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Background: The outbreak of coronavirus disease 2019 (COVID-19) pandemic is currently an international public health crisis. The Indian government had announced the suspension of colleges indefinitely across India. Students of medical colleges are facing distress due to the abrupt disruption of academic routine. Objectives: The study aimed to assess the prevalence and correlates of stress, anxiety, and depression among undergraduate medical students of a medical college of North India during COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted among medical students of a medical college in North India. Data were collected via a prevalidated, semi-structured questionnaire consisting of sociodemographic and behavioral questions and three standard psychometric scales, i.e., Perceived Stress Scale, Coronavirus Anxiety Scale, and Major Depression Inventory Scale for assessing stress, anxiety, and depression, respectively. Data were analyzed using the Statistical Package for the Social Sciences (version 27.0; SPSS Inc., Chicago, IL, USA). Results: We reported that majority of students (86.5%) have increased social media usage. The level of stress is moderate (72.5%) to high (19%), and depression is also reported in many students from moderate (11%) to severe (17.8%) levels. A small proportion of students showed anxiety though anxiety scores are significantly higher for males than females and for 1st- and 2nd-year subjects than final-year subjects. More than 60% of students are physically active who also showed a low level of stress, depression, and anxiety than sedentary subjects. Conclusion: Our results show that stress, anxiety, and depression were high in medical students during lockdown. Increased food intake and social media usage were risk factors for developing stress, anxiety, and depression. Physical activity has a positive impact on mental health of the students.

Background Several non-invasive technologies are nowadays available in the market which claim to determine the hemoglobin levels instantly without the requirement of the blood sample. But no study has shown the significance of such non-invasive devices on a routine basis for determining their impact on anemia reduction programs. This study is conducted to determine the impact of regular hemoglobin screening on the women population to determine its potential in reducing anemia, using a digitalized non-invasive device.Method A cross-sectional study was conducted on 203 women of reproductive age group, residing in the Moradabad district. Repetitive readings were taken after a time interval of a minimum of 1 month for determining the impact of regular screening. The entire data collection process was carried out using the EzeCheck mobile app.Results It was observed that the prevalence of anemia was reduced upon the second time screening and was accepted by the women population. Repetitive testing has a significant impact on reducing anemia prevalence. Also, the simplified non-invasive technology for estimating the hemoglobin values, makes the user more comfortable to take the test.Conclusion Non-invasive devices should be used regularly to keep track of hemoglobin levels which will help in the effective treatment of anemia. The mobile app-based testing could help to easily evaluate the reports of the patients from any remote location with instant result interpretation and health assistance.

Anaemia is a major public health problem, especially in resource constrained settings. Dependency on assessment of blood hemoglobin (Hgb) concentration impedes anemia detection, risk stratification and intervention. Thus, valid, frugal and scalable technologies are needed. EzeCheck is a noninvasive portable device developed in India for predicting hemoglobin levels in human beings aged 4 years and above using a finger-tip biosensor. In this assessment, we aimed to: (i) evaluate EzeCheck's performance with an automated whole blood hemato-analyzer (Sysmex XN 1000) as the gold standard, and (ii) estimate EzeCheck's agreement with Sahli's method and HemoCue (Hb-301) in real-world primary and higher care facilities. Paired assessments were done at five sites across India i.e., Bhubaneshwar, Shimla, Solan and Mashobra and Ulhasnagar. Participants across all age groups (4 years and above) were assessed. We used a range of statistical tests to evaluate the performance of EzeCheck. It was found that EzeCheck performed well across age and gender categories with convincing validity, concordance, precision and accuracy, and acceptable bias. While comparing EzeCheck with Hemato-analyzer, no statistically significant systematic bias was found. However, EzeCheck showed significant systematic bias when compared to Sahli's method and HemoCue. We concluded that EzeCheck could detect anemia (as per WHO Hgb cut-offs) in 'real-world settings' and 'across age and gender categories', with high sensitivity, specificity and accuracy, and can serve as a replacement to traditional methods of hemoglobin assessment. Further, for countries with higher prevalence of anemia where universal screening may be mandated, the positive predictive value of EzeCheck will be higher. The likelihood ratios also indicated that the device had moderate-to-good utility. EzeCheck is suitable for embedment into program and out-patient health care settings in resource constrained contexts as a spot-check hemoglobinometer.

Epilepsy, a common neurological disorder characterised by recurrent seizures, can manifest in unusual clinical presentations such as abdominal pain, nausea, vomiting, and bloating associated with diverse Central Nervous System (CNS) symptoms like confusion, fatigue, headache, dizziness, and syncope. The importance of recognising and documenting such unusual presentations lies in their potential to be misdiagnosed or overlooked, delaying appropriate treatment and causing undue distress to both the patients and their families. In the present case series, patients presented with gastrointestinal or chest pain for a prolonged period. As the symptoms did not subside with treatment, an Electroencephalogram (EEG) was performed to rule out epilepsy. In all three cases (10-year and 10-month-old female, 11-year-old male, seven-year-old male), EEG revealed a generalised seizure disorder. The present case series highlights unusual presentations of epilepsy in paediatric patients, including Abdominal Epilepsy (AE) and epileptic angina. These cases underscore the importance of considering epilepsy as a potential aetiology in patients with recurrent and atypical symptoms.

Aim: The present research was carried out to evaluate the amount of usage of dental care opportunities and also to assess the problems faced by health care workers (HCWs) of a south Indian district in using dental services. Methodology: This study had around 500 participants who belonged from various health care sectors who were selected with the help of multistage sampling. The data obtained from this cross-sectional research was analysed statistically using SPSS 22.0. Results: It was noticed that around 35% of participants went for a dentist's appointment in past 1 year where male members predominated (45%). One of the commonest reasons for utilizing dental care services was pain as an dental emergency factor (70%). Other reasons were dental caries (18%) restoration, breakage of tooth (10%) and a host of other factors (11%). Around 350 participants felt that going to the dentist was only necessary when there was an emergency (61%). Conclusion: The target population less frequently visited the dentist to maintain their teeth as they believed when you have pain, that is the time you go to a dental specialist.

Advent of pediatric handheld fundus cameras like RetCam, 3netra Forus, and Phoenix ICON pediatric retinal camera has aided in effective screening of retinopathy of prematurity (ROP), especially in countries with limited number of trained specialists. Recent advent of various smartphone-based cameras has made pediatric fundus photography furthermore affordable and portable. Future advances like ultra-wide field fundus cameras, trans-pars-planar illumination pediatric fundus camera, artificial intelligence, deep learning algorithm, and handheld SS-OCTA can help in more accurate imaging and documentation. This article summarizes the features of existing and upcoming imaging modalities in detail, including their features, advantages, challenges, and effectiveness, which can help in implementation of telescreening as a standard screening protocol for ROP across developing as well as developed countries.

Psoriasis is a multisystem disorder with a significant impact on the quality of life (QoL) of the patient. QoL in psoriasis is influenced by epidemiological factors, the type and extent of the disease, and underlying comorbidities. Various tools have been developed to assess the QoL in patients with psoriasis, namely psoriasis specific, skin specific, generic QoL, and mixed measures. In this review, we present a concise overview of the different indices and the pros and cons of various tools to assess the impact of psoriasis on patients.

Physicians have to play the role of a team leader and counselor and take written informed consent for high-risk surgeries in many cases. This is the first step toward initiating a mutually trustworthy relationship with the patient and family. The situation is more sensitive when vulnerable patients like small premature babies or the elderly are under consideration. In the event of a death, leadership and processes in place become extremely critical. We share our experience and practice pattern during this process, especially suited to India, but the broad principles would apply to most human situations. Hopefully, some of these can be incorporated into the existing training curriculum for team building and the art of effective physician-patient communication that should be intricately woven into the curriculum for the Science of Ophthalmic care.

Purpose: To evaluate the causes of jet stream injury (JSI)-related iatrogenic retinal breaks (IRBs) during vitreoretinal surgery (VRS). Methods: The precise surgical environment, which includes the indication and type of surgical procedure, retina status, details of instrumentation and fluidic parameters, and characteristics of the jet responsible for the IRB, was noted from case records. The nature of IRB and its healing and impact on anatomical and visual outcomes were analyzed. Results: Five eyes of five patients with complete documentation of both the JSI and the IRB were included. Two cases were operated for macular hole, and one each for vitreous hemorrhage, retinal detachment, and endophthalmitis. One case had infusion-fluid-related JSI, while four developed it because of injection of surgical adjuncts (drugs, PFCL, and dye). JSI developed in two cases when the vitreous cavity was filled with fluid, while it was air-filled in three cases. In four cases, the fluid migrated into subretinal space, necessitating further maneuvers following which the breaks healed, but were directly responsible for vision loss in two cases. Conclusion: JSI related IRBs are rare but may be directly responsible for vision loss if they impact the macula. The balance between jet stream velocity, its distance from the retinal surface, the intervening media (vitreous cavity), and retinal health play an important role. It can occur because of both infusion as well as injection jets. Precautions must be taken in cases vulnerable to complications with suggested modifications in the surgical technique.

The current technique for implanting flanged intraocular lens (IOL) suffers from complications like haptic exposure and tilting of the implanted IOL. We describe a modification of the currently described technique to obviate its shortcomings. Five eyes of five patients with a minimum of 1 year of follow-up were included. In this technique, two scleral pockets were made nasal and temporal to embed the flanged haptics. The primary outcome measure was the improvement in visual acuity (VA) postoperatively and the secondary outcome measures were postoperative complications. The primary objective of this current modification is to simplify the surgical technique for secondary IOL implantation and make it more replicable and predictive. The mean age of the patients was 19.44 years. The mean preoperative VA was 0.44 logMAR which improved to 0.26 logMAR at the 6-week postoperative visit. The mean follow-up was 496+/− 80 days. The maximum follow-up was 647 days. There were no postoperative complications such as haptic exposure, hypotony, or IOL tilt in any cases. The new E-flanged IOL technique has good visual outcomes and does not have postoperative complications. It has less intraoperative manipulation and complications.

Purpose: To describe the clinical presentation and demographic distribution of retinitis pigmentosa (RP) in patients with Usher syndrome (USH). Methods: This is a cross-sectional observational hospital-based study including patients presenting between March 2012 and October 2020. In total, 401 patients with a clinical diagnosis of USH and RP in at least one eye were included as cases. The data were retrieved from the electronic medical record database. For better analysis, all 401 patients were reclassified into three subtypes (type 1, type 2, and type 3) based on the USH criteria. Results: In total, there were 401 patients with USH and RP, with a hospital-based prevalence rate of 0.02% or 2/10,000 population. Further, 353/401 patients were subclassified, with 121 patients in type 1, 146 patients in type 2, and 86 patients in the type 3 USH group. The median age at presentation was 27 years (IQR: 17.5–38) years. There were 246 (61.35%) males and 155 (38.65%) females. Males were more commonly affected in all three subtypes. Defective night vision was the predominant presenting feature in all types of USH (type 1: 43 (35.54%), type 2: 68 (46.58%), and type 3: 40 (46.51%) followed by defective peripheral vision. Patients with type 2 USH had more eyes with severe visual impairment. Conclusion: RP in USH is commonly bilateral and predominantly affects males in all subtypes. Patients with USH and RP will have more affection of peripheral vision than central vision. The key message of our study is early visual and hearing rehabilitation in USH patients with prompt referral to otolaryngologists from ophthalmologists and vice versa.

Purpose: To analyze the impact of a revised care plan for retinopathy of prematurity (ROP) during SARS-CoV-2 pandemic in a tertiary eye care facility in eastern India. Methods: In a retrospective study, we analyzed the medical records of babies managed for ROP during the peak of the SARS-CoV-2 pandemic, with particular reference to the challenges, and the revised strategies addressing travel restrictions for five months, from April to August 2020. The strategy included selective referral (babies with higher treatment probability), longer follow-up intervals (babies with non-alarming findings), use of locally available workforce, and teleconsultation whenever feasible. Results: In the given period, 222 babies were examined versus 624 in the preceding year (P = 0.001). The average gestational age, birth weight, and postmenstrual age at presentation were 30.4 weeks, 1.31 kg, and 37.7 weeks, respectively. The first examination was on time in 40.1% of babies but was delayed by a median of 23 days in the remaining babies. In the cohort, 56.7% of babies had any ROP, and 27.9% required treatment (versus 8.8% in the previous year; P < 0.001). The intravitreal anti–vascular growth factor (anti-VEGF) injection was more often used than in the previous year (n = 72 vs 36; P < 0.0001). The treatment outcome was comparable before and after the SARS-CoV-2 lockdown period. There was no report of health issues among the care providers attributable to ROP care. Conclusion: The revised strategy resulted in a smaller pool of babies screened but a larger proportion of babies treated for ROP. This strategy could be used more profitably in future ROP care.

Purpose: To describe the clinical presentation and demographic distribution of retinitis pigmentosa (RP) in Laurence–Moon–Bardet–Biedl (LMBB) syndrome patients. Methods: This is a cross-sectional observational hospital-based study wherein 244 patients with RP in LMBB syndrome presenting to our hospital network between March 2012 and October 2020 were included. An electronic medical record database was used for data retrieval. Results: There were 244 patients in total, with a hospital-based prevalence rate of 0.010% or 1000/100,000 population. The mean and median age of patients was 15.22 ± 7.56 and 14 (IQR: 10–18.5) years, respectively, with the majority being in the age group of 11–20 years (133/244 patients; 54.50%). Males were more commonly affected (164 patients; 67.21%), and the majority (182 patients; 74.59%) were students. All 244 patients (100%) complained of defective central vision at presentation. More than one-fourth of the patients had severe visual impairment to blindness at presentation. Prominent retinal feature at presentation was diffuse or widespread retinal pigment epithelial degeneration in all patients. Conclusion: Patients with RP in LMBB syndrome present mainly in the first to second decade of life with severe visual acuity impairment to blindness early in life. It is important to rule out LMBB syndrome in early-onset RP with central visual acuity impairment. On the contrary, all patients diagnosed or suspected with LMBB syndrome systemic features at physician clinic should also be referred for ophthalmic evaluation, low vision assessment, rehabilitation, and vice versa.

Purpose: To describe the clinical profile and treatment outcomes of infants with retinopathy of prematurity (ROP) presenting with isolated exudative retinal detachment (ERD). Methods: Retrospective interventional case series. Preterm infants diagnosed with ROP with ERD at presentation were included. All demographic details, clinical findings, and treatment given were documented. The anatomical outcome was categorized as good, fair, and poor. Refractive outcome was classified into mild, moderate, and severe according to spherical equivalent at the last visit. Results: Fifteen eyes (8 patients) were included. Mean gestational age was 31.3 weeks, and birth weight was 1462.6 g. All eyes presented with aggressive ROP. Patches of retinal edema in avascular retina were seen in all eyes. A total of 86.6% of eyes had vascular sclerosis while 86.6% of eyes had subretinal exudates. The anatomical outcome was good in all eyes. In addition, 40% of eyes had a mild refractive error. Conclusion: Exudative retinal detachment in ROP is rare. The use of unregulated oxygen can be a contributory factor. Vascular sclerosis is consistent with hyperoxia-induced retinopathy models. Retinal edema and subretinal exudates indicate disrupted inner and outer blood-retinal barrier. Treatment outcomes are good when diagnosed and treated in time.

Purpose: To evaluate patterns of pediatric vitelliform macular dystrophy (PVMD). Methods: This is a retrospective analysis of Indian children with vitelliform macular dystrophy (VMD) presenting within the first decade of life. Records were evaluated for clinical findings, family screening, and investigative findings including optical coherence tomography (OCT), fundus autofluorescence (FAF), full-field electroretinogram (ERG) and electrooculogram (EOG). Electrophysiology was scrutinized and audited for acquisition and interpretation errors. Findings on follow-up were also recorded. Results: 46 eyes of 24 patients were included. Mean age at presentation was 7.17 ± 2.17 years. Mean follow-up duration was 1.55 ± 1.69 years. Best disease was the commonest type of VMD detected (21 patients), while autosomal recessive bestrophinopathy was seen in three cases. Mean logMAR BCVA was 0.364 which decreased to 0.402 on follow-up. Hyperopia was noted in 29 out of 46 eyes (mean being +3.87 D, range ebing +0.75 to +8.75 D). Four eyes of four children had choroidal neovascular membrane at presentation, while another child developed while in follow-up. Solid type subretinal deposit was the commonest OCT finding (n = 29/38) and central hyper FAF was the commonest pattern (n = 18/32). EOG was available for review in 32 eyes, but was unreliable in 11 eyes. Seven eyes demonstrated complete absence of light rise on EOG. Conclusion: PVMD can present in advanced forms. Progression to complications with loss of visual acuity can happen within the first decade of life. EOG shows grossly suppressed waveforms in the light phase in a large number of such children.

Abstract Inflammation plays a key role in the pathogenesis of retinal vascular diseases. We have shown earlier an increase in the activity of matrix metalloproteinases in the vitreous and tears of preterm born babies with retinopathy of prematurity (ROP) compared to those with no-ROP leading to a shift in the balance of angiogenic (vascular endothelial growth factor [VEGF], matrix metalloproteinase [MMPs], complement component [C3]) and anti-angiogenic (opticin, thrombospondin) in ROP eyes. We now confirmed that tear MMP levels in premature infants perfectly correlates with disease severity. Next, we demonstrated that a reduced opticin levels in ROP vitreous are regulated by MMPs secreted by activated microglia. Upon exposing the human microglia cell line (CHME3) to hypoxia, an increased expression of inflammatory proteins (MMP9, VEGF) was noticed while opticin reduced significantly (p = 0.005). Further, the reduced opticin’s expression by microglial cells under hypoxia could be rescued by inhibiting the MMP activity using doxycycline and EDTA. The inhibition of MMP activity altered the expression of other key signaling molecules under hypoxia. Our study clearly explains that increased activity of MMPs under hypoxia regulates the expression of opticin as seen in the vitreous humor of ROP and could serve as a potential target for ROP management.

Background: Pigmented contact dermatitis (PCD) is a non-eczematoid variant of contact dermatitis, mainly characterised by hyperpigmentation. It occurs due to contact with a low amount of allergen over a long duration of time. PCD is frequently seen in Indians but is often misdiagnosed or underdiagnosed because of the asymptomatic nature of the entity. The aetiology and the allergens implicated in PCD in the Indian subcontinent is still an enigma because of the limited studies done. Materials and Methods: This was an institution-based cross-sectional study, done at a tertiary hospital. Patch testing with Indian Cosmetic Series was conducted in a standardised method. Readings were taken at 48 hrs/72 hrs and on the 7th day [Figure 2]a and [Figure 2]b. The International Contact Dermatitis Research Group (ICDRG) scoring system was used to grade the readings. Results: Out of the 38 biopsy proven cases of PCD, 18 (47%) showed lichenoid features, 17 (45%) showed spongiotic features, 3 (8%) showed a mixed lichenoid and spongiotic pattern. Among total 1216 (32 patches × 38 patients) patch applied, 42 (3.4%) showed positivity in 30 patients. Among allergen categories, colorant (PPD) was found to be most common (37%) followed by fragrances (18%), preservatives (15%), anti-microbial (11%) and emulsifier and anti-oxidants (each 8%). Conclusion: It is important to identify the allergens implicated in PCD to help in better management of the condition. Patch testing proves to be a non invasive, low cost method and its role is indispensable in identifying the correct allergen.

Recent decade has seen a shift in the causes of childhood blinding diseases from anterior segment to retinal disease in both developed and developing countries. The common retinal disorders are retinopathy of prematurity and vitreoretinal infections in neonates, congenital anomalies in infants, and vascular retinopathies including type 1 diabetes, tumors, and inherited retinal diseases in children (up to 12 years). Retinal imaging helps in diagnosis, management, follow up and prognostication in all these disorders. These imaging modalities include fundus photography, fluorescein angiography, ultrasonography, retinal vascular and structural studies, and electrodiagnosis. Over the decades there has been tremendous advances both in design (compact, multifunctional, tele-consult capable) and technology (wide- and ultra-wide field and noninvasive retinal angiography). These new advances have application in most of the pediatric retinal diseases though at most times the designs of new devices have remained confined to use in adults. Poor patient cooperation and insufficient attention span in children demand careful crafting of the devices. The newer attempts of hand-held retinal diagnostic devices are welcome additions in this direction. While much has been done, there is still much to do in the coming years. One of the compelling and immediate needs is the pediatric version of optical coherence tomography angiography. These needs and demands would increase many folds in future. A sound policy could be the simultaneous development of adult and pediatric version of all ophthalmic diagnostic devices, coupled with capacity building of trained medical personnel.

Four-dimensional (4D) printing of shape memory polymer (SMP) imparts time responsive properties to 3D structures. Here, the authors explore 4D printing of a SMP in the submicron length scale, extending its applications to nanophononics.

Purpose: Intraocular infection in patients with COVID-19 could be different in the presence of treatment with systemic corticosteroid and immunosuppressive agents. We describe the epidemiology and microbiological profile of intraocular infection in COVID-19 patients after their release from the hospital. Methods: We analyzed the clinical and microbiological data of laboratory-confirmed COVID-19 patients from April 2020 to January 2021 presenting with features of endogenous endophthalmitis within 12 weeks of their discharge from the hospital in two neighboring states in South India. The data included demography, systemic comorbidities, COVID-19 treatment details, time interval to visual symptoms, the microbiology of systemic and ocular findings, ophthalmic management, and outcomes. Results: The mean age of 24 patients (33 eyes) was 53.6 ± 13.5 (range: 5–72) years; 17 (70.83%) patients were male. Twenty-two (91.6%) patients had systemic comorbidities, and the median period of hospitalization for COVID-19 treatment was 14.5 ± 0.7 (range: 7–63) days. Infection was bilateral in nine patients. COVID-19 treatment included broad-spectrum systemic antibiotics (all), antiviral drugs (22, 91.66% of patients), systemic corticosteroid (21, 87.5% of patients), supplemental oxygen (18, 75% of patients), low molecular weight heparin (17, 70.8% of patients), admission in intensive care units (16, 66.6% of patients), and interleukin-6 inhibitor (tocilizumab) (14, 58.3% of patients). Five (20.8%) patients died of COVID-19-related complications during treatment for endophthalmitis; one eye progressed to pan ophthalmitis and orbital cellulitis; eight eyes regained vision >20/400. Fourteen of 19 (73.7%) vitreous biopsies were microbiologically positive (culture, PCR, and microscopy), and the majority (11 patients, 78.5%) were fungi. Conclusion: Intraocular infection in COVID-19 patients is predominantly caused by fungi. We suggest a routine eye examination be included as a standard of care of COVID-19.

Hand dermatitis (HD) is a chronic, relapsing, and remitting inflammatory condition that adversely affects the quality of life of the individual and gravely impacts the mental and socioeconomic well-being by causing professional hindrance and often leading to loss of wages. Despite being one of the most common skin conditions seen by dermatologists, it is often underreported. With the coronavirus pandemic ongoing, there is an emphasis on hand hygiene—being a widely publicized and important preventive measure to control the spread of the Coronavirus disease (COVID-19) virus. Emphasis on hand hygiene has led to a surge in HD, and the presence of HD, in turn, leads to compromised hand hygiene practices and this breach in the skin barrier contributes to another portal of entry of infective agents. We undertook a comprehensive English literature search across multiple databases such as PubMed, SCOPUS, EMBASE, MEDLINE, and Cochrane using keywords and MeSH items to obtain and review several relevant articles. Thus, this review focuses on various clinical, diagnostic as well as therapeutic aspects of this much prevalent and debilitating skin condition which deserves more attention especially during the times of the COVID-19 pandemic where the utmost emphasis is being given to handwashing leading to a vicious cycle of a surge in the cases of HD and compromised skin barrier causing increased susceptibility to the COVID-19 infection.

When silicon solar cells are used in the novel lightweight photovoltaic (PV) modules using a sandwich design with polycarbonate sheets on both the front and back sides of the cells, they are much more prone to impact loading, which may be prevalent in four-season countries during wintertime. Yet, the lightweight PV modules have recently become an increasingly important development, especially for certain segments of the renewable energy markets all over the world—such as exhibition halls, factories, supermarkets, farms, etc.—including in countries with harsh hailstorms during winter. Even in the standard PV module design using glass as the front sheet, the silicon cells inside remain fragile and may be prone to impact loading. This impact loading has been widely known to lead to cracks in the silicon solar cells that over an extended period of time may significantly degrade performance (output power). In our group’s previous work, a 3D helicoidally architected fiber-based polymer composite (enabled by an electrospinning-based additive manufacturing methodology) was found to exhibit excellent impact resistance—absorbing much of the energy from the impact load—such that the silicon solar cells encapsulated on both sides by this material breaks only at significantly higher impact load/energy, compared to when a standard, commercial PV encapsulant material was used. In the present study, we aim to use numerical simulation and modeling to enhance our understanding of the stress distribution and evolution during impact loading on such helicoidally arranged fiber-based composite materials, and thus the damage evolution and mechanisms. This could further aid the implementation of the lightweight PV technology for the unique market needs, especially in countries with extreme winter seasons.

Purpose: Retinopathy of prematurity (ROP) is now emerging as one of the major causes of preventable childhood blindness. The proportion of preterm babies has increased dramatically over the past decade. Our study aims to emphasize the need for ROP screening and management services in these preterm infants. Methods: ICD-coded medical records of children less than 10 years of age presenting to a subspecialty eye hospital from 2000 to 2017 were reviewed. ROP, congenital cataract, congenital glaucoma, and vitamin A deficiency were the most common diagnoses. We evaluated the trend of these diseases from 2000 to 2017. Results: Our data suggested a 20-fold increase in the attendance of children with a diagnosis of ROP who now make over 2% of outpatient children. Vitamin A deficiency has declined over time whereas cataract and glaucoma have remained stable. Conclusion: Our data indicate a need to scale up ROP screening integrated with neonatal care, as well as to build capacity for the treatment of acute and late-stage ROP in India.

Lightweight photovoltaics (PV) modules are important for certain segments of the renewable energy markets—such as exhibition halls, factories, supermarkets, farms, etc. However, lightweight silicon-based PV modules have their own set of technical challenges or concerns. One of them, which is the subject of this paper, is the lack of impact resistance, especially against hailstorms in deep winter in countries with four seasons. Even if the front sheet can be made sufficiently strong and impact-resistant, the silicon cells inside remain fragile and very prone to impact loading. This leads to cracks that significantly degrade performance (output power) over time. A 3D helicoidally architected fiber-based polymer composite has recently been found to exhibit excellent impact resistance, inspired by the multi-hierarchical internal structures of the mantis shrimp’s dactyl clubs. In previous work, our group demonstrated that via electrospinning-based additive manufacturing methodologies, weak polymer material constituents could be made to exhibit significantly improved toughness and impact properties. In this study, we demonstrate the use of 3D architected fiber-based polymer composites to protect the silicon solar cells by absorbing impact energy. The absorbed energy is equivalent to the energy that would impact the solar cells during hailstorms. We have shown that silicon cells placed under such 3D architected polymer layers break at substantially higher impact load/energy (compared to those placed under standard PV encapsulation polymer material). This could lead to the development of novel PV encapsulant materials for the next generation of lightweight PV modules and technology with excellent impact resistance.

Introduction: Rituximab is slowly getting recognized as a promising steroid-sparing agent in the treatment of moderate to severe cases of pemphigus vulgaris (PV). We evaluated and compared the effectiveness, safety, and cost of therapy of rituximab versus dexamethasone cyclophosphamide pulse (DCP) in Indian patients with PV. Materials and Methods: It is a retrospective data analysis, from the Immunobullous disease clinic in a tertiary centre of eastern India, of management of PV. In our institute we use either rituximab or DCP for the management of moderate to severe cases of PV, depending on that we retrospectively divided the treated cases of PV in two groups. Patients who were treated with rheumatoid arthritis (RA) protocol of rituximab were considered to be group 1. Patients who were treated with DCP were included in group 2. Response was assessed by pemphigus area, and activity score (PAAS), Dermatology life quality index (DLQI); photographic documentation, and blood parameters were monitored. Results: Both groups showed significant improvement in PAAS and DLQI, the improvement was faster and well sustained in the rituximab group. In terms of safety and development of new vesicles, rituximab had a better profile with only 1 patient having adverse effects and none with new vesicles as compared to DCP (3 had adverse effects and 2 developed new vesicles). Conclusions: Rituximab offers the advantage of early and prolonged remission, lesser adverse effects, better effectiveness, less risk of relapses, faster improvement of PAAS, and DLQI. Though rituximab is an expensive drug, but on evaluating the cost of whole therapy, it was seen that rituximab infusions are actually cheaper compared to DCP pulse. We suggest, rituximab can be used as the first-line of therapy for pemphigus vulgaris in the Indian context.

Background: Acne vulgaris is a chronic inflammatory disease primarily affecting the adolescents, with a profound impact on their quality of life. There is conflicting data regarding its association with metabolic syndrome. Objective: To assess the prevalence of metabolic syndrome (MetS) and obesity in patients with acne vulgaris, and determine its impact on the patient's quality of life. Methods: We conducted a cross-sectional, case-control study involving 50 patients with acne vulgaris (cases) and 50 age and sex-matched controls without acne. Acne vulgaris was graded according to clinical severity using the GAGS scale. NCEP-ATP III criteria and modified classification of body mass index (BMI) for Asian Indians were used to diagnose MetS and obesity, respectively, in both cases and controls. We used the DLQI questionnaire to evaluate its impact on the quality of life. Results: Cases and controls were comparable with respect to parameters like age, BMI, systolic blood pressure (SBP), diastolic blood pressure (DSBP), and serum triglyceride while fasting blood sugar (FBS, case > control) and serum high-density lipoprotein (HDL, control > case) were significantly different (P < 0.05, independent t-test). Prevalence of MetS was higher in cases (32%) than controls (14%), though comparable (P = 0.06, Chi-square). Only SBP, FBS, and serum HDL showed a significant correlation with the severity of acne. Obesity was comparable between cases (18%) and controls (10%), without any relation to acne severity. Acne exerted a moderate impact on the quality of life (mean DLQI 9.3). Severe acne showed higher DLQI, although their correlation was not statistically significant (P = 0.8, ANOVA). Conclusion: Although acne patients may develop MetS and obesity, there is a lack of significant association. Thus, we should examine all obese patients, irrespective of dermatological disorder, to rule out metabolic syndrome. Acne also affects the patient's quality of life, thus emphasizing the need for additional psychosocial counselling.

Abstract The paper analyzes Divakaruni’s rewriting of the mythical story of Draupadi (from Sanskrit Mahbharata) in her The Palace of Illusions (2008), as well as her projection in the Indian popular rituals. It investigates Draupadi’s iconic status as a fierce feminist standing her ground even against the violence she experiences at the hands of men, among them, her five husbands. My thesis is that the narrative of Draupadi will continue to remain a cult myth, thereby leading to more future artistic manifestations, primarily because her assimilation in the Indian cultural psyche is somewhat incomplete, as she remains an untamed woman with strong political and sociological views, refusing to bow down to the questionable standards of the Indian society, voicing her dissent, rage and protest at her exploitation at the hands of a patriarchal system. Her emancipation in the ancient narrative, and furthermore in the retellings and rituals today, acts both in favor of her as well as goes against her: she is a mythical woman who is denied justice and who is constantly demanding equanimity, thus becoming an icon for the supporters of equal rights for women in the present century, who can draw their inspiration from this ancient myth.

In this study, we demonstrate the use of parallel plate far field electrospinning (pp-FFES) based manufacturing system for the fabrication of polyacrylonitrile (PAN) fiber reinforced polyvinyl alcohol (PVA) strong polymer thin films (PVA SPTF). Parallel plate far field electrospinning (also known as the gap electrospinning) is generally used to produce uniaxially aligned fibers between the two parallel collector plates. In the first step, a disc containing PVA/H2O solution/bath (matrix material) was placed in between the two parallel plate collectors. Next, a layer of uniaxially aligned sub-micron PAN fibers (filler material) produced by pp-FFES was directly collected/embedded in the PVA/H2O solution by bringing the fibers in contact with the matrix. Next, the disc containing the matrix solution was rotated at 45° angular offset and then the next layer of the uniaxial fibers was collected/stacked on top of the previous layer with now 45° rotation between the two layers. This process was continued progressively by stacking the layers of uniaxially aligned arrays of fibers at 45° angular offsets, until a periodic pattern was achieved. In total, 13 such layers were laid within the matrix solution to make a helicoidal geometry with three pitches. The results demonstrate that embedding the helicoidal PAN fibers within the PVA enables efficient load transfer during high rate loading such as impact. The fabricated PVA strong polymer thin films with helicoidally arranged PAN fiber reinforcement (PVA SPTF-HA) show specific tensile strength 5 MPa·cm3·g−1 and can sustain specific impact energy (8 ± 0.9) mJ·cm3·g−1, which is superior to that of the pure PVA thin film (PVA TF) and PVA SPTF with randomly oriented PAN fiber reinforcement (PVA SPTF-RO). The novel fabrication methodology enables the further capability to produce even further smaller fibers (sub-micron down to even nanometer scales) and by the virtue of its layer-by-layer processing (in the manner of an additive manufacturing methodology) allowing further modulation of interfacial and inter-fiber adherence with the matrix materials. These parameters allow greater control and tunability of impact performances of the synthetic materials for various applications from army combat wear to sports and biomedical/wearable applications.

This study used melt-electrospinning writing to fabricate three-dimensional fiber constructs by embedding them in a polyvinyl alcohol (PVA) matrix to obtain thin composite films. Fourier transform infrared spectroscopy (FTIR) and dynamic scanning calorimetry (DSC) were used to demonstrate an interaction between the polycaprolactone (PCL) fibrous phase and the PVA matrix phase. Following this, the mechanical deformation behavior of the composite was investigated, and the effect of reinforcement with three-dimensional fibrous constructs was illustrated. The specific strength of the composite was found to be five times higher than the specific strength of the neat PVA matrix. Additionally, the specific toughness of the composite was determined to be roughly four times higher than the specific toughness determined for the neat PVA matrix. These results demonstrate the potential of using melt-electrospinning writing for producing three-dimensional fibrous constructs for composite reinforcement purposes.

There has been increased interest to develop protective fabrics and clothing for protecting the wearer from hazards such as chemical, biological, heat, UV, pollutants etc. Protective fabrics have been conventionally developed using a wide variety of techniques. However, these conventional protective fabrics lack breathability. For example, conventional protective fabrics offer good protection against water but have limited ability in removing the water vapor and moisture. Fibers and membranes fabricated using electrospinning have demonstrated tremendous potential to develop protective fabrics and clothing. These fabrics based on electrospun fibers and membranes have the potential to provide thermal comfort to the wearer and protect the wearer from wide variety of environmental hazards. This review highlights the emerging applications of electrospinning for developing such breathable and protective fabrics.

Nature has taught us fascinating strategies to design materials such that they exhibit superior and novel properties. Shells of mantis club have protein fibres arranged in a 3D helicoidal architecture that give them remarkable strength and toughness, enabling them to absorb high-impact energy. This complex architecture is now possible to replicate with the recent advances in additive manufacturing. In this paper, we used melt electrospinning to fabricate 3D polycaprolactone (PCL) fibrous design to mimic the natural helicoidal structures found in the shells of the mantis shrimp’s dactyl club. To improve the tensile deformation behavior of the structures, the surface of each layer of the samples were treated with carboxyl and amino groups. The toughness of the surface-treated helicoidal sample was found to be two times higher than the surface-treated unidirectional sample and five times higher than the helicoidal sample without surface treatment. Free amino groups (NH2) were introduced on the surface of the fibres and membrane via surface treatment to increase the interaction and adhesion among the different layers of membranes. We believe that this represents a preliminary feasibility in our attempt to mimic the 3D helicoidal architectures at small scales, and we still have room to improve further using even smaller fibre sizes of the modeled architectures. These lightweight synthetic analogue materials enabled by electrospinning as an additive manufacturing methodology would potentially display superior structural properties and functionalities such as high strength and extreme toughness.