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AIM: To assess the eyedrop instillation technique by medical interns, and to study the effect of video-assisted training. Methods: This was a hospital based prospective study performed on interns of teaching institute. First, interns were asked to instil the eye drops on volunteers which was video recorded. Interns were then given ‘video-assisted training’ (VAT) of correct technique and again reassessment was performed immediately, after one-week and one-month interval. All the recorded videos were evaluated by a single independent blinded expert and scored according to the scoring system devised by subject experts based on the available literature. The data were entered in Microsoft Office Excel and statistical analysis was performed. Results: The study showed that before training 43.80% had good practice with mean test score of 6.32 ± 1.63. Immediately after video-assisted training, there was significant improvement in technique of instilling eye drop with mean test score of 9.01 ± 0.62 (P < 0.0001), after one week, the mean test score was 9.52 ± 0.71 (P < 0.0001), and after one-month, mean test score was 9.56 ± 0.75 (P < 0.0001). Each step of eyedrop instillation was compared before and after the VAT and the difference was found to be statistically significant (P value < 0.05). Conclusion: In our current study, initially interns had practised incorrect technique of instillation of eyedrop. But after video-assisted training there has been notable improvement in the technique of instilling eyedrop. Periodic VAT might be helpful in ensuring them to follow the correct technique regularly.

This cross-sectional study aimed to investigate the role of peak inspiratory flow rate (PIFR) in the management of inhalation therapy for patients with chronic obstructive pulmonary disease (COPD). Conducted in the Department of Pulmonary Medicine at a tertiary care institute from July 2021 to January 2022, this study included a total of 351 patients who were clinically diagnosed with stable COPD and currently receiving inhaler therapy. Participants underwent comprehensive assessments that included demographic data collection, the use of the ABCD assessment tool to evaluate disease severity, the COPD Assessment Test (CAT) for quality of life measurement, and assessments for adherence to inhaler therapy and inhaler technique proficiency. The primary focus was on determining the prevalence of suboptimal PIFR and identifying associated demographic and clinical factors. The results indicated that 45% of the patients exhibited suboptimal PIFR, which is critical for effective medication delivery in COPD management. Analysis revealed several significant predictors of suboptimal PIFR: female gender, lower CAT scores, the type of inhaler device used, and a Modified Medical Research Council grade of ≥2, which indicates increased levels of breathlessness. These findings underscore the importance of assessing PIFR in COPD patients to ensure effective drug delivery. The study suggests that personalized inhaler device prescriptions tailored to individual PIFR can enhance treatment efficacy and improve overall management outcomes for COPD patients. By addressing factors contributing to suboptimal PIFR, healthcare providers can optimize inhalation therapy and ultimately improve patient quality of life.

In this paper, a multi-objective grey wolf optimization (GWO) algorithm based Bidirectional Long Short Term Memory (BiLSTM) network machine learning (ML) model is proposed for finding the optimum sizing of distributed generators (DGs) and shunt capacitors (SHCs) to enhance the performance of distribution systems at any desired load factor. The stochastic traits of evolutionary computing methods necessitate running the algorithm repeatedly to confirm the global optimum. In order to save utility engineers time and effort, this study introduces a BiLSTM network-based machine learning model to directly estimate the optimal values of DGs and SHCs, rather than relying on load flow estimates. At first, a multi-objective grey wolf optimizer determines the most suitable locations and capacities of DGs and SHCs at the unity load factor and the same locations are used to obtain optimum sizing of DGs and SHCs at other load factors also. The base case data sets consisting of substation apparent power, real power load, reactive power load, real power loss, reactive power loss and minimum node voltage at various load factors in per unit values are taken as input training data for the machine learning model. The optimal sizes of the DGs and SHCs for the corresponding load factors obtained using GWO algorithm are taken as target data sets in per unit values for the machine learning model. An adaptive moment estimation (adam) optimization approach is employed to train the BiLSTM ML model for identifying the ideal values of distributed generations and shunt capacitors at different load factors. The efficacy of the proposed ML-based sizing algorithm is demonstrated via simulation studies.

PURPOSE: The purpose of this study was to evaluate and estimate the knowledge, attitude, and practices of Indian fresh medical graduates with respect to ophthalmic emergencies. MATERIALS AND METHODS: This cross-sectional study was conducted on 1300 participants who had completed compulsory rotatory residential internship with the help of a questionnaire distributed through social platforms. The Chi-square and Pearson's coefficient relation tests were used. Statistical analysis was done using IBM SPSS. P

Purpose: This study aimed to assess and compare the changes in peripapillary retinal nerve fiber layer (RNFL) thickness in nondiabetics and diabetics with various stages of diabetic retinopathy (DR). Methods: The study subjects were divided into four groups based on their diabetic status and findings, namely, controls (normal subjects without diabetes [NDM]), diabetics without retinopathy (NDR), nonproliferative DR (NPDR), and proliferative DR (PDR). Peripapillary RNFL thickness was assessed using optical coherence tomography. One-way analysis of variance (ANOVA) with the post-Tukey HSD test was done to compare RNFL thickness in different groups. The Pearson coefficient was used to determine the correlation. Results: There was statistically significant difference in measured average RNFL (F = 14.8000, P < 0.05), superior RNFL (F = 11.7768, P < 0.05), inferior RNFL (F = 12.9639, P < 0.05), nasal RNFL (F = 12.2134, P < 0.05), and temporal RNFL (F = 4.2668, P < 0.05) across the different study groups. Pairwise comparison showed that there was a statistically significant difference in RNFL measured (average and all quadrants) in patients with DR (NPDR and PDR) and the NDM control group (P < 0.05). In diabetics without retinopathy, the RNFL measured was reduced compared to controls, but it was statistically significant only in the superior quadrant (P < 0.05). Average RNFL and RNFL in all quadrants showed a small negative correlation with the severity of DR and it was statistically significant (P < 0.001). Conclusion: In our study, peripapillary RNFL thickness was reduced in diabetic retinopathy compared to normal controls and the thinning increased with the severity of DR. This was evident in the superior quadrant even before the fundus signs of DR set in.

Background & Objective: To assess the knowledge, attitude, and practice of research methodology among ophthalmology residents. Materials & Methods: The study was conducted by sharing a pretested semi-structured questionnaire to ophthalmology residents using an online Google form. Responses were collected, which were analyzed using IBM SPSS software version 28. Results: In our study, 372 responses were analyzed, and among respondents (71%) were females. Most residents had good knowledge (74.2%) and a positive attitude (91.9%) whereas only 64.5% had a good practice. The poor practice was attributed to barriers like lack of guidance (56.7%), lack of orientation (55%), and lack of time (48.3%). Among the participants, only 43.5% had been part of a research work other than a mandatory dissertation and publication. The practice levels were significantly good in respondents with good knowledge (p=

An autonomous robotic vehicle (ARVs) is a self-driving vehicle that uses advanced technologies to navigate through the environment without human intervention. These vehicles can be used for various applications, including transportation, logistics, surveillance, and exploration. Route planning (RP) is the process of determining the most efficient and safe route for a vehicle, pedestrian, or any other mode of transportation to reach a destination. Route management is the process of selecting a collision-free path through an environment, which in practice is frequently crowded. Therefore, offering a RP solution for robotic systems is essential. The particle swarm optimization (PSO) method incorporates inertia weights and imitates the cooperative behavior of the flock’s population as well as its predatory nature to address route modeling issues. The Dijkstra algorithm (DA) works by determining the shortest path among the closest vertices between the source and destination. To choose the best path, inertia weight is also taken into account. By analyzing algorithms, we presented the combination technique for RP. In order to give a reliable route planning method, we suggested the weight-controlled particle swarm-optimized Dijkstra algorithm (WCPSODA). MATLAB was used to run the simulation, and conventional tools were used to evaluate the results. The findings of the study show that the suggested systems are capable of performing well.

Abstract In this paper, a Pareto multiobjective and grasshopper optimization algorithm (GOA) based optimum proportional–integral–derivative (P–I–D) controller design is proposed for improving the vehicle active suspension system dynamics under road disturbance conditions. The Pareto objectives considered are minimization of sprung mass suspension deflection, tyre deflection, sprung mass acceleration minimization and eigenvalue-based objective function. State space model for quarter vehicle active suspension system with P–I–D controller is developed for analyzing the stability and dynamic performance of the system. The sinusoidal-based bump road disturbances are used for testing the robustness of the proposed control technique. Simulation results have been presented to show the advantage of the proposed Pareto multiobjective and GOA-based P–I–D controller over the weighted multiobjective and genetic algorithm-based P–I–D controller in terms of stability and dynamics of the active suspension system.

The global GDP has witnessed a significant upswing, majorly due to the growth of the construction industry. Embracing the whole-life costing (WLC) approach, the construction sector strategically manages expenses across a construction project’s life cycle. However, despite its widespread adoption, accurate cost forecasting remains a major challenge. The intricate interplay of various influencing factors has not been fully explored, leading to inaccurate cost estimations. A comprehensive understanding of specific factors and their interrelationships is crucial to address this issue. Therefore, it is imperative to conduct further research to identify and explore the subtle nuances of these factors that impact whole-life cost estimation. Our study fills this gap, analysing 51 factors from 84 papers across prominent repositories. We assess interrelationships using a systematic literature review and pairwise comparison as in the analytical hierarchy process. The International Construction Measurement Standards (ICMS) framework structures these relationships and is represented in the causal loop diagrams (CLDs). The pioneering CLDs are a notable contribution, illustrating interrelationships and polarities among the 51 WLC factors. Six reinforcing loops and one balancing loop provide valuable insights into their dynamic nature. Importantly, lower-level factors do not always directly connect with upper-level factors. Instead, they interact within the same level before linking to top-level factors. These findings are significant for professionals, such as cost estimators, quantity surveyors and scholars, offering a comprehensive understanding of the WLC system.

Purpose: To study the ocular symptomatology and clinical profile of coronavirus disease-19 (COVID-19) positive patients admitted at a tertiary care institute. Methods: This cross-sectional, observational, and descriptive study was conducted on 200 reverse transcriptase-polymerase chain reaction positive confirmed COVID-19 patients in a tertiary care institute from September 2020 to October 2020. Ocular and systemic history was collected from the patients, clinical findings and investigation values were noted and analyzed. Results: Out of 200 COVID-19 positive patients in our study, 54% of the patients were graded as mild COVID-19 cases, 34% of the patients were graded as moderate, and 12% of the patients were graded as severe COVID-19 cases. The prevalence of ocular symptoms was 10.5%. Burning sensation of the eyes was the most common ocular symptom. A higher occurrence of ocular symptoms was observed in febrile patients and it was found to be statistically significant. The ocular symptoms worsened with a rise in temperature. Conclusion: Our study reveals that in COVID-19 positive patients, the most common systemic symptom was fever and the most common ocular symptom was burning sensation. In most of the cases, ocular symptoms appeared before or with the appearance of systemic symptoms. Most ocular symptoms were either mild or moderate grade. Ocular symptoms were higher in febrile patients with the severity increasing during febrile period in most patients. With this, we need to consider all patients coming to the outpatient department with complaints of burning sensation of eyes, eye pain and red eye as possible COVID-19 cases, and do due diligent workup.

PURPOSE: The aim of this study was to compare the visual acuity (VA) by smartphone-based applications – EyeChart and the Peek Acuity to the standard Snellen chart to explore the possibility of using them as an alternative in tele-ophthalmology in the current COVID-19 pandemic. MATERIALS AND METHODS: An analytical type of observational study was done on 360 eyes of 184 patients above 18 years of age. Patients with VA

Purpose: The purpose of this study is to assess the level of awareness about glaucoma and impact of short education among patients visiting ophthalmology outpatient department (OPD). Methods: A hospital-based cross-sectional study was carried at our institute. The patients were given a pretested questionnaire containing nine questions to assess the awareness level before and after the short education about glaucoma. Microsoft Office Excel and IBM SPSS version 21 were used for statistical analysis. Results: The study showed that only 40% and 38% of the participants were aware of the term intraocular pressure and glaucoma, respectively. It was observed that participants 40 years in both pre-test and post-test. Awareness among urban population was 58.92%, while in rural it was 29.85% in pre-test. Of the population 39.89% with formal education while 14.28% patients with no formal education were aware of glaucoma. The mean pre-test score was 1.66 ± 2.35 before the short education programme and the post-test score was 8.49 ± 1.09; the difference was statistically significant with P value < 0.0001. Conclusion: In our study, the awareness of glaucoma in the population was low; however, it was slightly higher in the younger age group, in urban areas and in educated population. Improvement in the knowledge about glaucoma was observed following short education. This waiting period in ophthalmology OPD can be effectively utilized for educating the patients about glaucoma as it has a higher impact than the regularly observed methods of imparting glaucoma education to the masses.

Aim: The aim of this study is to assess the knowledge, attitude, and practice toward eye care among ophthalmology postgraduate of Karnataka in coronavirus disease 2019 (COVID-19) pandemic. Methods: A self-designed questionnaire was prepared and sent to ophthalmology postgraduates in the various colleges in Karnataka using Google form platform as an online survey. The sample size was calculated to be 100. Results: Out of 100 participants, 80% were female with 84% aged between 26 and 30 years. The rates for correct answer for knowledge about COVID-19 ranged from 60% to 92%. In terms of practice, 65% of them showed good practice. Ninety-four percent of the participants told that COVID-19 has adversely affected their postgraduation training, especially the surgical training. Conclusion: The postgraduate residents of ophthalmology showed a satisfactory level of knowledge and attitude toward COVID-19 with an obvious difference in practice with regard to disciplines. Practice can be further improved by webinars, Continuing Medical Education Programs (CMEs), and guidance from the experts. Since the surgical training has been greatly affected, more frequent video-based surgical teaching programs, virtual simulation platforms, and practice on model eyes must be encouraged for the surgical training of the residents.

PURPOSEThe use of all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) in the treatment of low- and intermediate-risk acute promyelocytic leukemia (APL) is the standard of care. We report the combined use of ATRA, ATO, and daunorubicin (DNR) in patients newly diagnosed with high-risk APL. The primary focus was to describe the drug dosage modifications made in the real-world scenario.METHODSIn this descriptive study, we included 16 out of 28 patients with high-risk APL from two tertiary care centers in South India (Vijayawada and Trichy) between January 2015 and December 2018. A unique approach of initiating ATRA at a dose of 25 mg/m2 on day 1 and escalation to 45 mg/m2 after cytoreduction with DNR and hydroxyurea was followed in all patients to avert differentiation syndrome, in the setting of hyperleukocytosis at presentation.RESULTSAll patients who survived the first 3 days of admission achieved complete remission after a median duration of 29 days. There were no deaths during induction or consolidation, and the regimen was well tolerated; two patients developed grade 3/4 peripheral neuropathy requiring treatment modification. After a median follow-up duration of 1.9 years, there were no hematologic or molecular relapses.CONCLUSIONThe study sheds light on the modifications made to recommended dosages of ATRA, ATO, and DNR to optimize outcomes in high-risk APL and reaffirms the importance of ATO use in the front-line setting to achieve durable responses with minimal toxicity.

Abstract Melioidosis is caused by an environmental Gram‐negative bacilli Burkholderia pseudomallei. Diabetes mellitus, occupational exposure to soil and water, pre‐existing renal diseases and thalassemia are significant independent risk factors for melioidosis. A 30‐year‐old male carpenter and smoker had a history of accidental aspiration of foreign body 2 months prior. On presentation, he had cough with expectoration and low‐grade intermittent fever for 1 month. His chest x‐ray displayed left lower zone consolidation with cavitation and presence of foreign body in the left lower lobe bronchus. Bronchoalveolar lavage inoculated onto 5% sheep blood agar and MacConkey agar grew B. pseudomallei. Melioidosis due to foreign body aspiration is rare. To the best of our knowledge, there have not been reports of melioidosis infection associated with foreign body inhalation. Hence, pulmonary melioidosis can be considered as a differential diagnosis in cases of foreign body with secondary infection even in immunocompetent host.

Schwannomas are the most common tumor of peripheral nerves. It comprises 1 to 2% of total thoracic tumor. Posterior mediastinum is the most common site in thorax. Hereby we are reporting two cases of schwannoma with different sites of origin. The classical presentation of schwannoma is an asymptomatic mass found on chest radiograph. This tumor is usually benign and slow growing. Imaging followed by histopathological examination is key to the diagnosis of this neoplasm. Resection of tumor cures the disease.

Introduction: Ipsilateral floating hip and knee injuries at the same time are very rare injuries, occurring due to high velocity trauma. With a small number of such case reports, the treatment guidelines regarding surgical fixation are yet to be formulated. Case report: We report an interesting case of hip dislocation, comminuted acetabular fracture, intertrochanteric and shaft of femur fracture and both bones leg fracture ipsilaterally. Open reduction of hip, antegrade femoral nailing with recon nail and closed tibial nailing was done in a single setting. Acetabular fracture was treated non-operatively. Conclusion: Patient's general condition, co-morbid status, fracture pattern and the surgical expertise of the trauma team should guide the definitive treatment and its sequence. Early fixation of long bones is warranted and acetabular fixation can be done in second stage.

Malakoplakia is an unusual inflammatory disease with uncertain pathogenesis affecting any organ in the body, but predominantly genitourinary tract, with specific predilection to the bladder. We report a rare case of isolated malakoplakia of the urachus in a 29-year-old male patient who presented with lower urinary tract symptoms without any hematuria. Investigations revealed sterile pyuria with no bacterial growth in urine. Radiological investigations revealed a mass in the urachal region. The patient underwent cystoscopy with biopsy followed by pelvic lymph node dissection and partial cystectomy with excision of the urachal mass. Histopathological examination of the mass revealed malakoplakia. Postoperative course was uneventful. To the best of our knowledge, this is the first ever case report of isolated urachal malakoplakia without any concomitant malignancy or bladder involvement reported in our country and one of the very few reported worldwide.

Introduction: Acute pancreatitis is the sudden onset of reversible inflammation of pancreas in which pancreatic enzymes cause autodigestion of the gland. Acute pancreatitis varies from mild (mortality rate

Adenomatoid odontogenic tumour (AOT), a tumour composed of odontogenic epithelium, is an uncommon tumour of odontogenic origin that accounts for only 2.2- 7.1% of all odontogenic tumours. Very few cases of AOT associated with Dentigerous cyst (DC) have been reported till date, most cases are in females and have a striking tendency to occur in the anterior maxilla. The present case is that of a 14-year-old female who revealed a large radiolucent lesion associated with the crown of an unerupted canine located in the left maxillary anterior region. The microscopic examination revealed the presence of AOT in the fibrous capsule of a DC. In this paper, we describe the importance of grossing, sectioning and complete examination of the slide to diagnose such hybrid lesions.