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Purpose: To evaluate changes in corneal backscattering after collagen cross-linking (CXL) for progressive keratoconus and compare its course with different techniques - standard epithelium-off CXL (SCXL), contact lens-assisted CXL (CACXL), and transepithelial CXL (TECXL). Setting: Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Design: Retrospective comparative study. Methods: Ninety-four eyes (SCXL: 47, CACXL: 30, and TECXL: 17) were compared. Corneal haze was quantified using Scheimpflug tomography, pre- and post-CXL at 1, 3, 6, and 12 months. Results: The baseline mean density score of the central anterior stromal layer was 16.14 ± 7.07, 15.85 ± 7.89 and 15.89 ± 7.21 in SCXL, CACXL, and TECXL groups, respectively (P 0.93). After SCXL, the score increased to 28.83 and 31.34 at 1 and 3 months, respectively (both P < 0.001) and dropped at 6 months (28.66, P < 0.001) and 12 months (23.72, P 0.003). Post-CACXL, the mean densitometry peaked at 3 months (20.35, P 0.14) and returned toward baseline at 6 months (18.82, P 0.15). After TECXL, it increased slightly at 1 month (18.47, P 0.17), decreased at 3 months (14.88, P 0.7), and plateaued over 1 year. No correlation with visual acuity was seen. Conclusion: Corneal haze increased significantly after SCXL, peaking at 3 months, declining over 6-12 months, and returning to baseline at 12 months. In contrast, post-TECXL and -CACXL, there was an insignificant increase in anterior corneal haze, which returned to baseline within 3-6 months. Keywords: Contact lens-assisted corneal cross-linking, corneal densitometry, 'epithelium-off' corneal cross-linking, keratoconus, transepithelial corneal cross-linking, Author(s): Barkha Gupta [1]; Chintan Malhotra (corresponding author) [1]; Supriya Dhar [1]; Khushdeep Abhyapal [1]; Arun K. Jain [1]; Amit Gupta [1] Keratoconus, an ectatic corneal disorder characterized by progressive [...]

This study aimed to comprehensively explore the intricacies of corneal neurotization (CN) and the nuanced factors that set it apart from routine clinical practice, exerting a substantial influence on its success. A symbiotic relationship is evident between corneal innervation and ocular surface health. The loss of corneal innervation results in a potentially challenging corneal condition known as neurotrophic keratopathy (NK). The majority of treatments are primarily focused on preventing epithelial breakdown rather than addressing the underlying pathogenesis. Consequently, to address the impaired corneal sensation (underlying etiology), a novel surgical approach has emerged, namely CN, which involves transferring healthy sensory nerve axons to the affected cornea. This review offers valuable insights into the existing body of supporting evidence for CN, meticulously examining clinical studies, case reports, and experimental findings. The aim is to enhance our understanding of the effectiveness and potential outcomes associated with this innovative surgical technique. The exploration of innovative therapeutic avenues holds promise for revolutionizing the management of NK, offering a potentially permanent solution to a condition once deemed incurable and severely debilitating. Keywords: Corneal neurotization, donor nerve, insensate cornea, interpositional nerve graft, neurotrophic keratopathy, reinnervation, Author(s): Manu Saini [1]; Arun Jain [1]; Murugesan Vanathi (corresponding author) [2]; Aman Kalia [1]; Kulbhushan Saini [3]; Parul Gupta [1]; Nripen Gaur [4] Neurotrophic keratopathy (NK) represents a rare [...]

Byline: Anchal. Thakur, Sushant. Adiga, Chintan. Malhotra, Kulbhushan. Sachdeva, Shubhi. Singh, Arun. Jain Purpose: To perform an intraindividual comparison of the quality of vision and the effect of decentration between [...]

Byline: Anchal. Thakur, Muskaan. Bansal, Divya. Challa, Chintan. Malhotra, Arun. Jain We describe a technique of scleral IOL fixation and optic centration of in the capsular bag subluxated IOL in [...]

Byline: Syeda. Mobeen, Pallavi. Saxena, Arun. Jain, Ravi. Deval, Khateef. Riazunnisa, Dibyabhaba. Pradhan Background: Colorectal cancer (CRC) is the fifth leading cause of death in India. Until now, the exact [...]

Byline: Muskaan. Bansal, Anchal. Thakur, Gaurav. Gupta, Ajay. Jurangal, Rahul. Khanna, Chintan. Malhotra, Amit. Gupta, Arun. Jain Purpose: This study was conducted to evaluate the accuracy of intraoperative aberrometry (IA) [...]

Byline: Anchal. Thakur, Surya. Sharma, Barkha. Gupta, Sraddha. Limbu, Chintan. Malhotra, Arun. Jain A 40-year-old female presented with pain, redness, watering, and foreign body sensation for three days duration. Visual [...]

Byline: Anchal. Thakur, Arun. Jain Corneal epithelium is the anteriormost layer of the cornea, which contributes to refractive power of the eye, minimizes stromal irregularity, as well as provides a [...]

Byline: Chintan. Malhotra, Barkha. Gupta, Rajneesh. Dhiman, Arun. Jain, Amit. Gupta, Jagat. Ram Purpose: To determine the pattern of corneal thickness and epithelial thickness distribution in healthy North Indian eyes [...]

Byline: Anchal. Thakur, Arun. Jain Successful removal of a hard cataract is accomplished by careful history taking, complete physical examination, the surgical technique chosen, incision creation, good capsulorhexis, hydrodissection, pupil [...]

Byline: Monika. Balyan, Arun. Jain, Chintan. Malhotra, Jagat. Ram, Deepika. Dhingra Purpose: To present a case series of intumescent white cataract cases managed by a new surgical technique to attain [...]

Byline: Monika. Balyan, Chintan. Malhotra, Arun. Jain We describe the clinical features of a rare congenital ectodermal dysplasia - Keratitis Icthyosis Deafness (KID) syndrome in a 45-year-old female patient, who [...]

Inflammation and oxidative stress are involved in the pathogenesis of preeclampsia. Therefore, the aim of this study was to investigate the expression of Toll-like receptor (TLR) (TLR-4, HMGB1, NFκB, IκBα) and hypoxic (HIF-1α, HIF-1β, PHD, pVHL) pathway proteins in the placenta of preeclamptic pregnant women after 28 weeks of gestational period. A possible association between these 2 pathways was also explored. A total of 194 placental tissues of preeclamptic as well as healthy pregnant women were analyzed by immunohistochemistry. On the basis of gestational age, the samples were divided into 2 groups, I (28–36 wk) and II (36 wk onwards), with 55 and 139 samples in the respective groups. The expression of both TLR (TLR-4, HMGB1, NFκB, IκBα) and hypoxic (HIF-1α, HIF-1β, PHD, pVHL) pathway proteins were significantly modulated in the placental tissues of preeclampsia as compared with control. The 2 pathways were interlinked in preeclampsia. This study highlights the intercorrelation of both TLR and hypoxic signalling pathways that may be a causative factor for the pathophysiology of preeclampsia.

INTRODUCTION According to the IRI, the volume market share of store brand grocery items has increased from, 15.3% in 1988 to 19.7% in, 1993. Sales of private label cereals alone [...]

A study was conducted to determine how consumers distinguish private label from national brands. Shoppers were allowed to participate in a taste test of five private label brand products. Intrinsic and extrinsic cues were used as variables to determine the consumer's perception of product quality, value of purchase intention. The results showed that shoppers based their perceptions on extrinsic cues, or national brands, while intrinsic cues or actual ingredients had little effect on their decisions. This indicated that shoppers were more willing to buy national brands than private label brands.

Store brand grocery items are private label products that constitute a key weapon for retailers against manufacturers in the battle for consumer loyalty. While store brand goods are generally priced lower than national brands and come with quality gurantees, they only account for 14% of total supermarket sales. Consumer perceptions of store brand quality is hypothesized to be affected by both instrinsic and extrinsic cues. The importance of these cues relative to each other is examined using data from 1,564 buyers of five products. The results indicate that consumers' have a tendency to rely more on extrinsic than on intrinsic use when evaluating the quality of a store brand item. The success of national brand products rests on the development of a strong brand image as well as on intrinsic product quality. However, private labels can successfully compete with national brands through the development of a strong image and good product quality.

'Remaining competitive' takes on many meanings, depending on your location in the world, but here are some thoughts on how American manufacturers can do it better today. By the time [...]

Objective: The aim of this study was to assess the quality of TURBT (transurethral resection of bladder tumor) using surrogate parameters and evaluate adherence to the guidelines regarding the management of bladder tumors.Materials and methods: A clinical audit of all new diagnosis of bladder cancer was undertaken from January 2016 to January 2017. A total of 101 new bladder cancer cases were included. Surrogates of TURBT quality including presence of detrusor in the specimen, rate of re-TUR, presence of carcinoma in situ, and 3-month recurrence rates were analyzed. Adherence to guidelines regarding management of non-muscle invasive bladder cancer including time to re-TUR and utilization of single instillation chemotherapy was evaluated.Results: Absence of detrusor muscle in the specimen of the initial TURBT was noted in 22.8% of the cases. The chance of including muscle in the specimen was almost four-fold for tumors larger than 3 cm. A single instillation of intravesical chemotherapy following TURBT was administered in only 40% of eligible patients; 54.3% of patients had a re-TUR, the majority (61.3%) for high-grade non-muscle invasive bladder cancer on initial TURBT. Re-TUR was done on average 10 weeks after initial TURBT. The 3-month recurrence rate was 36.0% with larger tumors (>3 cm) being more prone to early recurrences. Early recurrences were not affected by intravesical instillations with bacillus Calmette–Guérin or mitomycin C although there was a positive association between the presence of carcinoma in situ on initial resection and early recurrences.Discussion and conclusion: One in two patients will have a re-TUR, and approximately one in two patients will have tumor on re-TUR. Single immediate chemotherapy instillations after TURBT are underutilized. The presence of carcinoma in situ on initial TURBT and tumor size were predictors of early recurrences.

Background: Psoriasis is a chronic immune mediated skin disorder with global prevalence of 0.2- 11.4%. Despite rare mortality, the severity of the disease could be understood by the accompanying comorbidities, that has even led to psychological problems among several patients. The cause and the disease mechanism still remain elusive. Objective: To identify potential therapeutic targets and affecting pathways for better insight of the disease pathogenesis. Method: The gene expression profile GSE13355 and GSE14905 were retrieved from NCBI, Gene Expression Omnibus database. The GEO profiles were integrated and the DEGs of lesional and non-lesional psoriasis skin were identified using the affy package in R software. The Kyoto Encyclopaedia of Genes and Genomes pathways of the DEGs were analyzed using clusterProfiler. Cytoscape, V3.7.1 was utilized to construct protein interaction network and analyze the interactome map of candidate proteins encoded in DEGs. Functionally relevant clusters were detected through Cytohubba and MCODE. Results: A total of 1013 genes were differentially expressed in lesional skin of which 557 were upregulated and 456 were downregulated. Seven dysregulated genes were extracted in non-lesional skin. The disease gene network of these DEGs revealed 75 newly identified differentially expressed gene that might have a role in development and progression of the disease. GO analysis revealed keratinocyte differentiation and positive regulation of cytokine production to be the most enriched biological process and molecular function. Cytokines -cytokine receptor was the most enriched pathways. Among 1013 identified DEGs in lesional group, 36 DEGs were found to have altered genetic signature including IL1B and STAT3 which are also reported as hub genes. CCNB1, CCNA2, CDK1, IL1B, CXCL8, MKI 67, ESR1, UBE2C, STAT1 and STAT3 were top 10 hub gene. Conclusion: The hub genes, genomic altered DEGs and other newly identified differentially dysregulated genes would improve our understanding of psoriasis pathogenesis, moreover, the hub genes could be explored as potential therapeutic targets for psoriasis.

To appraise the efficiency of three differential horizontal double-armed suture placements based on the topographic mapping of the contralateral normal eyelid in external levator aponeurosis surgery for unilateral congenital ptosis.

Byline: Arun. Jain, Reema. Bansal, A. Rajwanshi Dear Editor We thank Chatterjee for showing their interest in our article.[sup] [1] The impression smear was taken after cleaning the eye of [...]

Byline: Arun. Jain, Jaspreet. Sukhija Aim: To report clinical experience and the comparative value of axial and instantaneous topography data in fitting Rose-K design contact lenses in moderate and severe [...]

Byline: Arun. Jain, Reema. Bansal, Vinaya. Felcida, A. Rajwanshi Purpose: To evaluate and compare impression smear with the conventional mechanical corneal scraping by potassium hydroxide (KOH) method in the diagnosis [...]

Byline: Arun. Jain, Jaspreet. Sukhija, Amod. Gupta Purpose: To evaluate the measure of intraocular pressure (IOP) in patients with scarred corneas obtained from the affected and non-affected areas. Materials and [...]

Byline: Arun. Jain, Jaspreet. Sukhija Purpose: To study the efficacy and safety of low dose topical Mitomycin C (MMC) in severe Vernal keratoconjunctivitis (VKC). Design: Placebo controlled double masked randomized [...]

Byline: Arun. Jain, Jaspreet. Sukhija, B. Radotra, V. Malhotra Seborrheic keratosis can simulate a malignant melanoma and should form the differential diagnosis of a malignant melanoma. Histopathology is confirmatory. Seborrheic [...]

To compare topographic, pachymetric and epithelial distribution patterns of clinically unaffected fellow eyes of patients with asymmetric keratoconus (AKC) with those of normal controls and keratoconic fellow eyes.

By finding different product attributes, relevant consumer appeals can be addressed to appropriate market segments. It has long been recognized that product or service benefits analysis may be useful in [...]

Byline: Arun. Jain, Jagjit. Saini, Rajeev. Gupta PURPOSE: Clinical comparison of intraocular pressure (IOP) measured with the Goldmann applanation tonometer (GAT), the ProTon tonometer (PT), and the Schiotz tonometer (ST), [...]

The authors examine the robustness of MDS configurations when incomplete rather than complete input data are used. Using two empirical studies, they show that robustness varies as the amount of incomplete data increases and that random methods of data deletion perform as well as cyclic designs. These findings provide empirical support for earlier Monte Carlo literature on the topic. The authors also show that individual characteristics of respondents, namely cognitive integration and imagery, influence the quality of configurations obtained with incomplete data. (Reprinted by permission of the publisher.)

Patients with psoriasis often complain of several linked disorders including autoimmune and cardiometabolic diseases. Understanding of molecular link between psoriasis and associated comorbidities would be of great interest at the point of patient care management. Integrative unbiased network approach, indicates significant unidirectional gene overlap between psoriasis and its associated comorbid condition including obesity (31 upregulated and 26 downregulated), ischemic stroke (14 upregulated and 2 downregulated), dyslipidaemia (5 upregulated, 5 downregulated), atherosclerosis (8 upregulated and 1 downregulated) and type II diabetes (5 upregulated, 5 downregulated). The analysis revealed substantial gene sharing among the different psoriasis-associated comorbidities. Molecular comorbidity index determining the strength of the interrelation between psoriasis and its comorbidities indicates prevalence of dyslipidaemia followed by type II diabetes among psoriasis patients. The Jaccard coefficient indices revealed psoriasis shared maximum number of biological pathways with dyslipidaemia followed by type 2 diabetes, ischemic stroke, obesity and atherosclerosis. Moreover, pathway annotation highlighted nearly 45 shared pathways amongst psoriasis and its comorbidities and a substantial number of shared pathways was found among multi-morbidities. Overall, the present study established conceivable link between psoriasis and comorbid diseases. The shared genes and overlapped pathways may be explored as a common productive target for psoriasis and its comorbid conditions.

Background/aimsTo describe in vivo confocal microscopy (IVCM) features of microsporidial keratoconjunctivitis in immunocompetent adult patients.MethodsPatients suspected clinically to be suffering from microsporidial keratoconjunctivitis (ie, presence of unilateral follicular and/or papillary conjunctivitis in conjunction with multifocal, coarse corneal epitheliopathy) were subjected to IVCM with the Rostock Cornea Module of the Heidelberg Retinal Tomograph 3, and combined potassium hydroxide and calcofluor white (KOH+CFW) staining of the corneal scrapings, to detect the microsporidial spores. Detection of spores in corneal scrapings was considered as being confirmatory for microsporidial infection.ResultsOf a total of 10 patients screened, 8 patients (7 male, 1 female) demonstrated the presence of oval, non-budding microsporidial spores which fluoresced bluish white on combined KOH+CFW staining. IVCM in seven of these eight patients demonstrated multiple rosette-like clusters/plaque of epithelial cells, within which hyper-reflective, pinpoint oval intracellular bodies (similar to the spores seen on microbiological staining) were present. One patient who had been on prolonged treatment with topical steroids showed the presence of the oval bright bodies scattered diffusely within the epithelial cells, without rosette formation.ConclusionsIn microsporidial keratoconjunctivitis, IVCM is able to detect presence of bright, ovoid spore-like structures in the epithelial layers. Epithelial rosette formation is another characteristic feature seen in a majority of these patients. These features may be used as a reliable screening tool for starting therapy, precluding the need for corneal scrapings in a majority of patients.

A 25-year-old man with history of electrocution presented with an intumescent cataract in the left eye and was scheduled for femtosecond laser–assisted cataract surgery. During delivery of the laser pulses for creation of the capsulotomy, leakage of milky intralenticular fluid was noted at multiple points, accompanied by an iris ricochet; that is, explosive outward displacement of the pupillary margin at the 3 o’clock position followed by a slower inward rebound. After the corneal incisions and capsule staining were opened with trypan blue dye, the anterior capsulorhexis margin was noted to be extending peripherally up to the equator at the site of the iris ricochet. This report highlights the possibility of peripheral extension of the anterior capsulorhexis margin during the creation of the femtosecond laser–assisted capsulotomy itself and emphasizes the importance of recognizing the iris ricochet sign as a possible indicator of this complication.

To evaluate the characteristics of pre-Descemet membrane corneal dystrophy by 3 different imaging modalities: in vivo confocal microscopy (IVCM), anterior segment optical coherence tomography (ASOCT), and Scheimpflug corneal densitometry analysis.

Chlorpyrifos (CPF) is an extensively used organophosphate pesticide for crop protection. However, there are concerns about it contaminating the environment and human health, with estimated three lakh deaths annually. The molecular modeling protocol was assisted in redesigning thirteen well-known CPF linkers and inserting them at five selectable CPF (R1-R5) positions of CPF to get 258 CPF derivatives. CPF and its derivatives were optimized using LigPrep and docked to a grid centralized on Trp214 using extra precision glide docking. The Binding free energy of complexes was calculated using molecular mechanics/generalized born surface area (MM-GBSA). CPF and CPFD-225 have glide scores of − 3.08 and − 6.152 kcal/mol, respectively, with human serum albumin and ΔG bind for CPF (− 33.041817 kcal/mol) (− 52.825 kcal/mol) for CPF-D225. The top ten CPF derivatives showed at least ninefold better binding free energy than the CPF proposed for polyclonal antibody production. Subsequently, molecular docking studies revealed that CPF and its derivatives could bind to human serum albumin (HSA). Furthermore, using the Desmond package, a 100-ns molecular dynamics (MD) simulation was performed on the potential binding site. The final systems of CPF-HSA and CPF-222D complexes consist of 76,014 and 76,026 atoms, respectively. The physical stability of both the systems (CPF-HSA and CPF-222D) was analyzed by considering the overall potential energy, RMSF, RMSD, Hydrophobic interactions, and water-mediated patterns, which showed total energy of − 141,610 kcal/mol and − 140,150 kcal/mol, respectively.