Search

Purpose: To explore the parental factors that impede early intervention for strabismus and thus identify strategies for improving access to specialized care. Methods: This hospital-based cross-sectional study included 110 parents of children under 19 years with strabismus receiving treatment at the squint clinic of a tertiary health care center in north India. A pre-validated survey questionnaire was administered to the participants, that had a section about the socio-demographics of the participants, another section addressed the parental knowledge about strabismus about diagnosis, and the need for an eye examination. It also sought information about referral source, the felt need for squint examination, and reasons for not seeking treatment. Results: A total of 110 parents/guardians of strabismus patients (59 exotropes and 51 esotropes) were interviewed using a survey questionnaire. Parents themselves identified 80% of cases, and a substantial link (P ​

Background Encapsulated pancreatic fluid collection (PFC) is a requisite for endoscopic drainage procedures. The 4-week threshold for defining walled-off necrosis does not capture the dynamic process of encapsulation. We aim to investigate the changes in the wall characteristics of PFC in acute necrotizing pancreatitis (ANP) by comparing baseline contrast-enhanced computed tomography (CECT) with follow-up CT scans.

Purpose: To report the long-term outcomes of bilateral symmetrical superior oblique (SO) nasal tenotomy in patients with large A-pattern exotropia (≥25 prism diopter [PD]). Methods: This retrospective study was conducted on 15 patients (aged: 4–28 years) of large A-pattern exotropia. An A-pattern was defined as >10 PD difference between up and down gaze at 6 m by use of the alternate prism cover test. Objective ocular torsion was assessed by fundus photography and subjective torsion by double Maddox rod test. All patients underwent horizontal muscle surgery according to the primary position horizontal deviation and bilateral symmetrical SO nasal tenotomy for A-pattern. Surgical success was defined as postoperative A-pattern of ≤10 PD, the absence of vertical and torsional diplopia, and the absence of V-pattern. The minimum follow-up period was 24 months. Results: A total of 15 patients of large A-pattern exotropia (7 males and 8 females) with a mean age of 17.09 ± 7.9 years were included in the study. All patients had bilateral SO overaction of grade +3 or +4 with a mean preoperative A-pattern of 30.3 ± 3.9 PD. At 24 months of follow-up, esotropia in down gaze (V-pattern) was present in four patients with a mean of 11.25 ± 2.5 PD, (range, 10–15 PD). The rest of the 11 patients maintained successful alignment with a mean A-pattern of 3.18 ± 1.17 PD, (range, 2–5 PD). There was significant A-pattern collapse with a mean of 31 ± 9.1 PD after 2 years of follow-up, which was significantly associated with preoperative A-pattern (Pearson correlation, r = 0.7; t[15] = 4.0; P = 0.002). The mean of pre- and postoperative objective ocular torsion was found to be −0.5 ± 4° and −4.8 ± 3.8° with a mean extorsion effect of 4.67 ± 3.85°. There was a statistically significant difference between pre- and postoperative ocular torsion (°) (t [30] = 5.42; P < 0.001), the change in ocular torsion was significantly associated with preoperative torsion (Pearson correlation, r = 0.5; t [30] = 7.2; P < 0.001). None of the patients had subjective torsion on the double Maddox rod test pre- and postoperatively. Conclusions: Bilateral symmetrical SO nasal tenotomy is effective in cases with large A-pattern (>25 PD). The reduction of A-pattern and postoperative change in fundus torsion have a positive correlation with preoperative A-pattern and preoperative torsion, respectively.

Background The role of dual-modality drainage of walled-off necrosis (WON) in patients with acute pancreatitis (AP) is established. However, there are no data on the association of clinical outcomes with the timing of percutaneous catheter drainage (PCD). We investigated the impact of the timing of PCD following endoscopic drainage of WON on clinical outcomes in AP.

Background: Retinal vein occlusion (RVO) is one of the most common causes of retinal vascular disease, second to diabetic retinopathy. We aimed to compare the lamina cribrosa thickness (LCT) of patients with unilateral branch RVO (BRVO) versus healthy individuals. Materials and Methods: This was a hospital-based, prospective, cross-sectional, and comparative study. Participants were newly diagnosed RVO cases (n = 25) and apparently normal age-matched healthy controls (n = 25). All the participants underwent systemic and comprehensive ophthalmic examination, including refraction and enhanced depth imaging optical coherence tomography. Relevant parameters were compared between the groups using the independent t-test. Statistical significance thresholds were set at a P < 0.05. Results: The mean age of cases (66.7% female) and controls (52% female) was 55.9 ± 7.4 and 59.4 ± 7.0 years, respectively, (P = 0.089). The mean LCT of the affected eyes in cases (176.6 ± 28.3 μm) was significantly lower compared to the unaffected eyes of cases (200.6 ± 33.1 μm, P = 0.008) and control eye (230.9 ± 36.9 μm, P = 0.001). Conclusions: A thinner lamina cribrosa (LC) was observed in both eyes of unilateral RVO patients compared with healthy, nonglaucomatous subjects’ eyes. The role of LCT as a local mechanical factor in the pathogenesis of BRVO and their relationship to systemic factors merits further investigation.

The upper eyelid is a complex structural part of the face that plays an important role in protecting the cornea from drying and damage to preserve vision. The eyelashes are an essential part of the upper eyelid and help in protecting the eyes from dust, foreign bodies, and sweat. Being a part of the face, which is the most noticeable part of the body, both structures hold an important role in reconstructive procedures. Reconstruction of both structures simultaneously is tricky but helps reduce the number of procedures required in achieving an aesthetically acceptable eye. Our techniques describe the use of the paramedian forehead flap with an anterior hairline to reconstruct the upper eyelid and eyelashes in a single stage in a posttraumatic near-total upper eyelid defect with a favorable outcome. Depending on the parting of the patient's hair, the anterior hairline of one side can be included in the distal edge of the flap while raising, which can be inset so that the direction and orientation of the eyelashes perfectly match. Our technique refurbishes an established technique for eyelid reconstruction to include eyelash reconstruction at the same time, thus saving time and resources without any inconvenience to the patient.

Cannabis is a psychoactive substance consumed worldwide in the form of smoking, vapors, food additives, or beverages. Delta 9 tetrahydrocannabinol (THC) is a primary component responsible for short and long-term effects on various cognitive and motor functions in a dose-dependent manner. The legal status of cannabis has shifted significantly in recent decades. Some regions maintain strict penalties, but others have legalized them for medicinal use. In India, the use of cannabis in any form is illegal; however, the use of bhang, a cannabis beverage made from leaves, is acceptable due to cultural reasons and thus permitted in some places. We report the case of a 28-year-old male who developed massive anterior wall myocardial infarction after consuming bhang during the Holi festival. He presented with sudden retrosternal chest pain, which was initially ignored till it intensified enough, prompting him to seek emergency medical help approximately 24 hours after symptom onset. Cannabis intoxication impaired attention and information processing, leading to delayed presentation. The patient was managed successfully by timely cardiac intervention. The evolving landscape of cannabis regulations necessitates heightened awareness among health authorities about potential cardiovascular risks associated with its consumption, particularly in forms like Bhang, where concentrations are unregulated and variable.

Background Periodontal disease is a chronic inflammatory disease of structures surrounding the teeth. Its etiology is multifactorial. The primary etiological factor is the microbial component; the other factors are systemic, behavioral, environmental, and psychological. Conventional management includes routine periodontal therapy involving prophylactic and surgical management. In developing countries like India, complementary medicine and alternative medicines like yoga are gaining popularity for improving systemic health. Hence this pilot study was designed to assess the psychometric properties of a structured questionnaire that can assess knowledge, attitude, and practice (KAP) regarding the impact of yoga on oral and periodontal health in Indian population. Methods The KAP questionnaire was developed (Stage One) using a deductive approach, and a psychometric evaluation of the questionnaire was performed to evaluate it’s reliability and validity (Stage Two). Initial content validation and test re-test reliability were assessed using kappa statistics with binary responses. An intraclass correlation coefficient (ICC) was used to assess the questions in the practice and attitude category with categorical variables. Further assessment of psychometric properties of the questionnaire was done using item response theory. The developed questionnaire had four principal sections: demography of participants; knowledge regarding yoga and oral health; attitude towards yoga and oral health; and practice towards implementing yoga for oral health. Results The ICC for all the assessed questions was greater than 0.60 suggesting satisfactory stability. Internal consistency measured using Cronbach’s alpha for knowledge, attitude, and practice items were reported to be 0.632, 0.923, and 0.591 respectively and that of the KAP total was 0.632. Conclusions The findings of this study showed that the questionnaire had an acceptable psychometric property for measuring KAP regarding yoga and it’s role in oral and periodontal health among Indian adults. The analysis of participant responses revealed that they had a medium level of knowledge regarding yoga and periodontal disease.

Introduction: Glaucoma is a significant cause of ocular morbidity following ocular trauma, particularly Closed Globe Injury (CGI), which frequently leads to elevated Intraocular Pressure (IOP). This type of trauma can result in various tissue damages such as radial sphincter tears, iridodialysis, angle recession, cyclodialysis, trabecular meshwork tears, zonule separation, or peripheral retinal dialysis. Damage in these areas can lead to early or delayed onset glaucoma. Aim: To evaluate the clinical profile, assess visual outcomes, and analyse management strategies in post-traumatic glaucoma with CGI. Materials and Methods: The retrospective cohort study was conducted at a tertiary eye care centre in Department of Ophthalmology, Regional Institute of Ophthalmology (RIO), Sitapur, Uttar Pradesh, India. from January 2020 to December 2022. Retrospective data of patients presenting with CGI and developing elevated IOP (>21 mmHg) were collected. Only patients with a minimum follow-up of three months were included. Various parameters, including demographics, IOP, Best-Corrected Visual Acuity (BCVA), and the effects of medical and surgical treatments on IOP and BCVA, were analysed. The Ocular Trauma Score (OTS) was also calculated. Statistical analysis was performed using Microsoft excel and Statistical Package for Social Sciences software version 21.0, with a significance level of 5%. Continuous variables were described as mean±Standard Deviation (SD), and an unpaired t-test was used for comparisons between pre- and postmanagement visual acuity and IOP. Results: Out of 259 eyes with ocular trauma, 93 (35.90%) were diagnosed with CGI and developed elevated IOP. The most common causes of elevated IOP were hyphema (37.63%) and angle recession mechanisms (32.25%). The median IOP at presentation was 35 mmHg (range: 12 to 71 mmHg) and decreased to 16.5 mmHg (range: 4 to 52 mmHg) at the last follow-up (p-value

Chronic myeloid leukemia (CML) patients frequently exhibit systemic symptoms such as fatigue, abdominal discomfort, weight loss, and fever but rarely can have atypical initial presentation in the form of ophthalmic manifestations, which can precede the diagnosis of the primary malignancy. We describe a case of a 29-year-old male who presented in our ophthalmology out-patient department (OPD) with complaints of painless, diminution of vision, which was sudden in onset in right eye (RE) and loss of vision in left eye (LE) for four and seven days, respectively. There had been a history of loss of weight and appetite for the past 2 months. The visual acuity (VA) recorded was finger counting two meters in RE and perception of light in LE with an inaccurate projection of rays in both eyes (BE). The anterior segment evaluation of both eyes (BE) was normal. Fundus revealed multiple elevated yellow subretinal lesions with exudative detachment in the RE and no view in the LE. Ultrasound-Brightness (USG B) scan in the LE revealed multiple hyperreflective echoes likely vitreous hemorrhage. Optical coherence tomography (OCT) showed subretinal hyperreflectivity with surrounding edema in RE suggestive of leukemic infiltrates. On further systemic investigations, chronic myeloid leukemia-chronic phase (CML-CP) was detected; hence, the diagnosis of RE exudative retinal detachment (RD) and LE vitreous hemorrhage with CML-CP was made. Ophthalmic involvement is more often seen in acute than chronic leukemia, which makes the diagnosis challenging. We describe a unique case of a young patient with CML-CP who initially presented with ocular involvement preceding systemic diagnosis. This case report illustrates the importance of a primary care physician or an ophthalmologist in the early diagnosis and prompt management of hematological malignancy, as ophthalmic manifestations may be a rare initial presenting feature in CML-CP. These conditions require urgent referral to a hematologist by a primary care physician in the view of early commencement of therapy.

Microbial inoculants can increase the yield of cultivated crops and are successful in independent trials; however, efficacy drops in large-scale applications due to insufficient consideration of microbial community dynamics. The structure of microbiomes, in addition to the impact of individual taxa, is an important factor to consider when designing growth-promoting inoculants. Here, we investigate the microbial network and community assembly patterns of Macrocystis pyrifera gametophyte germplasm cultures (collectively referred to as a "seedbank") used to cultivate an offshore farm in Santa Barbara, California, and identify network features associated with increased biomass of mature sporophytes. We found that [1] several network features, such as clustering coefficient and edge ratios, significantly vary with biomass outcomes; [2] gametophytes that become low- or high-biomass sporophytes have different hub taxa; and [3] microbial community assembly of gametophyte germplasm cultures is niche-driven. Overall, this study describes microbial community dynamics in M. pyrifera germplasm cultures and ultimately supports the development of early life stage inoculants that can be used on seaweed cultivars to increase biomass yield.

By enabling self-driving capabilities, autonomous vehicles (AVs) are revolutionizing transportation. Artificial intelligence (AI) integrating with AVs improves their perception, decision-making, and control systems. Despite AVs' remarkable growth and acceleration, two significant challenges emerge, i.e., distributed data and computational overhead. To address these challenges, we proposed a novel architecture combining split and federated learning (FL) for traffic sign classification in AVs. Our method distributes deep learning (DL) models across multiple AV systems, allowing efficient DL model training and usage. To mitigate computational overhead on vehicular clients, split learning partitions have been applied between the vehicular clients and a server. Additionally, FL advances this approach by simultaneously addressing data decentralization concerns and constructing a strong traffic sign detection model. It achieves this by training the model individually on each client and on that individual client's data and transmitting only crucial weight parameters of the DL model; it also adds a layer of security by avoiding the direct transfer of location-revealing image data. To send model weight parameters in a timely manner, we employed the staggering benefits of a 5G network, which improves the accuracy of applied DL models in each communication round. The proposed architecture offers efficient and real-time model training and utilization for accurate traffic sign identification in AVs by harnessing the capabilities of split learning, FL, and 5G networks. The experimental findings show that our architecture is effective, with a maximum accuracy of 99.54 % on the German Traffic Sign Research Benchmark (GTSRB) dataset with five client architectures, contributing to improving AV technology and developing intelligent transportation systems. Further, we analyze the performance of a 5G network in terms of phase noise and modulation; it is depicted from the experiment that the 5G network is showing noteworthy performance than the 4G network.

Fahr's syndrome, a rare disease, is characterized by symmetrical and bilateral intracranial calcification. Here, we present the case of a 25-year-old female. She presented with progressive diminution of vision, dysarthria, and slowness of movements and had a history of seizures. Neurological examination revealed Parkinsonian features and episodes of stiffness all over the body. Right eye ultrasound-B scan and swept-source optical coherence tomography revealed optic nerve head (ONH) calcification, which is not a common finding. A computed tomography scan of the brain revealed bilateral, symmetrical, large areas of calcification over the basal ganglia, thalamus, and globus pallidus. In our patient, age and ONH calcification were two uncommon presentations.

This case report describes and discuss the significance of necrotizing ulcerative periodontitis. A wide range of oral lesions has been documented in individuals infected with the potential life-threatening human immunodeficiency virus (HIV). HIV-infected patients are at an increased risk of a unique form of periodontal disease called ‘necrotizing ulcerative periodontitis’. These lesions are the most severe form of periodontitis identified but of rare occurrence among HIV patients, with a prevalence of less than 5%. Disease progress is managed by thorough local debridement under antibiotic coverage. Here, we report a case of a 44-year-old female who reported with an extensive area of ulcerations, and necrosis of marginal gingiva, interdental papilla, and attached gingiva. Blood investigations revealed an absolute CD4+ cells count of 75 cells/mm3 and HIV-positive status. Necrotizing ulcerative periodontitis is as an indicator of underlying systemic immunosuppression. Further, the occurrence of ulcerative periodontitis led to the diagnosis of HIV in the present case.

The rapid expansion of the Internet of Things (IoT) on a global scale has facilitated the convergence of revolutionary technologies such as artificial intelligence (AI), blockchain, and cloud computing. The integration of these technologies has paved the way for the development of intricate infrastructures, such as smart homes, smart cities, and smart industries, that are capable of delivering advanced solutions and enhancing human living standards. Nevertheless, IoT devices, while providing effective connectivity and convenience, often rely on traditional network interfaces that can be vulnerable to exploitation by adversaries. If not properly secured and updated, these legacy communication protocols and interfaces can expose potential vulnerabilities that attackers may exploit to gain unauthorized access, disrupt operations, or compromise sensitive data. To overcome the security challenges associated with smart home systems, we have devised a robust framework that leverages the capabilities of both AI and blockchain technology. The proposed framework employs a standard dataset for smart home systems, from which we first eliminated the anomalies using an isolation forest (IF) algorithm using random partitioning, path length, anomaly score calculation, and thresholding stages. Next, the dataset is utilized for training classification algorithms, such as K-nearest neighbors (KNN), support vector machine (SVM), linear discriminate analysis (LDA), and quadratic discriminant analysis (QDA) to classify the attack and non-attack data of the smart home system. Further, an interplanetary file system (IPFS) is utilized to store classified data (non-attack data) from classification algorithms to confront data-manipulation attacks. The IPFS acts as an onsite storage system, securely storing non-attack data, and its computed hash is forwarded to the blockchain’s immutable ledger. We evaluated the proposed framework with different performance parameters. These include training accuracy (99.53%) by the KNN classification algorithm and 99.27% by IF for anomaly detection. Further, we used the validation curve, lift curve, execution cost of blockchain transactions, and scalability (86.23%) to showcase the effectiveness of the proposed framework.

Purpose: To study the effect of refractive errors on pattern visual evoked potential (VEP) recordings in the pediatric population. Methods: This cross-sectional observational study assessed 240 eyes of 120 participants attending the outpatient department of a tertiary care center in North India. Participants were between 8 and 18 years of age; 30 participants each were recruited into four groups, namely emmetropia, myopia, hypermetropia, and amblyopia. They were then subjected to pattern reversal VEP, with P-100 amplitude and latency recorded for each participant. Results: The emmetropic group in this study provided normal values of P-100 parameters, namely P-100 latency and P-100 amplitude with readings of 115.78 ± 10.19 ms and 11.11 ± 4.08 μV, respectively. P-100 amplitude was significant compared to P-100 latency in detecting the presence or absence of a specific type of refractive error. It was found that there was a significant association between severity of myopia and P-100 latency (both unaided and aided) with P < 0.05. The severity of hypermetropia showed a significant association with P-100 amplitude (unaided) (P < 0.05). Receiver operating characteristics analysis revealed P-100 amplitude to be a good predictor of refractive error and the cut-offs were calculated. Conclusion: The P-100 parameters of the pediatric Indian population were comparatively higher than conventional values. P-100 latency seemed to better correlate with myopia, while hypermetropia correlated with P-100 amplitude. P-100 amplitude appears to be the most significant predictor of the presence of refractive error in an individual.

Objective: Observation and comparison of resolution of signs and relief of symptoms in patients of Vernal Keratoconjunctivitis (VKC) treated with 0.1% olopatadine eye drops or 1.5% bepotastine besilate eye drops. Materials and Methods: It was a prospective observational study of 60 patients of VKC from January 2018 to July 2019. Thirty confirmed cases of VKC were included in the study in each group. One group received 0.1% olopatadine eye drops and second group received 1.5% bepotastine besilate eye drops and were followed up for a period of 4 weeks. The main outcome measures were scoring and comparison of Total subjective symptom scores (TSSS) and Total objective sign scores (TOSS) within and between the groups at each follow up. Wilcoxon rank-sum test (Mann Whitney U test) was used to compare the two groups in terms of symptom and sign score at each of the time points. Friedman test was used to explore the change in score over time within each group. Generalized Estimating Equations method was used to explore the difference in change in score between the two groups over time. A p value of < 0.05 was considered statistically significant. Results: With treatment both TSSS and TOSS decreased consistently in both groups at the end of the two week and four week follow up time points. P Value of Comparison of the Two Groups in Terms of Difference of Subjective Score Total from Baseline to Follow-up Time points was statistically significant (P

Purpose: To estimate prevalence of common ocular morbidities including color blindness among school-attending children of an urban foothill town of Uttarakhand State in Northern India. Methods: A cross-sectional study was conducted among school-going children of age group 6–16 years of standard I–XII. Schools were selected using population proportionate to the size sampling technique. Detailed ocular examination including color vision and unaided or aided visual acuity for various ocular morbidities was done. Data was entered into MS excel with statistical analysis using SPSS version 23 with significant P value

Abstract This study aims to identify the topics that users post on Twitter about organic foods and to analyze the emotion-based sentiment of those tweets. The study addresses a call for an application of big data and text mining in different fields of research, as well as proposes more objective research methods in studies on food consumption. There is a growing interest in understanding consumer choices for foods which are caused by the predominant contribution of the food industry to climate change. So far, customer attitudes towards organic food have been studied mostly with self-reported methods, such as questionnaires and interviews, which have many limitations. Therefore, in the present study, we used big data and text mining techniques as more objective methods to analyze the public attitude about organic foods. A total of 43,724 Twitter posts were extracted with streaming Application Programming Interface (API). Latent Dirichlet Allocation (LDA) algorithm was applied for topic modeling. A test of topic significance was performed to evaluate the quality of the topics. Public sentiment was analyzed based on the NRC emotion lexicon by utilizing Syuzhet package. Topic modeling results showed that people discuss on variety of themes related to organic foods such as plant-based diet, saving the planet, organic farming and standardization, authenticity, and food delivery, etc. Sentiment analysis results suggest that people view organic foods positively, though there are also people who are skeptical about the claims that organic foods are natural and free from chemicals and pesticides. The study contributes to the field of consumer behavior by implementing research methods grounded in text mining and big data. The study contributes also to the advancement of research in the field of sustainable food consumption by providing a fresh perspective on public attitude toward organic foods, filling the gaps in existing literature and research.

The corticosteroids have been used for preemptive management of surgical sequelae after mandibular third molar extraction. The aim of this article was to review the efficacy of methylprednisolone versus dexamethasone in the management of postsurgical pain, swelling, and trismus after mandibular third molar surgery. Randomized, double-blinded studies from PubMed, CINAHL, Scopus, DOSS, Cochrane central, and Web of Science were identified by using a search strategy. Randomized controlled trials evaluating the efficacy of use of dexamethasone versus methylprednisolone for mandibular third molar extraction were only considered. The studies involving the use of any other corticosteroid agent were excluded. Outcomes assessed were postoperative pain, the number of rescue analgesics required, swelling, trismus, and adverse events. The search strategy yielded 1046 articles for title and abstract screening, out of which only seven studies were included in the systematic review after full text screening. There was considerable heterogeneity between the studies with regards to the method as well as the parameters assessed. Risk of bias was low in three studies and unclear in other four studies. On pooled analyses, there was no significant difference with respect to pain, rescue analgesics, and swelling in the test and the control group. Forest plot analysis showed that dexamethasone had lesser trismus in early postoperative period (postoperative day 2) as compared to methylprednisolone. None of the included studies reported any adverse effects. Both the corticosteroids have similar efficacy in reducing the postoperative pain and swelling; however, dexamethasone showed statistically significant difference from methylprednisolone in reducing trismus (estimated standardized mean difference of −0.69 mm; 95% CI: −1.01 to −0.38; p

Introduction: Central Serous Chorioretinopathy (CSCR) is a disease characterised by localised Neurosensory Detachment (NSD) with or without focal Pigment Epithelial Detachments (PED) and altered Retinal Pigment Epithelium (RPE). Since, CSCR being a pachychoroid entity the visualisation and evaluation of choroidal vessels have shown that vascular layers are altered in the disease process. Aim: To assess Subfoveal Choroidal Thickness (SFCT), in acute CSCR patients in both affected and fellow unaffected eyes using Swept Source Optical Coherence Tomography (SS-OCT), and to compare these with age-matched control group. Materials and Methods: This was a hospital-based case-control study, conducted between July 2018 to May 2019 at Outpatient Department (OPD) of Aravind Eye Hospital, Coimbatore, India. Total of 41 patients and 41 controls from OPD were included. Uncorrected Visual Acuity (UCVA) and Best Corrected Visual Acuity (BCVA) were measured on Snellen’s chart. After pupil dilatation, posterior segment evaluation with slit lamp bio microscopy using a 90D lens and documentation with fundus photograph were done. All subjects were examined using SS-OCT which was done for both the eyes. Descriptive analysis such as mean, standard deviation and percentage were used to exhibit the clinical parameters. Independent t-test analysis was more suitable for this data. All the statistical tests were examined with 5% (p-value≤0.05) level of significance. Results: The age (mean±SD) of cases and controls were 38.44±6.14 years and 37.21±2.72 years, respectively. The mean SFCT of affected and unaffected fellow eye of cases were 465.39±60.02 μm and 407.12±57.29 μm respectively, (p-value

Abstract Background Sunflower is an important oilseed crop domesticated in North America approximately 4000 years ago. During the last century, oil content in sunflower was under strong selection. Further improvement of oil properties achieved by modulating its fatty acid composition is one of the main directions in modern oilseed crop breeding. Results We searched for the genetic basis of fatty acid content variation by genotyping 601 inbred sunflower lines and assessing their lipid and fatty acid composition. Our genome-wide association analysis based on the genotypes for 15,483 SNPs and the concentrations of 23 fatty acids, including minor fatty acids, revealed significant genetic associations for eleven of them. Identified genomic regions included the loci involved in rare fatty acids variation on chromosomes 3 and 14, explaining up to 34.5% of the total variation of docosanoic acid (22:0) in sunflower oil. Conclusions This is the first large scale implementation of high-throughput lipidomic profiling to sunflower germplasm characterization. This study contributes to the genetic characterization of Russian sunflower collections, which made a substantial contribution to the development of sunflower as the oilseed crop worldwide, and provides new insights into the genetic control of oil composition that can be implemented in future studies.

Abstract Background Cor triatriatum and supramitral ring are congenital anomalies which result in formation of three chambers of atria. To the best of our knowledge, simultaneous presence of both entities in the same patient resulting in the formation of four chambers of atria has not been described in the literature. Here, we report a case of simultaneous presence of cor triatriatum and supramitral ring associated with Raghib syndrome and Eisenmenger syndrome. Case presentation We report the case of a middle-aged gentleman, who presented to us with features of atrial septal defect with Eisenmenger syndrome. Multimodality imaging confirmed the simultaneous presence of supramital ring and cor triatriatum resulting in “cor tetratriatum” along with Raghib syndrome. Presence of Eisenmenger syndrome compelled us to offer medical therapy for the patient. Conclusion This is the first case report describing the simultaneous presence of supramitral ring and cor triatriatum resulting in a new entity—“cor tetratriatum”.

The dominant mechanism of the excitonic insulator transition in Ta2NiSe5 and the nature of its high-temperature phase are debated. The authors report transient reflectivity measurements indicating a significant electronic contribution to the transition and a gapped state of preformed excitons at high temperatures.

Purpose: Pterygium is a triangular fibrovascular subepithelial ingrowth of degenerative bulbar conjunctival tissue over the cornea. It is now considered to be a result of uncontrolled cellular proliferation as overexpression of p53 protein and Ki-67 nuclear protein was found in the epithelium. This study was done to find the expression of p53 and Ki-67 with the severity and duration of the pterygium to explain the etiopathogenesis. Methods: Data were analyzed from 43 Indian participants of all age groups. All patients were divided according to the severity of pterygium (mild, moderate, and severe groups) and according to the duration of pterygium (4 years). The samples were studied by immunohistochemistry by using antibodies against p53 and Ki-67 proteins considering >5% expression as significant. Results: Of 43 cases, p53 and Ki-67 expression were positive in 33 cases. In mild, moderate, and severe cases p53 positivity was 33.3%, 78.4%, 100%, respectively. P53 expression increased with duration, 79.3% positive in 4 years. With increasing severity of pterygium, mild, moderate, and severe cases, Ki-67 positivity was 66.7%, 78.37%, 66.7%, respectively. Ki-67 expression with duration, 79.3% positive in 4 years of the duration of pterygium with no statistical significance. Conclusion: Our study revealed that with increasing duration and severity of pterygium, p53 expression was observed to be increasing. Ki-67 expression increased with the duration of pterygium but not with the severity.

Purpose: To ascertain ophthalmologist's perceptions about webinars as a method of continued medical education during the COVID-19 pandemic. Methods: In a cross-sectional study, a 21-question survey was circulated using digital media platform to approximately 1400 ophthalmologists in India between 16th August 2020 to 31st August 2020. The questionnaire focussed on the quality and usefulness of webinars based on the Bloom's taxonomy. The responses (on 4- or 5-point Likert scale) were analyzed among three professional groups- ophthalmologists in-training, consultants in public sector, and private practitioners. Results: 393 ophthalmologists participated in the survey, with a response rate of 28%. The mean age was 34.6 ± 9.7 years, and males constituted 49.6% (199/393) of the respondents. Forty-seven percent of the respondents perceived the quality of webinars as good or excellent (185/393), 72.8% reported knowledge gain from webinars (286/393), and 63.9% felt that webinars are important in clinical practice and should continue post-COVID-19 pandemic (251/393), with distinct responses among the professional groups. The drawbacks perceived were overt number of webinars (371; 94.4%), confusion regarding which webinars to attend (313; 79.6%), repetition of the information (296; 75.3%), limited opportunity for participant interaction (146; 37.2%) and disparate weightage to the core disciplines of Ophthalmology. Conclusion: Most respondents had favorable perceptions of Ophthalmology webinars happening during the COVID-19 pandemic. However, there is need for improvisation in the volume of webinars, target-audience-based delivery, and participant interaction to add value to this new dimension of teaching-learning.

A 30-year-old female presented with gradually progressive diminution of vision for 1 month, with night blindness for the past 5 years and difficulty in hearing for the past 10 years. Her developmental history and family history were unremarkable. Ocular examination revealed visual acuity of 6/36 in both eyes. Fundus showed features of retinitis pigmentosa with bilateral macular edema. Audiometry revealed bilateral sensorineural hearing loss; although, her vestibular functions were preserved. Clinical diagnosis of Usher syndrome type 3 was made based on normal hearing at birth, delayed presentation of progressive visual and auditory impairment with normal vestibular function, and developmental milestones. Her macular edema resolved after 3 months of treatment with topical dorzolamide therapy. The unique feature of this case is the presence of bilateral macular edema in type 3 Usher syndrome, which is rarely reported in literature.

Myiasis is the invasion of living animal tissue by fly larvae. Orbital tissue infestation involvement occurs in 5% of all myiasis cases and is potentially destructive. Infection by Chrysomya bezziana is very rare in clinical practice. A 65-year-old woman with history of left eye evisceration presented to the emergency department due to a creeping sensation in the left eye socket and underwent medical and surgical treatment for C. bezziana ophthalmomyiasis. A systematic review was performed to identify ophthalmomyiasis cases caused by C. bezziana published in PubMed and Embase until December 2019. C. bezziana can cause major destruction to both vital and non-vital tissues. It should be treated promptly to prevent extensive damage and life-threatening conditions. This report provides an overview of the epidemiology, causes, risk factors, diagnosis, and treatment options that could assist clinicians in diagnosis and management of this condition.

Acute high-risk pulmonary embolism (PE) is defined as PE with either cardiac arrest, obstructive shock, or persistent hypotension at presentation. The incidence of venous thromboembolism (VTE) is lower following spine surgery compared to joint arthroplasty surgeries. The use of anticoagulants after spine surgery for the prevention of VTE is associated with a definite risk of epidural hematoma resulting in neurologic sequelae. Here, we report a case of a 57-year-old female who presented with cardio-respiratory arrest following spine surgery due to acute high-risk PE. In view of recent spine surgery and traumatic cardiopulmonary resuscitation, which are considered as contraindications for systemic thrombolysis and unavailability of cardiac surgery unit, the patient was treated with pharmaco-mechanical intervention resulting in successful recovery with no development of epidural hematoma or neurologic sequelae. Prophylactic anticoagulation for the prevention of VTE and the risk of epidural hematoma should be balanced after a case of spine surgery.

Aim: To study the intraocular pressure (IOP) and tear production changes in uncomplicated pregnant women at term pregnancy and immediate postpartum. Materials and methods: The patients admitted in the Department of Obstetrics and Gynaecology for delivery were included in the study. A total of 106 participants who were at term uncomplicated pregnancy were selected according to the inclusion and exclusion criteria. They were subjected to type 1 Schirmer's testing and intraocular pressure measurement by Perkin's tonometer before and after delivery. Result: There was no significant pre- and postdelivery IOP difference between the different age groups (

Morning glory disc anomaly (MGDA) is a rare congenital malformation that results from the incomplete formation of the optic nerve in utero. The majority of the patients have unilateral involvement and poor vision leading to sensory strabismus. Morning Glory Syndrome (MGS) may be a part of other syndromes and systemic abnormalities like transsphenoidal basal encephalocele, midfacial malformations, absent optic chiasma, MoyaMoya syndrome, and renal agenesis. In the present report, we describe a patient with a large disc with an excavated posterior scleral opening with a white glial tuft at the centre. The blood vessels were increased in number and arranged radially from the disc with peripapillary hyperpigmentation in clumps. Funnel-shaped excavation of the posterior globe was also noted on MRI. Associated ocular features were microcornea, nystagmus, esotropia, and systemic features included chronic myeloid leukemia- Philadelphia chromosome (CML-PC) and empty sella turcica. We report an unusual association of MGS with CML-PC.

Background: Optic disc oedema (ODE) is an important manifestation in various ocular as well as systemic disorders. Measurement of retinal nerve fibre layer (RNFL) thickness in ODE patients may help in monitoring the progress of the disease and treatment response. Objective: To assess the clinical characteristics, aetiology and retinal nerve fibre layer (RNFL) imaging features of optic disc oedema (ODE) patients. Design: A retrospective observational study. Methods: This hospital-based study included performed for patients presenting with unilateral or bilateral ODE at the ophthalmology outpatient department of a tertiary institute between January 2019 and December 2019. Clinical features of all ODE patients were noted. RNFL thickness was measured by spectral-domain optical coherence tomography (Cirrus 500, Carl Zeiss Meditec, Dublin, CA, USA). Results: Sixty-four patients with ODE were seen with female preponderance (56.2%). The mean age of presentation was 36.8 ± 13.8 years. Bilateral ODE was seen in 57.8% patients. The most common cause of bilateral ODE was idiopathic intracranial hypertension (IIH) and vascular papillopathy. Retinal vein occlusion (RVO)-associated ODE was the most common unilateral presentation. Presenting visual acuity was best with IIH and worst with anterior ischaemic optic neuropathy (AION). The mean duration of symptoms was maximum with intracranial space-occupying lesion associated papilloedema and minimum with AION. The mean RNFL thickness was highest in uveitis-associated ODE, followed by compressive ON, and IIH. A positive correlation was noted between clinical ODE severity and RNFL thickness. All aetiological categories (except uveitic and compressive) had maximum RNFL thickening in the inferior quadrant and minimum in the temporal quadrant. Conclusion: The current study provides a clinical profile and RNFL measurements of ODE patients at this locality. The clinical severity of ODE correlated positively with RNFL thickness and most of the categories of ODE followed the normative pattern of RNFL thickness (inferior > superior > nasal > temporal) despite thickening.

Introduction: Pseudoexfoliation (PEX) is a systemic disease characterised by the accumulation of dandruff-like fluffy deposits of fibrillar granular material. It is the most common cause of secondary open angle glaucoma. Pseudoexfoliation Glaucoma (PXG) is typically associated with rapid visual field loss, greater severity of optic neuropathy and pressure spikes. Aim: To evaluate the clinical characteristics of Pseudoexfoliation Syndrome (PXS) and PXG in the eastern part of Uttar Pradesh. Materials and Methods: This retrospective cross-sectional study was done on a total of 40 patients with 78 eyes, at Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India. The authors reviewed the medical records database to identify all patients aged 35 years or older with PXG or PXS who attended the outpatient clinic between January 1, 2020 and January 31, 2021. Ethical approval was obtained from the Institutional Review Board at Sitapur Eye Hospital, Sitapur. Continuous variables were calculated by MannWhitney U test student’s t-test and qualitative variables using the chi-square test. The p-value

Purpose: To compare the long-term postoperative outcomes of unilateral horizontal muscle strabismus surgery in patients with sensory esotropia and sensory exotropia. Methods: This retrospective study included 30 patients of sensory deviation who underwent strabismus surgery between January 2017 and December 2020 and had 24 months of follow-up. The patients were classified into Group A (sensory esotropia) and Group B (sensory exotropia) of 15 each. The successful outcome was assigned to a patient with postoperative deviation ≤10 prism dioptres (PD) in primary position. Results: The mean age of the sample was 20.87 ± 6.88 years, 18 were male (60%) and 12 were female (40%). The mean preoperative deviation in Group A was 38.8 ± 10.46 PD and in Group B, it was 48.0 ± 5.92 PD. Successful surgical outcome (≤10 PD) at postoperative day 1 was achieved in 29 patients (96.77%). One patient (3.33%) having sensory exotropia was found to have residual deviation >10 PD. These results were maintained at the 6th month and 12th month of follow-up and there was no significant difference between surgical outcomes of both groups (Chi-square test, P = 0.309). At the 24th month follow-up, 23 patients maintained good surgical outcome; all seven patients who had surgically failed outcome (>10 PD) belonged to the exotropia group, which was statistically significant (Chi-square test, P = 0.002). The mean postoperative deviation at the final visit at 24 months of follow-up in Group A was 3.6 ± 2.16 PD and in Group B, it was 10.87 ± 2.82 PD. The long-term outcomes are significantly worse in patients of sensory deviations with organic vision loss and sensory exotropia. Other factors which determined the long-term successful postoperative outcome were best-corrected visual acuity (BCVA), childhood-onset strabismus, and younger age at surgery. Conclusions: Good primary position alignment can be achieved in patients with sensory deviations with single strabismus surgery. Type of deviation, BCVA, age of onset, and age at the time of surgery were the factors associated with successful long-term alignment.

Objective: To determine the prevalence of third molar agenesis and associated characteristics. Material and Methods: A total of 2374 panoramic radiographs were retrieved from the radiological archives and evaluated in a computer monitor under optimum viewing conditions. The basic demographic data (age and sex) and the primary findings regarding the presence or absence of third molars in the maxillary and mandibular arches were recorded systematically in a specially designed proforma. Categorical variables were compared using the Chi-square test. Results: A total of 2000 panoramic radiographs were included in the study, of which 1004 were females (50.2%), and 996 were of males (49.8%). The incidence of third molar agenesis was 486 patients (24.3%). Maxillary third molar showed a higher prevalence of agenesis (28.8%) than mandibular third molars (16.4%). A total of 1514 patients (75.7%) had third molars in all four quadrants, and the remaining 486 patients (24.3%) had agenesis of third molar tooth in at least one of the quadrants. Single tooth agenesis was observed in 219 (11%) patients, two teeth agenesis in 172 (8.6%) patients, three teeth agenesis in 39 (2%) patients, and four teeth agenesis in 56 (2.8%) patients. Conclusion: The present study exhibited a maximum number of single tooth agenesis. It was also observed that maxillary third molar agenesis is more than the mandibular third molar and the right side is more than the left side. Agenesis of the third molar is more prevalent in males as compared to females.

Purpose: The aim of this study was to carry out blue light photography of fluorescein-stained corneas using a novel smartphone attachment. Methods: A smartphone attachment known as the cobalt blue light unit (C-BLU) was developed. It can filter out all wavelengths of light except the blue light emerging from the flashlight of a smartphone. A pilot study was carried out wherein the images captured with the C-BLU system were compared with slit-lamp photographs of the same patients. This setup was then used to photo document fluorescein-stained corneas in various clinical settings assembled at point-of-care. Results: Many pathologies of the fluorescein-stained cornea were captured using the C-BLU filter. It was used effectively in various settings (remote eye camps, intensive care units (ICU), pediatric group, corneal trauma triaging, etc.). C-BLU was assembled and used by optometrists and ophthalmology residents. The images captured were used for documenting, assisting in the treatment, and also for telecommunication of the patients' findings. Conclusion: C-BLU is a low-cost pocket-size filter which is easy to use with a modern smartphone without any technical expertise needed to obtain a clear image of fluorescein-stained pathological corneas.

We report a case of primary angioplasty of right coronary artery (RCA) through right radial artery access in a patient with aberrant right subclavian artery (arteria lusoria) and anomalous origin of RCA. Major challenges in such cases are difficulty in hooking coronary ostia and getting enough support from the guide catheters. However, another challenge confronted in this patient was the anomalous origin of RCA from the left sinus. Herein, we discuss key aspects of management in this scenario. Arteria lusoria with anomalous RCA can be confronted during the transradial intervention. Use of an appropriate guide catheter to facilitate the procedure in this scenario can help interventionists to manage such a situation, and this can be a useful alternative in those patients with unfavorable transfemoral access along with this rare anomaly.

Summary: In yeast mitochondria, transcription initiation requires assembly of mitochondrial RNA polymerase and transcription initiation factor MTF1 at the DNA promoter initiation site. This protocol describes the purification of the component proteins and assembly of partially melted and fully melted initiation complex states. Both states co-exist in equilibrium in the same sample as seen by cryoelectron microscopy (cryo-EM) and allow elucidation of MTF1’s structural roles in controlling the transition into elongation. We further outline how analysis of the complex by light scattering, thermal shift assay, and ultrafiltration assay exhibits reproducible results.For complete details on the use and execution of this protocol, please refer to De Wijngaert et al. (2021).

We report here a rare case of Bardet–Biedl syndrome (BBS). A 7-year-old boy was diagnosed to have BBS based on the clinical features: retinitis pigmentosa sine pigmento, obesity, postaxial polydactyly, syndactyly, and hypogenitalism. It was associated with mild hepatomegaly with deranged liver function test and mild renal involvement radiologically, high-arched palate, and low intelligence quotient. The patient was prescribed proper refractive correction and subjected to multidisciplinary management. BBS has ocular and systemic manifestations, requiring a multidisciplinary approach to treatment.

Background: Globally, ocular morbidities are one of the most underdiagnosed, underreported, and undertreated public health concern. Among estimated 39 billion blind in world, India shares major proportions, with majority of them living in rural population. In India, religious festivals like Kumbh Mela that involve mass gatherings are mainly attended by middle and elderly population who are usually susceptible to various ocular diseases. Therefore, we analyzed the data of our eye camp to document pattern and magnitude of ocular morbidities among pilgrims attending a mega religious festive event. Methods: In a cross-sectional, descriptive study, we included all those patients who participated in a mega eye camp “Netrakumbh” from January to March 2019 at Kumbh Mela, Prayagraj, India and were attended by voluntary ophthalmologist from All India Institute of Medical Sciences, Rishikesh. Presenting chief complaints and detailed history were collected from all participants. All patients underwent comprehensive eye examination including visual acuity, slit lamp biomicroscopic examination, tonometry, etc., Data were compiled and analyzed utilizing SPSS 22.0. Results: A total of 47142 eyes of 23571 persons of all age groups (range 5 years to 70 years) with approximate equal gender distribution attending the mega eye camp were examined. The most common ocular morbidity noticed after ocular examination was refractive error with underlying cause majorly as presbyopia, followed by cataract, after cataract, convergence insufficiency, lids, and adnexal disease, etc. Conclusions: This study highlights the changing pattern of common ocular morbidities presently among middle and elderly populations in developing countries like India.

Abstract Background Accurate prediction of crop flowering time is required for reaching maximal farm efficiency. Several models developed to accomplish this goal are based on deep knowledge of plant phenology, requiring large investment for every individual crop or new variety. Mathematical modeling can be used to make better use of more shallow data and to extract information from it with higher efficiency. Cultivars of chickpea, Cicer arietanum, are currently being improved by introgressing wild C. reticulatum biodiversity with very different flowering time requirements. More understanding is required for how flowering time will depend on environmental conditions in these cultivars developed by introgression of wild alleles. Results We built a novel model for flowering time of wild chickpeas collected at 21 different sites in Turkey and grown in 4 distinct environmental conditions over several different years and seasons. We propose a general approach, in which the analytic forms of dependence of flowering time on climatic parameters, their regression coefficients, and a set of predictors are inferred automatically by stochastic minimization of the deviation of the model output from data. By using a combination of Grammatical Evolution and Differential Evolution Entirely Parallel method, we have identified a model that reflects the influence of effects of day length, temperature, humidity and precipitation and has a coefficient of determination of R 2=0.97. Conclusions We used our model to test two important hypotheses. We propose that chickpea phenology may be strongly predicted by accession geographic origin, as well as local environmental conditions at the site of growth. Indeed, the site of origin-by-growth environment interaction accounts for about 14.7% of variation in time period from sowing to flowering. Secondly, as the adaptation to specific environments is blueprinted in genomes, the effects of genes on flowering time may be conditioned on environmental factors. Genotype-by-environment interaction accounts for about 17.2% of overall variation in flowering time. We also identified several genomic markers associated with different reactions to climatic factor changes. Our methodology is general and can be further applied to extend existing crop models, especially when phenological information is limited.

Congenital absence of extraocular muscle is rare. The most common extraocular muscle found to be congenitally absent is superior oblique followed by inferior rectus. Patients with absent inferior rectus muscle can present with abnormal head posture and incomitant hypertropia with limitation of ocular motility in the field of action of the inferior rectus with or without torticollis. Microphthalmos, microcornea, coloboma, and Axenfeld–Rieger syndrome are known to be commonly associated with inferior rectus muscle aplasia. Orbital computed tomography (CT) or magnetic resonance imaging before surgery is useful for confirmation of the diagnosis and plan of management. We report satisfactory surgical outcome of anterior transposition of inferior oblique in a case of inferior rectus aplasia with iris coloboma, microcornea, and anomalous insertion of inferior oblique. The patient had right hypertropia in primary position which increased on levoversion and left tilt. Preoperative orbital CT revealed congenital absence of inferior oblique. Peroperatively, congenital absence of inferior rectus was confirmed, and inferior oblique was found to be hyperplastic and abnormally inserted to the sclera. Anterior transposition of inferior oblique was done with satisfactory outcome.

Waardenburg syndrome (WS) is a rare congenital disorder primarily characterized by characteristic facial abnormalities as dystopia canthorum and synophrys; depigmentation of the hair, skin (premature graying of hair), and/or the iris of both eyes; and/or congenital deafness. Here, we report a rare case of WS with associated dry eyes. A 4-year-old female presented with blue eyes and no tear and nasal secretion production since birth. She was also deaf and dumb since birth. On examination, it was recognized as an atypical case of WS type 2 clinically, with several classical features such as white forelock, bilateral blue iris, hypopigmented fundus, smooth philtrum, bilateral profound hearing loss, and a rare association of bilateral dry eyes. The patient was given proper refractive correction, treatment of her dry eyes, and subjected to multidisciplinary approach as for the management of sensorineural hearing loss. It was a case of WS type 2 with a rare association of bilateral dry eyes.

The coronary angiographic (CAG) findings of ST elevation myocardial infarction (STEMI) in patients of coronavirus disease 2019 (COVID-19) range from increased coronary artery thrombus burden to normal coronaries due to STEMI mimics. Here we report the case of a 45-year-old gentleman who presented with evolved inferior wall myocardial infarction with ongoing angina along with mild COVID-19. CAG showed normal epicardial coronaries except for distal right posterior descending coronary artery (RPDA) 100% occlusion on careful examination. He was treated for the myocardial infarction with medical management along with treatment of COVID-19. The importance of our case is to highlight the possibility of distal total occlusion of small coronary branches which may be missed if not carefully looked for as a normal CAG in COVID-19 patient will require only supportive therapy, while the finding of distal 100% occlusion of RPDA deemed us to prescribe optimal medical therapy as per acute myocardial infarction protocol along with treatment for COVID-19.

Wheat is the third most harvested and consumed grain in the world. However, a large part of wheat crop becomes spoiled due to diseases. There are over two dozen of wheat diseases that are harmful to the crops. Therefore, the manual diagnosis of these diseases becomes very challenging. Automatic wheat disease classification can be helpful in improving the quantity and quality of the crop yield. Further, it can be a useful mechanism for crop quality assessment, and pricing. Deep learning based image analysis has applications in disease diagnosis and classification. The spike and leaves are the most affected parts of a wheat plant. Majority of diseases can be recognized by the characteristics of these parts. The paper presents a novel wheat disease classification method. A new deep learning model is trained to accurately classify wheat diseases in 10 classes. The proposed method has a high testing accuracy of 97.88%. Furthermore, it gives an improvement of 7.01% and 15.92% for the accuracy metric over the other two popular deep learning models – VGG16 and RESNET50, respectively. Experimental results establish that the proposed method performs better on other parameters such as precision, recall, and f-score.

Mandibular parasymphysis fracture is very commonly observed especially in old age when there is resorptions of the alveolar ridges. In cervical dystonia, there is centrally mediated disease in which there is uncontrolled and spasmodic contraction of the facial and the masticatory muscles. Due to the application of this sudden and uncontrolled force, there is a tendency of the bone to unfavourably remodel and weaken. The case presented here is of a geriatric patient who presented to us with a fracture at the right parasymphysis and left dentoalveolar region of the mandible and was suffering from cervical dystonia. Management of this case posed a challenge in every step, and it needed a resurgery where the fracture was managed by the placement of reconstruction plate. Not many cases in the literature have been reported where dystonic movements have resulted in the fracture of the mandible.

Background. The presence of opioid receptors around the peripheral nerves offers the possibility of providing postoperative analgesia, thereby encouraging the study of the effect of opioids in combination with local anesthesia (LA). Studies have also reported the efficacy of peripherally administered opioids in achieving adequate analgesia in regions with inflammation. Applying the concept of peripheral opioid receptors, our study aimed to evaluate the effectiveness of opioid analgesia in managing postoperative pain. The split-mouth study was carried out to evaluate the efficacy of buprenorphine added to lidocaine 2% in providing postoperative analgesia after the surgical extraction of the impacted mandibular third molar. Materials and Methods. We conducted a randomized, double-blinded, split-mouth trial among 21 patients with impacted mandibular third molars bilaterally. In all patients, bilateral impacted mandibular third molars were extracted at different periods. The primary outcomes assessed were postoperative analgesia by the VAS score and the number of rescue analgesics consumed by patients at 24, 48, and 72 hours of interval via a questionnaire. Results. There was a statistical significant difference in postoperative analgesia duration at 24 (P = 0.012) and 48 hours (P = 0.024), respectively, between the test and control group. Even though the mean number of rescue analgesics consumed by the test group was less than that of the control group, no significant difference was seen. Conclusion. Buprenorphine added to lidocaine 2% showed a minimal decrease in the pain score and duration of postoperative analgesia with no difference in the frequency of rescue analgesics consumed between the test and control.