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Introduction: Dry Eye Disease (DED) is a multifactorial disease which causes ocular discomfort and visual disturbances. It is one of the major causes of patients’ visit to the clinic. The prevalence of DED has increased in recent times due to increased time spent on computers and mobile phones, ageing population and highly stressful social environment. Various studies done in past on DED prevalence have given the variable results. Aim: To determine the prevalence of DED and analyse the associated risk factors in a tertiary care centre in Sonepat, Haryana, India. Materials and Methods: Present study was a cross-sectional observational study done in outpatient Department of Ophthalmology at Bhagat Phool Singh Government Medical College for Women, Sonepat, Haryana, India, from April 2021 to December 2021. Total 820 patients, aged >18 years were administered Ocular Surface Disease Index (OSDI) questionnaire. Patients with OSDI score >12 and positive one or both of the dry eye objective tests of Schirmer’s and Tear film Break Up Time (TBUT) below cut-off value were labeled as DED and were evaluated for association with various risk factors. Data were statistically analysed by Chi-square test, Wilcoxon-Mann-Whitney U test and Fisher’s exact test. Results: The mean age of patients were 39.65±15.52 years ranging between 18-79 years. DED was found to be more prevalent in females 120 (56.1%) compared to males 94 (43.9%). The prevalence of DED was 26.1% (214/820). Maximum prevalence was found in the age group 18-40 years (43.9%). Out of the 214 DED patients, 113 (52.8%) had mild, 95 (44.4%) had moderate and 6 (2.8%) had severe dry eye. The risk factors significantly associated (p<0.05) with DED were: more than 3.71 hours of Visual Display Terminal (VDT) use, occupational VDT users, homemakers, previous ocular surgery, uncorrected refractive error, diabetes mellitus, hypertension, Chronic Obstructive Pulmonary Disease (COPD), alcohol intake and mask use. Conclusion: DED is a significant cause of ocular morbidity, affecting more than quarter (26.1%) of the study population. Awareness and identification of risk factors for dry eye which are occupational VDT users, previous ocular surgery, uncorrected refractive error, diabetes mellitus, hypertension, COPD, alcohol intake and mask use is important for effective prevention and management of DED. [ABSTRACT FROM AUTHOR]

Atrial myxomas are the most common primary heart tumors. Two-dimensional echocardiography is the diagnostic procedure of choice. The majority of myxomas are located in the left atrium. Myxoma in the right atrium is an uncommon location. The co-occurrence of right atrial myxoma with atherosclerotic coronary artery disease (CAD) is uncommon. In our case, right atrial myxoma was associated with CAD, which makes it a unique case because very few cases of right atrial myxoma coexistent with CAD are described in literature. [ABSTRACT FROM AUTHOR]

A double-chambered right ventricle (DCRV) is a rare congenital heart disease and an uncommon cause of congestive heart failure. An anomalous muscle band divides the right ventricle into two cavities: the proximal high-pressure chamber and the distal low-pressure chamber. Most cases are diagnosed and treated during childhood. Furthermore, there is a tendency for progression, if not treated early. Echocardiography is considered useful for the diagnosis of this ailment. Most of the patients have associated congenital anomalies, such as ventricular septal defect, pulmonary stenosis, and subaortic stenosis. Isolated DCRV is a rare entity. Hence, we report a case of an isolated DCRV in an adult patient. [ABSTRACT FROM AUTHOR]

The paper examines 1422 global publications on health tourism research, as covered in Scopus database during 2007-16, experiencing an annual average growth rate of 7.26% and qualitative impact averaged to 8.78 citations per paper. The top 10 most productive countries individually contributed global share from 2.91% to 22.41%, with largest global publication share coming from USA (24.12%), followed by U.K. (12.59%), Canada and Australia (7.45% and 7.10%), India and Germany (3.45% and 3.38%) etc. Together, the 10 most productive countries accounted for 70.61% share of global publication output during 2007-16. Six of top 10 countries scored relative citation index above the average (1.46): Italy (2.97), Netherlands (1.99), Germany (1.92), Canada (1.66) and France (1.59) during 2007-16. Medicine, among subjects, contributed the largest publication share (66.67%),%), followed by social sciences (20.32%), business, accounting & management (12.38%), environment science (8.65%), biochemistry, genetics & molecular biology (5.70%), nursing (5.49%), arts & humanities (4.57%) and economics, econometrics & finance (3.66%) during 2007-16. The top 15 most productive organizations and authors together contributed 17.02% and 14.77% respectively as their share of global publication output and 27.66% and 32.41% respectively as their share of global citation output during 2007-16. Among the total journal output of 1317 papers, the top 10 journals contributed 17.16% share to the global journal output during 2007-16. Of the total global health tourism research output, the top 19 highly cited publications registered citations from 82 to 178 and they together received 2224 citations, with 117.05 citations per paper. These 19 highly cited papers involved the participation of 26 authors and 27 organizations. Among leading countries contributing to high cited research, the largest number of papers (7) came from USA, followed by U.K (5 papers), Italy (4 papers), Belgium, Netherlands and Canada (3 papers each), Denmark, Australia and Germany (2 papers each), Switzerland, France, New Zealand, Spain, Iran, Thailand, Laos, Cambodia, Philippines, Indonesia, Vietnam, Israel and Chile (1 paper each). The 19 highly cited papers involved the participation of 95 authors and 78 organizations. These 19 highly cited papers were published in 16 journals; of which of which 2 papers were published in Emerging Infectious Diseases and Human Reproduction and 1 paper each in other journals. [ABSTRACT FROM AUTHOR]

Single atrium (SA) is one of the rare congenital anomalies in which there is a complete absence of the atrial septum without an endocardial cushion defect associated with the absence of malformation of the atrioventricular (AV) valves. The term "common atrium" is used to denote the condition where there is a complete absence of the atrial septum or it is represented by a small strand of tissue present at the superior atrial wall of the common chamber, absence of interventricular communication, and accompanying AV cushion defect. Our patient demonstrated typical echocardiographic features of three-chambered heart (SA), which is a rare entity. [ABSTRACT FROM AUTHOR]

The paper examines 492 Indian publications on gallbladder cancer research, as covered in Scopus database during 2006-15, experiencing an annual average growth rate of 2.46% and citation impact of 7.10. The world gallbladder cancer output (6289 publications during 2005- 14) came from several countries, of which the largest global publication share (21.07%) came from USA, followed by Japan (15.58% share), China, (11.32%), India (7.82% share), South Korea (5.76% share), U.K., Germany and Italy (from 4.09% to 4.82%), France and Canada (from 2.02 to 2.67%) during 2006-15. India's global publication share was 7.82% and hold 4th rank in global output during 2006-15. India's international collaborative publications share in gallbladder cancer was 9.96% during 2006-15, which increased from 9.80% to 10.07% from 2006-10 to 2011-15. Medicine, among subjects, contributed the largest publication share (92.68%), followed by biochemistry, genetics and molecular biology (3.789%), pharmacology, toxicology and pharmaceutics (3.46%), immunology and microbiology (1.42% share) and agricultural and biological sciences (1.22% share) and during 2006-15. Diagnosis, surgery, pathology and prognosis, among treatment methods, together accounted for 89.84% share of the total publication output on gallbladder cancer in India during 2006-15. The four cities, namely, Delhi, Lucknow, Mumbai and Varanasi together accounted for 56.90% of the country output during 2006-15. The most productive 15 Indian organizations, authors and journals in gallbladder cancer research together contributed 67.89%, 53.66% and 37.80% share respectively in the cumulative publications output of India in gallbladder cancer research during 2006-15. [ABSTRACT FROM AUTHOR]

Four field experiments were conducted to investigate biological N fixation (BNF) by irrigated soybean under conservation agriculture (CA) as compared with conventional tillage when crop residue (CR) is retained on the soil surface, and the fate of N-labelled fertilizer in succeeding wheat in the semi-arid subtropical soil. Comparable amounts of BNF by soybean were obtained using N isotope dilution and N natural abundance methods, suggesting that the latter, a less costly method could be employed to estimate BNF. Soybean could fix 61-125 kg N ha (52-85% of total N uptake), depending upon tillage and CR management. Significant increases in BNF by soybean were recorded when CR was retained on the soil surface of CA plots presumably due to better activity of rhizobia because of the relatively cooler rhizosphere environment. Recovery of applied fertilizer N in the soil-plant system at harvest of the wheat crop showed that 36-47% of it was utilized by the crop, 37-49% was left in the soil profile and 5-27% was lost (unrecovered fertilizer N). The recovery of fertilizer N in the soil profile revealed that the majority of it was present in the first 15 cm (54-61%), although downward movement of fertilizer N was also evident up to 120 cm soil depth. These results illustrate enormous benefits of CA practices with CR retained on soil surface on BNF in soybean, and similar patterns in N uptake and translocation from vegetative parts to grain and utilization of applied fertilizer N by wheat in both tillage systems. [ABSTRACT FROM AUTHOR]

We describe an adult female presenting with dyspnea in whom both transthoracic and transesophageal echocardiography detected a mobile sac-like structure in the right ventricular outflow tract ( RVOT) containing a heterogenous echogenic mass. This sac-like structure markedly changed its shape and size during the cardiac cycle. These findings and the fact that the patient lived in a rural area raised the possibility that this was a hydatid cyst. A bubble study using normal saline was useful in detecting a contained rupture of the cyst. Bubble echoes were noted within the sac-like structure but did not penetrate the inner wall of the cyst which contained echogenic material, indicating that the rupture was confined only to the outer layers. At surgery, a 0.5 cm communication was noted between the cyst and the RVOT and pathology confirmed the diagnosis of hydatid cyst. [ABSTRACT FROM AUTHOR]

Background: Although probing dry-weight improves blood pressure control, its effect on echocardiographic left ventricular mass index (LVMI) is unknown.Methods: Shortly following dialysis, 292 echocardiograms in 150 patients participating in the DRIP trial were obtained at baseline and longitudinally every 4 weeks on 2 occasions.Results: At baseline, LVMI was 136.3 g/m(2) in the control group and 138.7 g/m(2) in the ultrafiltration group (p > 0.2 for difference). The change from baseline in LVMI in the control group was +3.5 g/m(2) at 4 weeks and +0.3 g/m(2) at 8 weeks (p > 0.2 for both changes). The change from baseline in LVMI in the ultrafiltration group was -7.4 g/m(2) at 4 weeks (p = 0.005) and -6.3 g/m(2) at 8 weeks (p = 0.045). With ultrafiltration, the change in LVMI diameter was -10.9 g/m(2) more compared to the control group at 4 weeks (p = 0.012) and -6.6 g/m(2) more compared to the control group at 8 weeks (p = 0.21). The reduction in interdialytic ambulatory blood pressure was also greater in response to probing dry-weight in those in the top half of LVMI at baseline (p = 0.02 for interaction effect at week 8).Conclusion: LVMI, an important determinant of prognosis among long-term dialysis patients, is responsive to probing dry-weight. [ABSTRACT FROM AUTHOR]

Crop species and their varieties vary in phosphorus (P) requirements for optimum production and response to P application. As crop recovery of added P often ranges from 10 to 40%, the rest accumulates in soil and may create potential for P leaching, depending upon the soil characteristics, duration of P applications, and cropping systems. Accumulation and distribution of Olsen P (plant-available labile P), total inorganic P, and total organic P were investigated in soil profiles of three field experiments differing in rate (9-44 kg P ha-1), frequency (applied once or twice annually), and duration (4-34 years) of fertilizer P applications, crop rotations, soil characteristics, and irrigation pattern (upland irrigated and flooded-rice crop) in a subtropical region. Profile samples were collected from soil depths of 0-15, 15-30, 30-60, 60-90, 90-120, and 120-150 cm of different treatments in these experiments and analyzed for different forms of P and soil characteristics. The results revealed that (i) annual applications of fertilizer P either to one crop (alternative-applied P) or to both crops (cumulative) led to the accumulation of residual fertilizer P in the form of Olsen P, varying from 44 to 148 kg P ha-1, and the magnitude of accumulation was proportional to applied fertilizer P rate, frequency, and duration; (ii) majority of residual fertilizer P accumulated as inorganic P (74-89%) followed by organic P (11-26%) and Olsen P (9-19%), illustrating that the inorganic P pool is a major sink for fertilizer P; (iii) application of fertilizer nitrogen (N) and potassium (K) alone or in combination with fertilizer P did not affect residual fertilizer P accumulation in soil profile; (iv) incorporation of farmyard manure enhanced the P enrichment of soil profile; (v) irrigation pattern, soil pH (7.1-7.7), and calcium carbonate (CaCO3) (trace-0.33%) did not influence P movement to deeper soil layers; silt, clay, and soil organic C (SOC) showed strong relationships with Olsen P (r = 0.827, 0.938, and 0.464, P < 0.01) and enhanced the retention of labile P in the plow layer; and (vi) only 6-29% total residual P moved beyond 30 cm deep in fine-textured soils under 22-year rice (Oryza sativa L.)-wheat (Triticum aestivum L.) and 34-year maize (Zea maize L.)-wheat rotations, whereas 41, 27, 20, 9, and 3% were located in soil layers 0-30, 30-60, 60-90, 90-120, and 120-150 cm deep, respectively, in coarse-textured soil profile under 4-year peanut (Arachis hypogaea L.)-sunflower (Helianthus annuus L.) field. These findings confirmed that interplay between the fertilizer P management (alternative vis-a-vis cumulative P application and optimal vis-a-vis excessive rates of fertilizer P in different crop rotations), amount of labile P accumulated in soil profile, and soil characteristics (silt, clay, and SOC) largely controlled the downward movement and resultant potential for P leaching in subtropical irrigated soils. [ABSTRACT FROM AUTHOR]

In this report, we present a case of 35-year-old lady who had presented with atypical chest pain and exertional breathlessness for past six months. Transthoracic and transesophageal echocardiograms showed a well-circumscribed, echo-dense mass in the right atrium, attached to the interatrial septum at the level of atrioventricular junction and in the vicinity of coronary sinus ostium. She underwent successful resection of the cardiac mass. Histopathology revealed paraganglioma, which was reconfirmed by immuno-histochemistry study. This represents an extremely rare presentation as primary cardiac tumors are 20-times less common than metastatic tumors and paraganglioma is one of the rarest primary cardiac tumors, accounting for < 1% of all cases. [ABSTRACT FROM AUTHOR]

Long-term continuous cereal cropping systems without returning crop residues to soil has led to depletion of inherent soil fertility in semiarid subtropical soils of South Asia. The inclusion of legumes and their residues assumes great significance to restore sustainability. Groundnut (Arachis hypogaea L.) and sunflower (Helianthus annus L.) are important oilseed crops of the region and have the feasibility to be grown in annual double crop rotation with the expansion of irrigation facilities. A 4-year field experiment with irrigated groundnut-sunflower rotation was conducted on a loamy sand soil (Typic Haplustept) to evaluate the effects of different rates of fertilizer N (0, 30 and 60 kg N ha-1) and P (0, 20, 30 and 40 kg P2O5 ha-1 corresponding to 0, 8.7, 13 and 17.5 kg P ha-1, respectively), applied either to one crop (direct for current crop and residual for succeeding crop) or to both crops (cumulative) each year, with or without 4 t ha-1 of groundnut crop residues (CR) on crop yields, nutrient uptake, fertilizer use efficiency and soil productivity parameters (pH, organic carbon, available N and P). The residual effects of P and CR were assessed on the succeeding groundnut crop. Winter-grown sunflower responded significantly and consistently to applied fertilizer N and P. Seed yield of sunflower increased significantly up to 60 kg N and 30 kg P2O5 ha-1 and there was no further increase with directly applied 40 kg P2O5 ha-1. Cumulative application of P produced sunflower yields comparable with those from direct applications. Incorporation of groundnut residue in conjunction with 30 kg N ha-1 significantly increased the sunflower yields that were statistically at par with those obtained with the lone application of 60 kg N ha-1. All through 4 years, the combined application of CR with 60 kg N ha-1 and 30 kg P2O5 ha-1 further improved the yield potential of sunflower by 10-11% and of succeeding groundnut by 10-24%, illustrating the benefit that fertilizer N and P could not achieve. Residual fertilizer P (30 kg P2O5 ha-1) produced optimum yields of groundnut, which were comparable with that from directly applied 20 kg P2O5 ha-1. After 4 years of study, soil organic carbon swelled by 22% and Olsen-P increased from initial 12 kg P ha-1 to 24-43 kg P ha-1 in fertilizer and CR-treated plots. These results illustrated that in groundnut-sunflower rotation, (1 )60 kg N and 30 kg P2O5 ha-1 are adequate for the sustaining optimal sunflower production; (2) whereas the application of fertilizer P to sunflower crop is required, P requirement of groundnut can be met from soil-derived and residual fertilizer P; and (3) incorporation of groundnut crop residues in conjunction with the adequate rates of N and P has complementary effects in maximizing the yields, uptake of N and P, and nutrient use-efficiency in sunflower as well as its residual effects on succeeding groundnut crop, and in sustaining long-term soil productivity. [ABSTRACT FROM AUTHOR]

The article describes the case of a 3-month-old male infant with primary carnitine deficiency presenting as intractable seizures. Topics discussed include his hypoglycemic episodes and metabolic acidosis, his echocardiography which showed left ventricular concentric hypertrophy with minimal pericardial effusion and the treatment given which include intravenous fluids, antibiotics and antiepileptic medication.

Ablation of Atrial Fibrillation. Introduction: Atrial fibrillation (AF) is often refractory to antiarrhythmic drugs, and patients who are intolerant of AF may require the maze operation fur cure. As a less invasive alternative, a catheter-based, right atrial compartmentalization procedure was evaluated. Methods and Results: Twelve patients with AF refractory to Class I and III antiarrhythmic drugs were studied. Four linear right atrial radiofrequency ablations were performed, from superior to inferior vena cava in the posterior wall and interatrial septum, anteriorly from the superior vena cava to the tricuspid annulus through the appendage, and across the tricuspid vaIve-inferior vena cant isthmus. The radiofrequency catheter was dragged along each line three to four times, until the atrial electrogram amplitude decreased by 75% and there was bidirectional conduction block in the tricuspid valve-inferior vena cava isthmus. One complication occurred: sinus node dysfunction requiring a pacemaker. Eight patients were discharged from the hospital on no antiarrhythmic drugs, and four were discharged on previously ineffective antiarrhythmic drugs. Total duration of follow-up was 21.3 ± 11.2 months. Four patients discharged on previously ineffective antiarrhythmic drugs had no recurrence of AF. One patient discharged off antiarrhythmic drugs had no recurrence of AF. Seven patients discharged off antiarrhythmic drugs had recurrent AF by 12.6 ± 13.0 months (median 6, range 1 to 39); 3 of these 7 responded to previously ineffective antiarrhythmic drugs without further AF and 4 did not. Thus, 8 of 12 patients (67%) had suppression of AF after ablation on previously ineffective medication or no medication. Conclusion: Right atrial compartmentalization may alter the substrate for AF. thus improving the efficacy of previously ineffective antiarrhythmic drugs. Because it is relatively safe, it may be a reasonable adjunctive intervention to maintain sinus rhythm in patients with drug-refractory AF. [ABSTRACT FROM AUTHOR]

A case is presented of an 18-year-old male who had been resuscitated following an episode of sudden death due to ventricular fibrillation. The patient was noted to have an abnormal deflection in the terminal QRS on surface ECG and an abnormal signal-averaged ECG demonstrating a late potential coincident with the terminal QRS abnormality on the ECG. The patient had easily inducible polymorphic ventricular tachycardia during electrophysiologic study, which was suppressed by quinidine but not by procainamide or beta blockers. The surface ECG and signal-averaged ECG also were normalized by quinidine but not by procainamide or beta blockers. The patient had no further arrhythmias on quinidine for 6 years until he inexplicably discontinued his medication and died suddenly shortly thereafter. The present case may represent a unique familial sudden death syndrome or possibly a variant of the sudden death syndrome associated with right bundle branch block and ST elevation in V1 through V3. Currently available data suggest that, in such patients, an implantable cardioverter defibrillator may provide better protection from sudden death than does antiarrhythmic drug therapy. [ABSTRACT FROM AUTHOR]

Raghib syndrome is a rare developmental complex consisting of termination of the left superior vena cava in the left atrium, absence of the coronary sinus, and an atrial septal defect commonly located at the posterior‐inferior angle of the atrial septum. This complex was considered unique to Raghib syndrome; however, cases with a normal atrial septum have been reported where the orifice of the unroofed coronary sinus functions as the inter‐atrial communication. Our patient demonstrated an isolated persistent left superior vena cava draining into the left atrium through unroofed coronary sinus and presence of ostium primum atrial septal defect. [ABSTRACT FROM AUTHOR]

A case of idiopathic hypertrophic osteo-arthropathy without pachydermia, in an 8-year-old boy born of non-consanguineous parents is described, with a brief review of the literature. [ABSTRACT FROM AUTHOR]

Background & objectives: Data on neonatal COVID-19 are limited to the immediate postnatal period, with a primary focus on vertical transmission in inborn infants. This study was aimed to assess the characteristics and outcome of COVID-19 in outborn neonates. Methods: All neonates admitted to the paediatric emergency from August 1 to December 31, 2020, were included in the study. SARS-CoV-2 reverse transcription- (RT)-PCR test was done on oro/nasopharyngeal specimens obtained at admission. The clinical characteristics and outcomes of SARS-CoV-2 positive and negative neonates were compared and the diagnostic accuracy of a selective testing policy was assessed. Results: A total of 1225 neonates were admitted during the study period, of whom SARS-CoV-2 RT-PCR was performed in 969. The RT-PCR test was positive in 17 (1.8%). Mean (standard deviation) gestation and birth weight of SARS-CoV-2-infected neonates were 35.5 (3.2) wk and 2274 (695) g, respectively. Most neonates (11/17) with confirmed COVID-19 reported in the first two weeks of life. Respiratory distress (14/17) was the predominant manifestation. Five (5/17, 29.4%) SARS-CoV-2 infected neonates died. Neonates with COVID-19 were at a higher risk for all-cause mortality [odds ratio (OR): 3.1; 95% confidence interval (CI): 1.1-8.9, P=0.03]; however, mortality did not differ after adjusting for lethal malformation (OR: 2.4; 95% CI: 0.7-8.7). Sensitivity, specificity, accuracy, positive and negative likelihood ratios (95% CI) of selective testing policy for SARS-CoV-2 infection at admission was 52.9 (28.5-76.1), 83.3 (80.7-85.6), 82.8 (80.3-85.1), 3.17 (1.98-5.07), and 0.56 (0.34-0.93) per cent, respectively. Interpretation & conclusions: SARS-CoV-2 positivity rate among the outborn neonates reporting to the paediatric emergency and tested for COVID-19 was observed to be low. The selective testing policy had poor diagnostic accuracy in distinguishing COVID-19 from non-COVID illness. [ABSTRACT FROM AUTHOR]

Background & objectives: Estimation of haemoglobin is the most widely used method to assess anaemia. Although direct cyanmethaemoglobin method is the recommended method for estimation of haemoglobin, but it may not be feasible under field conditions. Hence, the present study was undertaken to compare indirect cyanmethaemoglobin method against the conventional direct method for haemoglobin estimation. Methods: Haemoglobin levels were estimated for 888 adolescent girls aged 11-18 yr residing in an urban slum in Delhi by both direct and indirect cyanmethaemoglobin methods, and the results were compared. Results: The mean haemoglobin levels for 888 whole blood samples estimated by direct and indirect cyanmethaemoglobin method were 116.1 ± 12.7 and 110.5 ± 12.5 g/l, respectively, with a mean difference of 5.67 g/l (95% confidence interval: 5.45 to 5.90, P<0.001); which is equivalent to 0.567 g%. The prevalence of anaemia was reported as 59.6 and 78.2 per cent by direct and indirect methods, respectively. Sensitivity and specificity of indirect cyanmethaemoglobin method were 99.2 and 56.4 per cent, respectively. Using regression analysis, prediction equation was developed for indirect haemoglobin values. Interpretation & conclusions: The present findings revealed that indirect cyanmethaemoglobin method overestimated the prevalence of anaemia as compared to the direct method. However, if a correction factor is applied, indirect method could be successfully used for estimating true haemoglobin level. More studies should be undertaken to establish agreement and correction factor between direct and indirect cyanmethaemoglobin methods. [ABSTRACT FROM AUTHOR]