well as taking adequate care of the equipment to minimize the damage. The aim of this article is to develop preferred practice patterns, by developing a consensus amongst the lead experts, that would help the institutes as well as individual vitreo-retina and uveitis experts to restart their practices with confidence. As the situation remains volatile, we would like to mention that these suggestions are evolving and likely to change as our understanding and experience gets better. Further, the suggestions are for routine patients as COVID-19 positive patients may be managed in designated hospitals as per local protocols. Also these suggestions have to be implemented keeping in compliance with local rules and regulations.

Tetanus of suspected dental causality

Tetanus infection by Clostridium tetani is a major health problem in many developing countries, including India. Significant morbidity and mortality is attributed to lack of awareness, hygiene and incomplete vaccination. The most common cause of tetanus infection follows cutaneous injury or infection. However, a localized point of entry cannot always be determined. Tetanus has been associated with tooth extraction, root canal therapy, gross caries, periodontal abscess and intraoral soft tissue trauma. The classic symptoms of trismus and risus sardonicus may result in an initial presentation to an oral and maxillofacial surgeon. Due to the rarity of this infection, the dentist or the health care provider may fail to corroborate the findings and be unsuspecting of the diagnosis. Prompt recognition is the key in such a scenario due to the inherent risk of rapid progress of symptoms, progressive deterioration of the health condition and catastrophic complications. A sound knowledge of the effects of tetanospasmin, the disease process, prevention and vaccination against tetanus with its management is essential for health care workers. The authors hereby present a case of tetanus with a suspected dental etiology to make the dental fraternity aware of this lurking malady.

All India Ophthalmological Society - Indian Journal of Ophthalmology consensus statement on preferred practices during the COVID-19 pandemic

The COVID-19 pandemic has taken tragic proportions and has disrupted lives globally. In the wake of governmental lockdowns, ophthalmologists need practical and actionable guidelines based on advisories from national health departments on how to conduct their duties during nationwide lockdowns and after these are lifted. In this paper, we present a preferred practice pattern (PPP) based on consensus discussions between leading ophthalmologists and health care professionals in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. In this document, the expert panel clearly defines the range of activities for Indian ophthalmologists during the ongoing lockdown phase and precautions to be taken once the lockdown is lifted. Guidelines for triage, governmental guidelines for use of personal protective equipment from ophthalmologists' point of view, precautions to be taken in the OPD and operating room as well as care of various ophthalmic equipment have been described in detail. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics and should help Indian ophthalmologists in performing their professional responsibilities without being foci of disease transmission.

A tissue-mimicking prostate phantom for 980 nm laser interstitial thermal therapy

Purpose: To develop a phantom with optical and thermal properties matched to human prostate. This phantom will provide a platform for the development and characterization of 980 nm laser interstitial thermal therapy (LITT) systems. Methods: A polyacrylamide gel was doped with Naphthol Green B, Intralipid, and Bovine Serum Albumin (BSA). The necessary concentration of each ingredient was determined by measuring the optical properties via fluence measurements and light diffusion theory. LITT was then performed under the same conditions as a previous clinical trial in which temperature was monitored via a thermal probe. The thermal data and induced coagulation zone were compared to clinical data to illustrate the similarity between the phantom and patient. LITT was also performed under magnetic resonance thermometry (MRT). Results: The requisite concentrations of Naphthol Green B, Intralipid and BSA were found to be 0.144% (w/v), 8.06% (v/v) and 31.4% (v/v) respectively. In the native state, the absorption coefficient and reduced scattering coefficient ( μs' ) were found to be 0.66 ± 0.06 cm^-1 and 8.27 ± 0.50 cm^-1 respectively, with μs' increasing to 17.63 ± 1.41 cm^-1 after coagulation. The thermal response of the phantom was similar to that observed clinically with maximum thermal probe measurements of 64.2 °C and 66.9 °C respectively. The shape of the induced coagulation zone was qualitatively and quantitatively similar to the MRT zone of elevated temperature and the coagulation zone observed clinically. Conclusions: A phantom which simulates optical and thermal response to 980 nm LITT was constructed and demonstrated to be similar to human prostate.

Syntheses and Characterisation of Amide Adducts of Uranyl Bis (β-Diketonates) the Molecular Structure of [UO2(DBM)2.C4H9CON(3-C5H11) (sec-C4H9)]

The first structurally characterised uranyl bis (β-diketonate)-amide adduct compound [UO2(DBM)2. C4H9CON ( 3-C5H11) ( sec-C4H9)] (DBM = dibenzoylmethanate) shows that the amide ligand bonded through its amido oxygen atom to the uranyl group. The average bond distances for U–O(uranyl), U–O(DBM) and U–O(amide) are 1.778(5), 2.346(5) and 2.411(5)Å respectively.

Treatment of acute avulsion of posterior cruciate ligament of left knee with bony fragment by Siddha Varmam therapy and traditional bone setting method

A 42-year-old man with the complaints of left knee swelling, severe pain, difficult to stand was reported to Siddha Varmam division after a road accident. He was diagnosed as acute avulsion of Posterior cruciate ligament (PCL). It was diagnosed based on the history of trauma, knee pain and swelling after trauma, positive posterior drawer test and avulsion fracture shown by radiograph. He was treated with Siddha Varmam therapy and traditional bone setting. After a month of treatment, the PCL avulsion fracture got healed without any surgical interventions and patient able to walk normally. This case report summarises the novel Siddha Varmam therapy and traditional bone setting treatments for acute avulsion of PCL with bony fragment.

Vulvar intraepithelial neoplasia: Risk factors for recurrence

OBJECTIVE

We studied a large population of women with high-grade vulvar intraepithelial neoplasia (VIN) in order to identify patient and treatment-related risk factors for recurrence and progression to cancer.

METHODS

For this retrospective cohort study of women with a histologic diagnosis of VIN within Southern California Permanente Medical Group between 1995 and 2007 medical records were reviewed; clinical, demographic and pathologic data were collected. Statistical analyses included Chi-squared and Student's t-tests, univariate and multivariate logistic regression, and cumulative incidence analysis.

RESULTS

914 patients with high-grade VIN were identified; 784 met inclusion criteria. We found 26.3% recurrences among treated women, with 2.2% progression to cancer (8.2% among those with recurrence). Risk factors for recurrence on multivariate analysis were: age >50years (OR, 1.44; 95%CI 1.01-2.07), immunosuppression (OR 2.08; 95%CI 1.42-3.06), metasynchronous VAIN or CIN (OR 1.76; 95%CI 1.08-2.88) in addition to margin status (OR 8.17; 95%CI 4.60-14.51) and adjacent LSA (OR 9.91; 95%CI 1.53-31.32) or HPV (OR 2.15; 95%CI 1.13-3.37) with excisional treatment. Recurrence rates did not differ significantly by smoking status and treatment modalities. Median time to recurrence was 16.9months; 25% had late recurrences (44-196months). Cumulative incidence analyses of time to recurrence shows a significantly higher risk among patients over age 50 (log-rank p=0.0031).

CONCLUSION

We identified independent risk factors for recurrence including age >50years, immunosuppression, metasynchronous vaginal or intraepithelial neoplasia, positive excision margins, and adjacent lichen sclerosus or human papilloma-virus. Regardless of treatment modality, 25% of recurrences occurred late, highlighting the need for long-term surveillance in women treated for VIN.