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Background/aimsThis was a cross-sectional comparative study. We evaluated the ability of three large language models (LLMs) (ChatGPT-3.5, ChatGPT-4, and Google Bard) to generate novel patient education materials (PEMs) and improve the readability of existing PEMs on paediatric cataract.MethodsWe compared LLMs’ responses to three prompts. Prompt A requested they write a handout on paediatric cataract that was ‘easily understandable by an average American.’ Prompt B modified prompt A and requested the handout be written at a ‘sixth-grade reading level, using the Simple Measure of Gobbledygook (SMOG) readability formula.’ Prompt C rewrote existing PEMs on paediatric cataract ‘to a sixth-grade reading level using the SMOG readability formula’. Responses were compared on their quality (DISCERN; 1 (low quality) to 5 (high quality)), understandability and actionability (Patient Education Materials Assessment Tool (≥70%: understandable, ≥70%: actionable)), accuracy (Likert misinformation; 1 (no misinformation) to 5 (high misinformation) and readability (SMOG, Flesch-Kincaid Grade Level (FKGL); grade level <7: highly readable).ResultsAll LLM-generated responses were of high-quality (median DISCERN ≥4), understandability (≥70%), and accuracy (Likert=1). All LLM-generated responses were not actionable (<70%). ChatGPT-3.5 and ChatGPT-4 prompt B responses were more readable than prompt A responses (p<0.001). ChatGPT-4 generated more readable responses (lower SMOG and FKGL scores; 5.59±0.5 and 4.31±0.7, respectively) than the other two LLMs (p<0.001) and consistently rewrote them to or below the specified sixth-grade reading level (SMOG: 5.14±0.3).ConclusionLLMs, particularly ChatGPT-4, proved valuable in generating high-quality, readable, accurate PEMs and in improving the readability of existing materials on paediatric cataract.

Purpose: To evaluate the clinical presentation, course, and outcomes of uveitis in paediatric patients with tubulointerstitial nephritis and uveitis syndrome (TINU). Methods: Multicentric Retrospective Cohort Study 110 patients ≤21 years of age diagnosed with TINU from 10 sites across the United States and Canada. Clinical diagnosis of TINU required uveitis diagnosed by an ophthalmologist, elevated serum creatinine (SCr) and elevated urine β2-microglobulin (β2M) or abnormal urinalysis. Renal biopsy and systemic illness were not mandatory. Univariate and multivariate analysis was performed to analyse risk factors and treatment modalities. Results: Median age was 13 years (Range (5.9–18.4); 52% male); median follow-up, 1.6 years (IQR 0.98–4.02). Uveitis was symptomatic in 90%, with bilateral anterior uveitis in 94%. Ninety-two (84%) patients required immunomodulatory treatment (IMT). Methotrexate (n = 44) and mycophenolate mofetil (n = 39) were the first agents after oral corticosteroids. 45% required addition of biologic agents (Adalimumab [n = 33], Infliximab [n = 8]). Younger age (p = 0.018), male sex (p = 0.011), and higher uveitis grade at presentation (p = 0.031) were associated with greater IMT ( ≥ 2) requirement. 53% had uveitis recurrence compared to 16% with nephritis recurrence. At the most recent visit, nephritis was controlled in 90%, while uveitis in 74%. Four (4%) patients required glaucoma surgery. Nine (8%) patients had renal complications. Conclusions: Most patients with TINU require steroid-sparing IMT for control of uveitis, with nearly half requiring addition of biologic agents. Urinalysis, urine β2M and SCr testing should be considered in children presenting with uveitis, especially when the disease is bilateral and anterior.

Background/Aims To establish normative curves for axial length and corneal curvature in the first decade of life.Methods This is a cross-sectional study from a single institution in the United States. Children from 0- to 10-years of age with no underlying ocular pathology were prospectively enrolled to obtain ultrasound biometry and hand-held keratometry while under anaesthesia for an unrelated procedure. Older cooperative children had optical biometry obtained in-office. Logarithmic quantile regression models were used to determine the change in axial length and average keratometry as a function of age.Results Single-eye measurements from 100 children were included. 75% of children were White and 49% female. Median axial length ranged from 20.6 mm (IQR, 20.2 to 21.1 mm) at age one year to 23.1 mm (IQR, 22.5 to 23.8 mm) at age ten years. Median average keratometry ranged from 44.1 D (IQR, 42.6 to 45.4 D) at age one year to 43.5 (IQR, 42.2 to 44.0 D) at age ten years. As age increased, there was a significant increase in axial length (0.74 mm per doubling of age; 95% CI, 0.62 to 0.82 mm), and a non-significant trend towards lower average keratometry (−0.21 D per doubling of age; 95% CI, −0.62 to 0.08 D).Conclusions We provide a set of normative charts for axial length and corneal curvature which may facilitate the identification of eyes outside the normal range and assist in the management of ocular conditions such as glaucoma or cataract.

E-adoption of emerging technology plays an important role during the pandemic. The COVID-19 pandemic taught us that everyone must make himself healthy and immune to viral disease. Diabetes is the most common disease in the Indian population found in people of every age. The objective of this research work is to use the emerging technologies such as machine learning to implement e-adoption in the healthcare system. The proposed methodology can predict the diabetes disease by using vital parameters like age, glucose level, blood pressure, etc. This proposed model is implemented into Python programming language and various machine learning classifiers such as random forest, decision tree, logistic regression, and XGBoost are used on PIMA database. Thereafter, comparative analysis is performed to test which technique is better for predicting and diagnosing diabetes disease. The method founds XGBoost classifier gives the highest accuracy (i.e., 84%) among all classifiers with single database and single classifier.

Objective: To evaluate the efficacy of immunomodulatory therapy (IMT) in paediatric anterior uveitis. Methods: Chart review of all patients ≤ 18 years treated for anterior uveitis using a stepladder approach during a 10-year period. The type and duration of IMT were noted. The data were analysed depending on chronicity, aetiology, and type of IMT using appropriate statistical tests. The outcome measures included ocular complications, the need for surgical intervention, and visual outcomes. Results: One hundred and thirty-four patients (191 eyes) were analyzed. The median age at diagnosis was 7 years (interquartile range (IQR): 7.5 years). The median follow-up was 4 years (IQR: 6 years). The most common causes of anterior uveitis were Juvenile idiopathic arthritis (64 patients, 47.8%) and undifferentiated (33 patients, 24.6%). All patients were started on topical steroids and cycloplegics. 94 (70%) patients required IMT. 92 (68.6%) were started on Methotrexate as the first agent, of which 21 (22%) were switched to a different agent owing to side effects. Biologic agent was added in 55 (41%) patients. 21 (16%) required switch to a second biologic agent, 5 (3.7%) to third, and 1 (0.8%) to fourth biologic agent. At the last exam, 11 (8%) had persistent inflammation. 55 (41%) had ocular complications, and 113 (84%) had a best corrected visual acuity ≥ 20/40. Conclusion: Early introduction of IMT and switch to different agents may be required to control anterior uveitis and reduce the complications in children. IMT is safe and effective in treating paediatric anterior uveitis.

The thermal characteristics of incompressible non-Newtonian power-law fluids across periodic array of circular cylinders have been examined using the finite volume-based numerical solver ANSYS-FLUENT for the following ranges of physical parameters: Reynolds number; 1 ≤ Re≤ 40: Prandtl number; 1 ≤ Pr≤ 100: power-law index; 0.40 ≤ n≤ 1.8; and fluid volume fractions ranging from 0.70 to 0.99. The thermal features have been described via isotherm patterns, local and average Nusselt numbers and the Colburn heat transfer factor and found to be strongly dependent over the above physical parameters. It was observed that the dense isotherms with the increasing inertial and viscous diffusion suggest an improvement in the rate of heat transfer across the periodic cylinders. An increase in local Nusselt number was seen with the increasing values of Reand/or Pracross all the fluid volume fractions. Further, the different behavior of the average Nusselt number was noticed because of the shear-thinning and shear-thickening natures. An enhancement of about 97% was noticed in the shear-thinning region between the extreme fluid volume fractions for the highest value of Prand the lowest values of Reand n. However, in many cases, the enhancement was noticed to be even more than 100%. An empirical correlation for the average Nusselt number and the Colburn heat transfer factor (jH) has been developed to give the additional physical insight of the results. Finally, the comparison was made with the available literature which displayed a good agreement with the present results.

To evaluate and compare the effect of diode laser assisted bleaching, ultrasonic scaling and powered tooth brushing on surface roughness and bacterial adherence on class V cavities restored with composites.

Oral cancer consists of squamous cell carcinoma within the oral cavity or on the lip. The clinical prognosis of this cancer is mostly poor owing to delayed diagnosis and a lack of appropriate early detection biomarkers to identify the disease. In the current study, we investigated the role of the S100A7 calcium-binding protein in oral squamous cell carcinoma as an activator of the p38/MAPK and RAB2A signaling pathway. The aim of the present study was to determine whether S100A7 and RAB2A have a role in tumor progression and to assess their potential as early detection biomarkers for oral cancer. This study elucidated the functional and molecular mechanisms of S100A7 and RAB2A activity in oral cancer, leading us to conclude that S100A7 is the major contributing factor in the occurrence of oral cancer and promotes local tumor progression by activating the MAPK signaling pathway via the RAB2A pathway. We hypothesize that S100A7 affects cell motility and invasion by regulating the RAB2A-associated MAPK signaling cascades. Also, the downregulation of S100A7 expression by RNA interference-mediated silencing inhibits oral cancer cell growth, migration and invasion.

Interleukin-6 (IL-6) signaling network has been implicated in oncogenic transformations making it attractive target for the discovery of novel cancer therapeutics. In this study, potent antiproliferative and apoptotic effect of diacerein were observed against breast cancer. In vitroapoptosis was induced by this drug in breast cancer cells as verified by increased sub-G1population, LIVE/DEAD assay, cell cytotoxicity and presence of terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL)-positive cells, as well as downregulation of antiapoptotic proteins Bcl-2 and Bcl-xL and upregulation of apoptotic protein Bax. In addition, apoptosis induction was found to be caspase dependent. Further molecular investigations indicated that diacerein instigated apoptosis was associated with inhibition of IL-6/IL-6R autocrine signaling axis. Suppression of STAT3, MAPK and Akt pathways were also observed as a consequence of diacerein-mediated upstream inhibition of IL-6/IL-6R. Fluorescence study and western blot analysis revealed cytosolic accumulation of STAT3 in diacerein-treated cells. The docking study showed diacerein/IL-6R interaction that was further validated by competitive binding assay and isothermal titration calorimetry. Most interestingly, it was found that diacerein considerably suppressed tumor growth in MDA-MB-231 xenograft model. The in vivoantitumor effect was correlated with decreased proliferation (Ki-67), increased apoptosis (TUNEL) and inhibition of IL-6/IL-6R-mediated STAT3, MAPK and Akt pathway in tumor remnants. Taken together, diacerein offered a novel blueprint for cancer therapy by hampering IL-6/IL-6R/STAT3/MAPK/Akt network.

The design of nanomedicines from the tuned architecture polymer is a leading object of immense research in recent years. Here, smart thermoresponsive micelles were prepared from novel architecture four-arm star block copolymers, namely, pentaerythritol polycaprolactone-b-poly(N-isopropylacrylamide) and pentaerythritol polycaprolactone-b-poly(N-vinylcaprolactam). The polymers were synthesized and tagged with folic acid (FA) to render them as efficient cancer cell targeting cargos. FA-conjugated block copolymers were self-assembled to a nearly spherical (ranging from 15 to 170 nm) polymeric micelle (FA-PM) with a sufficiently lower range of critical micelle concentration (0.59 × 10–2to 1.52 × 10–2mg/mL) suitable for performing as an efficient drug carrier. The blocks show lower critical solution temperature (LCST) ranging from 30 to 39 °C with high DOX-loading content (24.3%, w/w) as compared to that reported for a linear polymer in the contemporary literature. The temperature-induced reduction in size (57%) of the FA-PM enables a high rate of DOX release (78.57% after 24 h) at a temperature above LCST. The DOX release rate has also been tuned by on-demand administration of temperature. The in vitro biocompatibilities of the blank and DOX-loaded FA-PMs have been studied by the MTT assay. The cellular uptake study proves selective internalization of the FA-PM into cancerous cells (C6 glioma) compared that into normal cells (HaCaT). In vivo administration of the DOX-loaded FA-PMs into the C6 glioma rat tumor model resulted in significant accumulation in tumor sites, which drastically inhibited the tumor volume by ∼83.9% with respect to control without any significant systemic toxicity.

Resistance to inhibitors of cholinesterase (Ric-8)Aand Ric-8Bare essential genes that encode positive regulators of heterotrimeric G protein αsubunits. Controversy persists surrounding the precise way(s) that Ric-8 proteins affect G protein biology and signaling. Ric-8 proteins chaperone nucleotide-free Gα-subunit states during biosynthetic protein folding prior to G protein heterotrimer assembly. In organisms spanning the evolutionary window of Ric-8 expression, experimental perturbation of Ric-8genes results in reduced functional abundances of G proteins because G protein αsubunits are misfolded and degraded rapidly. Ric-8 proteins also act as Gα-subunit guanine nucleotide exchange factors (GEFs) in vitro. However, Ric-8 GEF activity could strictly be an in vitro phenomenon stemming from the ability of Ric-8 to induce partial Gαunfolding, thereby enhancing GDP release. Ric-8 GEF activity clearly differs from the GEF activity of G protein–coupled receptors (GPCRs). G protein βγis inhibitory to Ric-8 action but obligate for receptors. It remains an open question whether Ric-8 has dual functions in cells and regulates G proteins as both a molecular chaperone and GEF. Clearly, Ric-8 has a profound influence on heterotrimeric G protein function. For this reason, we propose that Ric-8 proteins are as yet untested therapeutic targets in which pharmacological inhibition of the Ric-8/Gαprotein–protein interface could serve to attenuate the effects of disease-causing G proteins (constitutively active mutants) and/or GPCR signaling. This minireview will chronicle the understanding of Ric-8 function, provide a comparative discussion of the Ric-8 molecular chaperoning and GEF activities, and support the case for why Ric-8 proteins should be considered potential targets for development of new therapies.

A technique of double optic capture with capsular bag fusion, in which the haptics are placed in the ciliary sulcus and the intraocular lens (IOL) optic is captured behind both the anterior continuous curvilinear capsulorrhexis and the posterior capsulotomy, is described. The technique allows the fusion of anterior and posterior leaflets of capsular bag for 360 degrees. Capsular fusion reduces the central lens epithelial cell migration, and capture of the IOL optic helps to reduce the incidence of visual axis opacification, which is particularly crucial to prevent in infants. Optic capture also helps to achieve a well-centered IOL that is resistant to movement and chaffing of uveal tissue even with the IOL haptics in the ciliary sulcus. A major advantage of double optic capture technique with capsular bag fusion is the ease of performance even in infants and young children, the stability of the IOL and minimization of secondary membranes.

Summary Thirty subjects engaged in maintenance and repair of moulds used for producing watermarks on paper were studied, along with 27 control subjects from the same paper mill. The workers were simultaneously exposed to copper, chromium, zinc, xylol, and fumes of sulphuric acid in the course of their work. The study subjects were investigated for clinical, occupational, radiological haematological and psychological details. The aforementioned combined exposure was found to be responsible for a high prevalence of symptoms pertaining to the respiratory system and higher nervous functions. Breathlessness (26.7%), expectoration (10.0%) and emphysema (10.0%) were significantly higher among the exposed subjects. The exposed subjects also showed lowered visuomotor coordination and delayed reaction to light and sound stimuli.

When a patient is brought to the emergency department with profound coma, absent brain stem reflexes, and apnea, the possibility of brain death should be considered. If this condition is irreversible, the patient meets the clinical criteria and may be declared dead. Prompt confirmation is important: valuable resources can be redirected to living patients, the decedent’s family can be given ministry, and transplantation of donor organs to needy patients can be facilitated. Although brain death is a clinical diagnosis, confirmation by additional testing is often required by local practice standards or local law. This article discusses the role of the radiologist in this situation and the examinations used for this purpose.

IntroductionUtility of syndromic case management (SCM) in symptomatic women facing huge misdiagnosis/overtreatment problems due to lack of accurate and confirmed diagnosis. As a consequence antibiotic resistance has accelerated along with an increase in risk of infection to their partner.Methodssymptomatic women (18–56 years old) were recruited in the study and examined by clinician based on subjective judgment and treated vaginal discharge with various clinical symptoms causing microorganisms by NACO-NACP III Algorithms for STI/RTI and comparative analysis using PCR-based diagnostic assay.ResultsWe found that; 646/3200 (20.18%) female patients reported vaginal discharge and recommended treatment for either CT, NG, TV and Candida and/or co-infection using pre-packed STI/RTI kits under NACP III. Based on PCR, 48/646 (7.43%) subjects tested positive for infection with NG/TV/CT. Amongst 46 patents, 28 (60.86%) were correct and conformed diagnosis by PCR and SCM both. While 18/46 (39.14%) were incomplete treated and overtreatment due to poor diagnosis. Out of 600/646 (92.87) treated patients were uninfected of these three pathogens. Based on PCR and SCM, prevalence of TV, NG and CT were shows huge variations. As a result, SCM is inaccurate as infection caused by any of these pathogens showed similar symptoms: vaginitis, cervicitis, genital ulcers, AVD and LAP. The recent increases of misdiagnosis, overtreatment and antibiotic resistance are cause for public health concern. Here our results clearly demonstrate that prevalence of CT and NG is still significant among female patients.ConclusionThe study underpins the need to implement diagnostic assays for identification of causative pathogen before implementing antibiotic treatment to patients with vaginal discharge. It also divulges the need to review the use of SCM for controlling sexually transmitted diseases.

IntroductionVaginal discharge (VD), a common gynaecological complaint, is often associated with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and Trichomonas vaginitis(TV). Prevention and control of these STIs/RTIs require understanding of demographic patterns and risk factors. Moreover, diagnosis in resource constrained settings can be facilitated using self-collected vaginal swabs, provided the reliability of the method is established. Aims were to establish the (1) association of sexual, demographic and hygienic practices for the above infections and (2) reliability of self-obtained over clinician-collected vaginal swabs for diagnosis.MethodsA total of 550 females aged 18–45 years (median: 32) attending two NACO designated STI/RTI clinics (Jan 2015-May 2016) with abnormal vaginal discharge were evaluated for relevant risk factors using a questionnaire. Swabs were self-collected by patients after instructions and subsequently by a physician under speculum examination. They were then examined by standard bedside tests, Gram staining, wet mount and culture.ResultsBV, VVC and TV were observed in 79 (14.4%), 144 (26.2%) and 3 (0.5%) patients respectively. VVC coexisted with BV in 58 (10.5%) patients. C. albicanswas isolated in 84 (58.33%) VVC cases. Prevalence of VD was higher in rural (p>0.5) and illiterate (p>0.5) patients. BV was strongly associated with douching (odds ratio 8.26) and moderately with use of condoms (odds ratio 1.6), whereas VVC showed minimal association. Use of cloths instead of sanitary pads was also a risk factor for BV (odds ratio 1.3) and with a minimal impact on VVC. Highly concordant self vs physician-collected results established the reliability of self-collected samples with Cohen’s Kappa values of 0.95 (BV), 0.99 (VVC) and 1.0 (TV).ConclusionAvoiding douching, using condoms and sanitary pads help in reducing the risk of acquiring VD. Reliability of self-collected swabs for diagnosis shall go a long way in strengthening National STI/RTI Program, especially in resource constrained settings.

To the Editor.—In reference to a question regarding potential complications after injuries sustained by a patient in a vehicular accident (QUESTIONS AND ANSWERS, 1982;248:1510), we offer the following comments. As stated by Dr Ben Eiseman, injuries to the thorax and abdomen by hitting against the steering wheel may cause substantial intrathoracic and intraabdominal trauma in a patient who may exhibit stable clinical status and normal vital signs.The potential injuries cited included rupture of the liver or spleen, traumatic rupture of the diaphragm, severed subclavian artery, ruptured aorta, and pulmonary and myocardial contusions. All of these injuries are fraught with the potential of serious consequences if not recognized and treated. One would like either to document or rule out the presence of these injuries in the least invasive manner and in as short a duration as possible.Depending on the available facilities at the treatment center, a combination of

Ninety-four male pump workers, employed in 41 petrol filling stations in Kanpur (formerly Cawnpore) and Lucknow—both in the Ganges plain of north India—were clinically examined. Headache, redness in eyes, lacrimation and signs like coated and/or furred tongue, throat and/or conjuctival congestion and carious teeth were significantly higher (P<.05) in workers exposed to petrol fumes than in controls, as also was the level of phenol in urine (P<0.01). Environmental measurements revealed higher concentrations of benzene, sulphur dioxide and photoionizable dust in the air at petrol stations, and most of the symptoms and signs could be attributed to petrol fumes and other environmental pollution.