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Purpose: To report the prevalence of amblyopia risk factors in children with congenital nasolacrimal duct obstruction.Methods: A retrospective review of records of children with the diagnosis of congenital nasolacrimal duct obstruction (NLDO), who underwent probing from January 2009 to October 2011, was done. All of them underwent a complete ophthalmic evaluation including cycloplegic refraction and strabismus evaluation before probing.Results: A total of 142 children were included in this study. The mean age at presentation was 22.38 months (sample standard deviation (SSD) - 15.88). Amblyopia risk factors were defined according to two sets of guidelines: The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) referral criteria guidelines and the new AAPOS Vision Screening Committee guidelines. Twenty-eight (20%) children were found to have some form of amblyopia risk factor based on the referral criteria prescribed by AAPOS. However, on applying modified guidelines described by Donahue et al., to analyze the same cohort, 21 children were found to have amblyogenic risk factors. Of these 28 children, 13 had significant astigmatism (>1.50 D), 8 children had hypermetropia (>3.50 D), and six children had anisometropia (>1.50 D). One child had significant cataract (media opacity >1 mm). None of the children in this series had either myopia or strabismus.Conclusion: Prevalence of amblyopia risk factor was found to be 20% in our study based on the older guidelines; however, it reduces to 14.78% by applying the modified guidelines. Despite this reduction, importance of a comprehensive ophthalmic examination including cycloplegic refraction in all children presenting with NLDO cannot be overstated. A close follow-up of these children is also essential to prevent the development of amblyopia. [ABSTRACT FROM AUTHOR]

Background: A community-based program for the comprehensive management of communication disorders among individuals with cleft lip and/or palate (CLP) was implemented in two rural districts in the state of Tamil Nadu, India. The program was successful in terms of early surgical repair, orthodontic management and speech correction; however, audiological surveillance was challenging due to poor follow-up rates., Purpose: The aim of the study was to compare tele-audiological and in-person audiological surveillance to identify the most beneficial approach for the identification and treatment of middle ear disease (MED) in individuals with CLP in this rural community-based program., Research Design: Quasi-experimental study., Study Sample: All beneficiaries older than 5 years actively seeking services in Cuddalore (n = 44) and Thiruvannamalai (n = 65) districts of Tamil Nadu, India, were included in the study. Individuals in Cuddalore district were assigned to the tele-audiological surveillance group, whereas individuals in Thiruvannamalai district were assigned to the in-person audiological surveillance group., Methods: In the tele-audiological surveillance group, video-otoscopy examinations were performed by trained community-based rehabilitation workers (CBRWs). Pure-tone audiometry and tympanometry were performed by an audiologist from the tertiary care hospital through remotely accessed equipment using broadband internet at the participants' homes and monthly camps. Findings from those with suspected MED were forwarded to the otolaryngologist at the tertiary care hospital for remote diagnoses and treatment plans. Subsequently, CBRWs relayed the otolaryngologist's recommendations to the individuals receiving services at the community. In the in-person audiological surveillance group, video-otoscopy, pure-tone audiometry, and tympanometry were performed by the audiologist following standard testing procedures at monthly camps. Individuals with suspected MED and impacted cerumen were referred for in-person diagnoses and treatment plans. Follow-up audiological surveillance was conducted in both districts after implementation of the otolaryngologist's recommendations., Data Analysis: The coverage, follow-up rate for intervention and cost-outcomes from the provider's perspective were analyzed and compared between two groups., Results: Tele-audiological surveillance provided superior coverage (68%) compared with in-person audiological surveillance (38%). The tele-audiological surveillance group showed greater follow-up compliance (61%) than the in-person audiological surveillance group (19%) for treatment plans such as cerumen management and hearing aid fitting provided locally. Compared with in-person audiological surveillance, tele-audiological surveillance resulted in cost saving of USD 47 per individual., Conclusion: Tele-audiological surveillance was beneficial for the purpose of identifying and providing treatment in patients having CLP with MEDs in rural locations., (American Academy of Audiology.)

Purpose : This study explored the feasibility of conducting school-based language screening using telepractice to expand its scope for providing speech-language pathology services in India. Method : Thirty-two primary school children underwent language screenings through in-person and telemethods. Screening through telemethod was conducted by a Speech-Language Pathologist (SLP) using digitised picture stimuli presented through videoconferencing and remote computing with assistance of a facilitator at school site. Technology and child-related factors influencing screening were documented using an inventory. Result : Language outcomes through in-person and telemethods revealed no significant differences in both receptive and expressive domains, suggesting absence of bias due to testing method used. Use of multiple internet options at both sites helped overcome technical challenges related to connectivity during screening through telemethod. The trained facilitator played a crucial role in overcoming child related factors such as poor speech intelligibility, poor audibility of voice, motivation, interaction with SLP and need for frequent breaks. Conclusion : Feasibility of conducting school-based language screening using multiple internet options and help of a facilitator at school demonstrates promise for delivery of services by SLP in resource constrained contexts such as India.

Background: In an attempt to reach remote rural areas, this study explores a community-based, pediatric hearing screening program in villages, integrating two models of diagnostic ABR testing; one using a tele-medicine approach and the other a traditional in-person testing at a tertiary care hospital., Methods: Village health workers (VHWs) underwent a five day training program on conducting Distortion Product Oto Acoustic Emissions (DPOAE) screening and assisting in tele-ABR. VHWs conducted DPOAE screening in 91 villages and hamlets in two administrative units (blocks) of a district in South India. A two-step DPOAE screening was carried out by VHWs in the homes of infants and children under five years of age in the selected villages. Those with 'refer' results in 2nd screening were recommended for a follow-up diagnostic ABR testing in person (Group A) at the tertiary care hospital or via tele-medicine (Group B). The overall outcome of the community-based hearing screening program was analyzed with respect to coverage, refer rate, follow-up rate for 2nd screenings and diagnostic testing. A comparison of the outcomes of tele-versus in-person diagnostic ABR follow-up was carried out., Results: Six VHWs who fulfilled the post training evaluation criteria were recruited for the screening program. VHWs screened 1335 children in Group A and 1480 children in Group B. The refer rate for 2nd screening was very low (0.8%); the follow-up rate for 2nd screening was between 80 and 97% across the different age groups. Integration of tele-ABR resulted in 11% improvement in follow-up compared to in-person ABR at a tertiary care hospital., Conclusions: Non-availability of audiologists and limited infrastructure in rural areas has prevented the establishment of large scale hearing screening programs. In existing programs, considerable challenges with respect to follow-up for diagnostic testing was reported, due to patients being submitted to traveling long distance to access services and potential wage losses during that time. In this program model, integration of a tele-ABR diagnostic follow-up improved follow-up in comparison to in-person follow-up. VHWs were successfully trained to conduct accurate screenings in rural communities. The very low refer rate, and improved follow-up rate reflect the success of this community-based hearing screening program.

Purpose: The aim of this study was to devise a grassroots-level strategy for identification and management of middle ear disorders in a community-based program for individuals with cleft lip and palate in 2 rural districts in the state of Tamil Nadu in South India., Method: Community workers underwent training to conduct video otoscopy using the ENTraview device. Community workers conducted video otoscopy on 160 individuals with cleft lip and palate between 3 and 35 years old in the community. Middle ear conditions were identified using store-and-forward telepractice. Diagnostic telehearing evaluation was conducted using synchronous pure tone audiometry and tympanometry for those who were identified with tympanic membrane (TM) and/or middle ear diseases (MEDs). A review of data collected over a 13-month period was carried out to assess coverage and follow-up intervention rates., Results: The program was successful in achieving 80% coverage for identification of TM and MEDs within 13 months of program implementation. TM and/or MEDs were identified in 26% (82/320 ears) of those who underwent video otoscopy. Telehearing evaluations were completed on 42 ears of individuals with TM and/or MEDs; 52% (22/42 ears) of these individuals had a minimal, mild, or moderate degree of hearing loss. Regarding follow-up for intervention, 78% qualified for surgical intervention, and 31% qualified for medication., Conclusions: This grassroots-level telemedicine approach was successful in achieving better coverage, and store-and-forward telepractice helped in providing remote diagnosis and recommendation by otolaryngologists to all individuals with TM/MEDs in the rural community. The follow-up for otological intervention significantly improved from that achieved in the previous years.

Objective: This study evaluated the cost and outcome of a community-based hearing screening programme in which village health workers (VHWs) screened children in their homes using a two-step DPOAE screening protocol. Children referred in a second screening underwent tele diagnostic ABR testing in a mobile tele-van using satellite connectivity or at local centre using broadband internet at the rural location., Design: Economic analysis was carried out to estimate cost incurred and outcome achieved for hearing screening, follow-up diagnostic assessment and identification of hearing loss. Two-way sensitivity analysis determined the most beneficial cost-outcome., Study Sample: 1335 children under 5 years of age underwent screening by VHWs., Results: Nineteen of the 22 children referred completed the tele diagnostic evaluation. Five children were identified with hearing loss. The cost-outcomes were better when using broadband internet for tele-diagnostics. The use of least expensive human resources and equipment yielded the lowest cost per child screened (Rs.1526; $23; €21). When follow-up expenses were thus maximised, the cost per child was reduced considerably for diagnostic hearing assessment (Rs.102,065; $1532; €1368) and for the cost per child identified (Rs.388,237; $5826; €5204)., Conclusion: Settings with constrained resources can benefit from a community-based programme integrated with tele diagnostics.

In this study, methanogenic consortia were isolated and characterized from eight different sediment samples of mangrove ecosystem located in Ennore, Chennai. Out of eight samples, two consortia (SpR6 and SSS8) were consistent and good at methane production. The maximum methane (6.95%) was produced by the sample collected from the swampy sediments (SSS8) of mangrove environment on 5th day of incubation. The pure colonies of methanogenic consortia (SSS8) isolated in the roll tube produced maximum methane (5%) on 70th day. Further, all the isolated consortia produced methane when it was grown with and without gaseous (H2 and CO2) substrate and the maximum production of 15.1% (SSS8) on 12th day of incubation in the presence of gaseous substrate. Also, the methanogenic consortium isolated from the mangrove environment produced significant amount of methane in tyndallized cow dung (4.7%) than in raw cow dung. The fluorescence of isolated colony and individual cells of methanogenic consortia, methane production, and the amplification of archeal specific 16S rRNA genes confirmed the presence of methanogenic bacteria in the Ennore mangrove sediments.

Video-laryngoscopy may provide an enhanced view of laryngeal structures compared to direct visualization. Commercial video-laryngoscopes are often expensive, limiting its adoption for routine use. We describe our initial experience using an inexpensive custom made device. Patients >15 years age, were randomly chosen, after informed consent, for video-laryngoscopy. A custom device easily assembled using an USB endoscopic camera, a conventional Macintosh laryngoscope blade size 3 or 4, and a personal computer was used. Patients with Mallampati class 1-3 were chosen. Video-laryngoscopy was recorded and reviewed. Twenty-four patients aged 16-68 years, of mean weight 58.46 ± 12.54 (40-86) kg were studied. The glottis could be visualized and intubation could be performed in all patients with 22/24 patients on first attempt. Mean duration of laryngoscopy was 22.17 ± 12.78 (7-59) s. Time taken for intubation, was mean of 28.58 ± 21.01 (9-89) s. Three patients with anticipated difficult airways could be intubated on the first attempt. Minor blood staining of the airway was seen in the video in two patients. Cormack-Lehane laryngoscopy grade visualized was 1 in 9/24, 2 in 15/24 patients. Percentage of glottic opening score was 62.29 ± 28.40 (20-100) %. Real-time video could be captured in all cases. The custom-made, inexpensive, video-laryngoscopy device is safe and reliable for clinical use. Real-time visualization and endotracheal intubation were successful in all patients, including those with anticipated difficult airway. Further, this device helps in archiving the video of intubation.

Activity limitation and participation restriction (AL/PR) on account of tinnitus was studied in the ICF framework in order to understand how tinnitus restricts individuals from fulfilling social and economic obligations. The objective of the study was to study the impact of tinnitus in the framework of ICF. Twenty-one adults in the age range of 20-60 years with chronic tinnitus (>3 months) and with normal hearing sensitivity were included in the study. THI was mapped to the framework of ICF. Twenty out of twenty-five items belonged to the domains under body function and five items addressed AL/PR. Five more AL/PR items applicable to tinnitus were added to THI. The THI+ICF questionnaire tested well on test reliability (0.987) and internal consistency (0.873). Body function was significantly more affected than AL/PR (P = 0.0005). These results suggest that tinnitus does not result in significant AL/PR from the ICF perspective. Further, psycho-acoustic characteristics such as intensity, frequency of tinnitus, and time since onset of tinnitus have only minimal if any impact on AL/PR.