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Abstract BackgroundOphthalmology residents take the Ophthalmic Knowledge Assessment Program (OKAP) exam annually, which provides percentile rank for multiple categories and the total score. In addition, ophthalmology residency training programs have multiple subspecialty rotations with defined minimum procedure requirements. However, residents’ surgical volumes vary, with some residents exceeding their peers in specific subspecialty rotations. ObjectiveThis study aims to identify if there is a difference in OKAP examination scores and surgical volume exposure during ophthalmology residency training between nonfellowship and fellowship applicants and among various subspecialties. MethodsA retrospective review of OKAP scores and surgical procedure numbers of graduating residents in an accredited academic ophthalmology residency program in the Midwest United States was conducted. Data were collected from 2012 to 2022. ResultsA total of 31 residents were identified. Most residents decided to pursue fellowship training upon graduation (20/31, 65% residents), and the rest chose to practice comprehensive ophthalmology (11/31, 35% residents). A total of 18/31 residents had OKAP score reports available. The fellowship group outperformed the nonfellowship group in multiple subsections and the total exam (PPPPPPPP ConclusionsIn our program, residents pursuing fellowship training had higher OKAP scores on multiple sections and the total exam. There was no significant difference in the overall surgical volume averages between fellowship and nonfellowship groups, but few differences existed in subspecialty procedures among fellowship applicants. Larger multicenter studies are needed to clarify the relationship between OKAP scores and ophthalmology fellowship decisions nationwide.

Abstract The extensive utilization of IoT applications leads to the aggregation of a substantial volume of data, presenting a crucial challenge in terms of data routing within these networks. RPL intentionally surpasses the limitations sometimes observed in low-power and lossy networks, which are particularly prevalent in IoT networks. The RPL protocol is designed specifically for static networks that do not involve mobility or topological changes. The RPL protocol guarantees continuous connectivity between nodes and mitigates the risk of data loss in stationary IoT applications that do not involve mobility or alterations in network configuration. The article utilizes a mobility aid technology known as network performance stability using the intelligent routing protocol (nPSIR), which expands upon RPL. The Mobility Support Entity (nPSIR) facilitates the displacement of all nodes, with the exception of the root node, and ensures uninterrupted connection during mobility. Moreover, it deals with the situation where there is a physical barrier between two interconnected nodes in a changing environment. In order to achieve this objective, it employs a dynamic trickle timer that operates within two distinct ranges. Furthermore, it utilizes a neighbor link quality table, a mechanism for selecting the most beneficial parent node in the event of migration, a measure of confidence, the identification of crucial regions, and a blacklist. Multiple simulations validate that nPSIR effectively decreases hand-off delay and improves packet delivery, despite the minor drawbacks of increased signaling costs and power consumption. The delivery ratio decreases the quantity of lost data packets and surpasses both RPL as a responsive protocol and mRPL as a proactive protocol in relation to mobility.

Abstract Background Proliferative vitreoretinopathy (PVR) is the leading cause of recurrent retinal detachment. Anterior PVR can contribute to recurrent retinal detachment and is often difficult to remove during conventional pars plana vitrectomy. The purpose of this study is to report surgical outcomes of single endoscopy-assisted pars plana vitrectomy (E-PPV) in patients with tractional retinal detachments associated with anterior proliferative vitreoretinopathy and epiciliary membranes. Methods Retrospective review of E-PPV between 2017 and 2021 at a tertiary referral center. Inclusion criteria involved adult patients who underwent E-PPV for tractional retinal detachment with anterior PVR and epiciliary membranes. Data collection included patients’ demographics, ophthalmic exam findings, and surgical outcomes. A series of independent sample tests of proportion were conducted using a p-value of 0.05 as the threshold for statistical significance. Results Eighteen out of 55 patients who underwent E-PPV met the inclusion criteria. There were six females (33%) and 12 males (p-value = 0.096). Age ranged between 27 and 82 years old (mean age 52.1 ± 17.3 years). Nine patients (50%) had a history of ipsilateral retinal detachment repair. Single E-PPV success rate was 100% after three months, and 94.4% at the latest follow up visit. Recurrent retinal detachment with posterior PVR occurred in one patient four months after surgery. Cataract progressed in 57% (8/14) of phakic patients, with 63% (5/8) undergoing cataract extraction surgery within the first postoperative year. Conclusion E-PPV enabled epiciliary membrane and anterior PVR visualization and removal. The single E-PPV success rate remained high at the latest follow up visit. E-PPV enabled the preservation of the phakic lens in all study patients. Larger prospective studies are needed on the role of E-PPV in retina surgeries.

A 58-year-old Caucasian female presented to the retina service with a 2-week history of bilateral decrease in vision. She had stage 4 renal cell carcinoma with osseous metastasis and choroidal metastasis for which she has been treated with Nivolumab immunotherapy. Her exudative retinal detachments resolved after cessation of Nivolumab in association with subtenon steroids (STK) and intravitreal bevacizumab injections. To the best of our knowledge, this is the first report in the literature describing the resolution of Nivolumab-related exudative retinal detachment after early local therapy using STK injections (10 mg), bevacizumab intravitreal injections, and cessation of Nivolumab. We hope by sharing this report to provide new insight into the management of similar patients.

Abstract Background To describe the dissection and removal of the anterior hyaloid membrane using the conventional surgical microscope. Case presentation This microscopic surgical approach involves dissecting the anterior hyaloid at the natural anatomical plane. A 30-gauge needle mounted on a 3.0 cc syringe is used to inject filtered air anterior to the anterior hyaloid membrane. Two patients needed this procedure; the first patient was pseudophakic with proliferative diabetic retinopathy, tractional retinal detachment, and vitreous hemorrhage. The second patient was phakic with proliferative diabetic retinopathy, anterior proliferative vitreoretinopathy, and recurrent vitreous hemorrhage. Both patients tolerated the procedure well with no complications. Conclusion Pneumatic dissection of the anterior hyaloid membrane is previously thought to be only possible with the aid of ophthalmic endoscopy. This novel surgical approach provides surgeons with the option to perform pneumatic dissection of the anterior hyaloid when ophthalmic endoscopy is not available. Prospective studies are needed to reveal possible additional benefits or risks associated with this approach.

Abstract Purpose To analyze endoscopic vitreoretinal surgery principles, applications, challenges and potential technological advances. Background Microendoscopic imaging permits vitreoretinal surgery for tissues that are not visible using operating microscopy ophthalmoscopy. Evolving instrumentation may overcome some limitations of current endoscopic technology. Analysis Transfer of the fine detail in endoscopic vitreoretinal images to extraocular video cameras is constrained currently by the caliber limitations of intraocular probes in ophthalmic surgery. Gradient index and Hopkins rod lenses provide high resolution ophthalmoscopy but restrict surgical manipulation. Fiberoptic coherent image guides offer surgical maneuverability but reduce imaging resolution. Coaxial endoscopic illumination can highlight delicate vitreoretinal structures difficult to image in chandelier or endoilluminator diffuse, side-scattered lighting. Microendoscopy’s ultra-high magnification video monitor images can reveal microscopic tissue details blurred partly by ocular media aberrations in contemporary surgical microscope ophthalmoscopy, thereby providing a lower resolution, invasive alternative to confocal fundus imaging. Endoscopic surgery is particularly useful when ocular media opacities or small pupils restrict or prevent transpupillary ophthalmoscopy. It has a growing spectrum of surgical uses that include the management of proliferative vitreoretinopathy and epiretinal membranes as well as the implantation of posterior chamber intraocular lenses and electrode arrays for intraretinal stimulation in retinitis pigmentosa. Microendoscopy’s range of applications will continue to grow with technological developments that include video microchip sensors, stereoscopic visualization, chromovitrectomy, digital image enhancement and operating room heads-up displays. Conclusion Microendoscopy is a robust platform for vitreoretinal surgery. Continuing clinical and technological innovation will help integrate it into the modern ophthalmic operating room of interconnected surgical microscopy, microendoscopy, vitrectomy machine and heads-up display instrumentation.

Leaves of fig, guava, olive and pomegranate and peels of ripe pomegranate fruits were mechanically pressed to obtain the crude juices. The resultant crude juices were subjected to the estimation of certain phytochemicals, i.e. total phenols, flavonoids, tannins and anthocyanins by HPLC. The assessment of their antioxidant activities were performed by three methods, i.e. DPPH, reducing power and metal chelating assays. The results indicated that the amounts of polyphenols, flavonoids, tannins and anthocyanins in crude pomegranate peels juices were markedly higher than those of other medicinal plants crude juices. The polyphenolic constituents in fig leaves, pomegranate leaves and peels, guava leaves and olive leaves were distinguished using HPLC. The major compounds found in all crude juices were gallic acid, ellagic acid, naringenin, ferulic acid and methyl gallate, respectively. Pomegranate peels crude juice exhibited the highest antioxidant activity assessed by the aforementioned methods in comparison with other medicinal plants crude juices.

Purpose: Toxoplasma gondii is the most common cause of infectious posterior uveitis worldwide in immunocompetent patients. Despite its prevalence, diagnosis can still be challenging and vision-threatening in cases with atypical presentations. This case exemplifies the importance of clinical exam and additional workup when required despite negative initial serology results. Observations: A 73-year-old immunocompetent woman presented with a 2-year history of recurrent panuveitis and retinal necrosis not responsive to systemic antiviral therapy. Toxoplasma serum antibodies (IgG and IgM) were not detected on systemic workup one year prior. The slit-lamp exam revealed mutton fat keratic precipitates, panuveitis, and necrotic retinal lesions adjacent to a retinal scar. Repeated Toxoplasma serum antibodies (IgG and IgM) were again negative. However, aqueous fluid testing by polymerase chain reaction (PCR) was highly positive for Toxoplasma gondii. The patient improved after starting systemic anti-toxoplasma therapy. Conclusion/Importance: To our knowledge, this is the first report in the literature of an immunocompetent patient with ocular toxoplasmosis and undetectable serum IgG and IgM. Aqueous fluid PCR testing is useful in suspected ocular toxoplasmosis in patients with vision-threatening lesions despite negative serology.

Abstract Background To report a case of orbital inflammation after bisphosphonate infusion in a patient who was already receiving immunosuppressive therapy. Case presentation A 56-year-old woman presented to the ophthalmology clinic with acute onset of right eye pain 24 h after receiving her first Zolendronic acid infusion. She has a past medical history of chronic inflammatory demyelinating polyneuropathy, Sjogren’s syndrome, and systemic lupus erythematosus that have been controlled with immunosuppressive therapy for three years. Clinical ophthalmic exam and MRI studies were significant for right orbital inflammation. The patient was started on oral prednisone with rapid resolution of symptoms. Conclusions This is the first case report of a patient receiving chronic immunosuppressive therapy to develop orbital inflammation after Zoledronic acid infusion. In addition, it demonstrates that corticosteroids can be an effective first line therapy in treating orbital inflammation in similar patients. Physicians should be aware of this rare but serious potential side effect of bisphosphonates, and have bisphosphonate-related orbital inflammation on their differential for proper initiation of treatment.

Herein, we report the synthesis of different novel sets of coumarin-6-sulfonamide derivatives bearing different functionalities (4a, b, 8a–d, 11a–d, 13a, b, and 15a–c), and in vitro evaluation of their growth inhibitory activity towards the proliferation of three cancer cell lines; HepG2 (hepatocellular carcinoma), MCF-7 (breast cancer), and Caco-2 (colon cancer). HepG2 cells were the most sensitive cells to the influence of the target coumarins. Compounds 13a and 15a emerged as the most active members against HepG2 cells (IC50 = 3.48 ± 0.28 and 5.03 ± 0.39 µM, respectively). Compounds 13a and 15a were able to induce apoptosis in HepG2 cells, as assured by the upregulation of the Bax and downregulation of the Bcl-2, besides boosting caspase-3 levels. Besides, compound 13a induced a significant increase in the percentage of cells at Pre-G1 by 6.4-folds, with concurrent significant arrest in the G2-M phase by 5.4-folds compared to control. Also, 13a displayed significant increase in the percentage of annexin V-FITC positive apoptotic cells from 1.75–13.76%. Moreover, QSAR models were established to explore the structural requirements controlling the anti-proliferative activities.

Nowadays, networks use many different paths to exchange data. However, our research will construct a reliable path in the networks among a huge number of nodes for use in tele-surgery using medical applications such as healthcare tracking applications, including tele-surgery which lead to optimizing medical quality of service (m-QoS) during the COVID-19 situation. Many people could not travel due to the current issues, for fear of spreading the covid-19 virus. Therefore, our paper will provide a very trusted and reliable method of communication between a doctor and his patient so that the latter can do his operation even from a far distance. The communication between the doctor and his/her patient will be monitored by our proposed algorithm to make sure that the data will be received without delay. We test how we can invest buffer space that can be used efficiently to reduce delays between source and destination, avoiding loss of high-priority data packets. The results are presented in three stages. First, we show how to obtain the greatest possible reduction in rate variability when the surgeon begins an operation using live streaming. Second, the proposed algorithm reduces congestion on the determined path used for the online surgery. Third, we have evaluated the affection of optimal smoothing algorithm on the network parameters such as peak-to-mean ratio and delay to optimize m-QoS. We propose a new Smart-Rout Control algorithm (s-RCA) for creating a virtual smart path between source and destination to transfer the required data traffic between them, considering the number of hops and link delay. This provides a reliable connection that can be used in healthcare surgery to guarantee that all instructions are received without any delay, to be executed instantly. This idea can improve m-QoS in distance surgery, with trusted paths. The new s-RCA can be adapted with an existing routing protocol to track the primary path and monitor emergency packets received in node buffers, for direct forwarding via the demand path, with extended features.

The huge bandwidth and hardware capacity form a high combination together which leads to a vigorous development in the Internet. On the other hand, different problems will come up during the use of the networks such as delay and node tasks load. These problems lead to degrade the network performance and then affect network service for users. In cloud computing, users are looking to be provided with a high level of services from the service provider. In addition, cloud computing service facilitates the execution of complicated tasks that needed high-storage scale for the computation. In this paper, we have implemented a new technique to retain the service and assign tasks to the best and free available node already labeled by the manager node. The Cloud Computing Alarm (CCA) technique is working to provide all information about the services node and which one is ready to receive the task from users. According to the simulation results, the CCA technique is making good enhancements on the QoS which will increase the number of users to use the service. Additionally, the results showed that the CCA technique improved the services without any degrading of network performance by completing each task in less time.

Refined cottonseed oil and hydrogenated palm oil were heated by two methods, i.e., conventionally by gas-cooker and microwaves. Quality assurance methods such as refractive index, color, diene content, acid value, peroxide value, TBA value, iodine value, petroleum ether insoluble oxidized fatty acid content and degree of polymerization were determined. Exposing the oil samples to various heating times and microwave oven power caused some hydrolysis to free fatty acids, accelerated the formation of hydroperoxides and secondary oxidation products. The values from each test increased with both the power settings of microware oven and time of heating. In general, the development of rancidity for refined cottonseed oil heated by microwaves was twice faster than that produced by conventional heating. Also, the chemical values for refined cottonseed oil were much higher than that of hydrogenated palm oil in all cases.

Butter was converted to samn by microwave and conventional heating. The quality of the processed samn by the two methods was followed by determining the acid, peroxide and TBA values over a period of six weeks at 60°C. The fatty acid composition of samn samples was determined by gas-liquid chromatographic technique. The data show that butter conversion to samn by microwave heating was accomplished in about one half of the time that conventional heating requires. Microwave heating obviously increased the development of samn rancidity compared with the conventional heating. The parameters used for measuring lipid rancidity indicated that the main cause of samn rancidity under the present conditions is an oxidation mechanism.

Purpose: To describe unilateral vasculitic central retinal vein occlusion in a young adult whose vision problems preceded systemic symptoms of COVID-19 infection. Methods: Observational clinical case report. Results: A 39-year-old immunocompetent man without prior ocular disease presented for vitreoretinal care complaining of decreasing vision in his right eye for 2 weeks. Headaches, pharyngitis, and coughing began 4 days after his visual symptoms. COVID-19 testing was negative before initial vitreoretinal evaluation and positive afterward. Dilated and tortuous major retinal veins in his right eye had prominent perivascular sheathing. A large subhyaloid hemorrhage spanned the macula. Subretinal hemorrhages were present in areas of sheathing, and diffuse nerve fiber layer hemorrhages were arrayed in the distribution of the radial peripapillary capillary plexus. Laboratory tests for inflammatory diseases were negative. The patient was hospitalized for COVID-19 pneumonia a few days after his initial vitreoretinal evaluation. Pars plana vitrectomy was performed for persistent subhyaloid hemorrhage 8 weeks after his hospitalization. The VA in the patient's right eye improved from counting-fingers to 20/30 postoperatively. Conclusion: The patient's findings are consistent with an atypical central retinal vein occlusion which we hypothesize to be of vasculitic origin because of prominent associated retinal phlebitis and venous sheathing. Concomitant subhyaloid, nerve fiber layer, and subretinal hemorrhages involved the superficial and deep retinal vascular complexes. The patient's COVID-19-related hospitalization and systemic management delayed surgical management of his subhyaloid hemorrhages, but a good visual result was achieved despite persistence of macular preretinal blood for 3 months. [ABSTRACT FROM AUTHOR]

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