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Dharani Ramamurthy,1 Sangeetha Srinivasan,2 Sruthi Chamarty,3 Tharaniy Velappan,1 Pavan Kumar Verkicharla,3 Angeline Kirubha Samuel Paulraj4 1Department of Optometry, Faculty of Medical & Health Sciences, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology, Chennai, Tamil Nadu, 603203, India; 2Vision Research Foundation, Chennai, Tamil Nadu, 600006, India; 3Myopia Research Lab, Brien Holden Institute of Optometry and Vision Sciences, Prof Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, 500034, India; 4Department. of Biomedical Engineering, College of Engineering & Technology, SRM Institute of Science and Technology, Chennai, Tamil Nadu, 603203, IndiaCorrespondence: Dharani Ramamurthy, Department of Optometry, SRM Medical College Hospital & Research Centre, Faculty of Medical & Health Sciences, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, 603203, India, Tel +91-44-47432650 ; +91-44-47432393, Email dharanir@srmist.edu.inAbstract: There is a huge unmet need for eye care with more than a hundred million people living without basic eye care services and facilities. There is an exigency to deploy adequate resources in terms of manpower and equipment to address this. The usage of smart devices in optometry and eye care practice has been gaining momentum for last half a decade, due to the COVID-19 pandemic and technological advancements in telemedicine. These smart devices will help facilitate remote monitoring of important visual functions, ocular signs and symptoms, thus providing better eye care services and facilities and promoting outreach services. Smart devices in optometry exist in the form of gadgets that can be worn in the wrist, and spectacle-mounted or head-mounted devices. On the other hand, with the ubiquitous nature of smartphones, a large number of smartphone applications have been developed and tested for advanced optometry and primary eye care practice, which may potentially reduce the burden of inadequate resources and the unmet need for eye care. This article aims to give an overview of the current trends and future perspectives on the application of such smart devices in optometric practice.Keywords: smartphone apps, artificial intelligence, virtual reality, augmented reality, myopia devices

Nanotechnology offers a promising solution to address the nutrient demands of cereals, which are nutrient-intensive crops typically reliant on large amounts of inorganic fertilizers. These large quantities of nutrients are supplied to the crop by applying a huge amount of inorganic fertilizer as a soil application led to a decline in environmental systems, particularly affecting the soil health, lesser use efficiency of fertilizers and water resources contamination. In this context, nanotechnology serves as a potential solution. The huge demand for nutrients in cereal crops is met by nano-fertilizers. The nano-fertilizers are now playing a promising role in fulfilling the nutrient requirement of the crops by replacing the normal conventional fertilizers not only for cereals but also for other agricultural crops. The mechanism of action of nano-fertilizers is that they are smaller than the pore size of plant cell walls, allowing them to easily enter and reach the plasma membrane. Nano-fertilizers have 100 times greater surface area than conventional fertilizers, allowing them to easily interact with plant surfaces and increase the absorption of nutrients. Therefore, the nutrient-use efficiency of the crop is increased and shown a positive effect on the physiological and growth parameters of cereal crops, resulting in enhanced yield and improved drought tolerance. This review discussed, the effects and efficiency of nano-fertilizers on cereal crop growth and the correlation between physiological, qualitative, quantitative traits with nano-form of application in detailed manner. This review concludes that nano-fertilizers are the potential nutrient source for cereal crops like rice (Oryza sativa L.), wheat (Triticum aestivum L.), maize (Zea mays) etc. and they are going to be a promising resource for nutrient management in agricultural crops.

In this review, we describe evidence that supports building a metaverse to promote healthy longevity. We propose that the metaverse offers several physical advantages (architecture, music, and nature), social (accessibility, affordability, community-building, and relief of social anxiety), and therapeutic (immersive, anti-inflammatory, and adjunctive use in complementary and integrative medicine). Lifelogging by patients may help clinicians personalize interventions by matching data to therapeutic outcomes. Although the metaverse cannot entirely replace our current model of care, a strategic approach will ensure adequate resource allocation and value assessment. In a collaborative effort between Reulay, Inc and Mayo Clinic, we are building a platform for the delivery of personalized and idiographic interventions to promote healthy longevity. To this end, we are using specific science-informed art design to reduce stress and anxiety for patients, with the progressive addition of integrated care elements that connect to this framework and connect treatment response to biomarkers that are relevant to healthy longevity. This review is a commentary on the thought process behind this effort.

This work assessed the effects of frequency & the pulse duration ratios on the weldability & structure-property relationships for the magnesium alloy AZ31B. In addition, AC/DC pulse welding with different pulse duration ratios was explored, to assess controlled repair welding on magnesium alloy castings. Complete penetration welds can be produced with conventional GTA welding using a heat input of ∼500 J/mm without the need for an active flux. However, the weld metal has a coarse grain structure and micro cracks, suggesting the need for an even better control of heat input for achieving defect free welds. Pulse GTA welding with at lower frequencies give relatively deeper penetration joints at different pulse duration ratios (1:1, 1:2 and 1:4). However, the full penetration welds are possible only with pulse duration ratio of 1:1. All the welds produced under pulsed GTA welding conditions were defect free. The grain sizes of the weld metals were much finer than for conventional GTA welding conditions and have a higher hardness compared to conventional GTA weld & also the parent alloy. Use of AC/DC mix for pulse welding, with the peak current being AC and the base current as DC, yields shallow penetration welds with no defects. The resultant weld metal microstructures are of finer grain size, and with finely distributed β-phase particles. This welding technique can be exploited for repair welding of magnesium alloy castings that have near-surface defects.

Alexandra Jankulov,1 Sawsan As-Sanie,2 Christopher Zimmerman,3 Jessica Virzi,4 Sudharsan Srinivasan,5 Hae Mi Choe,3 Chad M Brummett5,6 1Oakland University William Beaumont School of Medicine, Rochester Hills, MI, USA; 2Department of Obstetrics & Gynecology, University of Michigan Health System, Ann Arbor, MI, USA; 3Department of Health Information and Technology Services, University of Michigan Health System, Ann Arbor, MI, USA; 4Department of Precision Health, University of Michigan Health System, Ann Arbor, MI, USA; 5Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA; 6Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USACorrespondence: Chad M Brummett, Department of Anesthesiology, University of Michigan, 325 E Eisenhower Pkwy Ste 100, Ann Arbor, MI, 48108, USA, Tel +1 734-998-0455, Fax +1 734-936-6585, Email cbrummet@med.umich.eduPurpose: The aim of this study was to describe the effectiveness of an electronic health record best practice alert (BPA) in decreasing gynecologic post-discharge opioid prescribing following benign minimally invasive hysterectomy.Patients and Methods: The BPA triggered for opioid orders > 15 tablets. Prescribers’ options included (1) decrease to 15 ≤ tablets; (2) remove the order/utilize a defaulted order set; or (3) override the alert.Results: 332 patients were included. The BPA triggered 29 times. The following actions were taken among 16 patients for whom the BPA triggered: “override the alert” (n=13); “cancel the alert” (n=2); and ‘remove the opioid order set’ (n=1). 12/16 patients had discharge prescriptions: one patient received 20 tablets; two received 10 tablets; and nine received 15 tablets. Top reasons for over prescribing included concerns for pain control and lack of alternatives.Conclusion: Implementing a post-discharge opioid prescribing BPA aligned opioid prescribing following benign minimally invasive hysterectomy with guideline recommendations.Keywords: hysterectomy, opioid, prescribing, patient discharge, practice patterns

Sruthi Srinivasan,1 Renee Garofalo,2 Ravaughn Williams2 1Alcon Research LLC, Johns Creek, GA, 30097, USA; 2Alcon Research, LLC, Fort Worth, TX, 76134, USACorrespondence: Sruthi Srinivasan, Alcon Research LLC, 11460 Johns Creek Parkway, Johns Creek, GA, 30097, USA, Tel +1 678 415 5315, Email sruthi.srinivasan@alcon.comAbstract: Dry eye disease (DED) is a chronic ocular surface disorder often characterized by decreased tear production and rapid tear evaporation that affect tear film stability and homeostasis. The common symptoms of DED include ocular discomfort, visual disturbances, dryness, and itching. Artificial tears are the mainstay of DED management and supplement one or more layers of the tear film. Artificial tear drops are available as a combination of viscosity-enhancing agents (demulcents/lubricants), humectants, and buffers either with or without preservatives. Artificial tears, as a combination of components (polymers/demulcents/viscosity-enhancing agents), can provide synergistic action compared with a single component for the management of multifactorial signs and symptoms of DED. This review describes the formulation components, physicochemical properties, mechanism of action, and summary of preclinical and clinical evidence on the hydroxypropyl guar-hyaluronic acid (HPG-HA) dual-polymer lubricant eye drops (SYSTANE™ HYDRATION). The dual-polymer eye drops consist of dual demulcents (propylene glycol and polyethylene glycol 400) and the polymers hydroxypropyl guar (HPG) and hyaluronic acid (HA). When instilled on the ocular surface, HPG forms a cross-linked gel matrix with borate ions that prolongs the retention of demulcents, thus providing long-lasting lubrication and ocular surface protection. Additionally, HA stabilizes the tear film, increases corneal wettability, and reduces friction during blinks due to its hygroscopic and viscoelastic properties. Preclinical evidence demonstrates that HPG HA dual-polymer lubricant eye drops provide protection against desiccation by cell hydration and surface retention, cell barrier protection, prolonged lubrication, and promotion of corneal re-epithelialization. Clinical scientific evidence demonstrates that HPG HA dual-polymer lubricant eye drops are safe and effective in the management of DED. Specifically, they reduce the signs and symptoms of DED, reduce dry eye symptoms post-cataract surgery, and improve tear film quality in healthy eyes.Keywords: artificial tears, cataract surgery, demulcent, dry eye disease, lubrication, symptom relief

The widely used orifice plate falls under restricted type flow devices, has the highest differential pressure and permanent pressure drop in the ensemble. The objective is to curtail the permanent pressure drop and maintain the differential pressure across the orifice plate, and thereby, the power required to pump the liquid is retrenched. So, three-hole, four-hole and five-hole orifice plates with an identical area to that of the single-hole orifice plate were designed and experiments were carried out. It is observed that the experimental results almost matched with the simulation data. In comparing the performance, the four-hole orifice plate yielded a higher differential pressure and higher-pressure loss. In contrast, the five-hole orifice yielded lower differential pressure and higher-pressure loss compared to the single-hole orifice plate. In case of three-hole orifice plate it performed better than the single-hole orifice with reduced pressure loss and higher differential pressure. It was also found that the power consumed by the pump for pumping was lower for three-hole, four-hole and five-hole orifice plates compared to the single-hole orifice plate. Thus, the three-hole orifice plate performs better than a single-hole orifice plate in terms of higher differential pressure, reduced permanent pressure loss and lower power consumption of the pump.

Gina Wesley,1 Katherine Bickle,2 Johnathon Downing,3 Bret Fisher,4 Brennan Greene,5 Colton Heinrich,6 David Kading,7 Shane Kannarr,8 Jason Miller,9 Satish Modi,10 David Ludwick,11 Joseph Tauber,12 Thao N Yeh,13 Sruthi Srinivasan14 1Complete Eye Care of Medina, Hamel, MN, USA; 2ProCare Vision Center, Granville, OH, USA; 3East West Eye Institute, Los Angeles, CA, USA; 4Eye Center of N Florida, Panama City, FL, USA; 5The Eye Care Institute, Louisville, KY, USA; 6Clarke EyeCare Center, Wichita Falls, TX, USA; 7Specialty Eyecare Group, Bellevue, WA, USA; 8Kannarr Eye Care LLC, Pittsburg, KS, USA; 9Insight Research Clinic, Powell, OH, USA; 10Alterman, Modi & Wolter, Poughkeepsie, NY, USA; 11Ludwick Eye Center, Chambersburg, PA, USA; 12Tauber Eye Center, Kansas City, MO, USA; 13Alcon Vision, LLC, Fort Worth, TX, USA; 14Alcon Research, LLC, Johns Creek, GA, USACorrespondence: Sruthi Srinivasan, Alcon Research, LLC, 11460 Johns Creek Parkway, Johns Creek, GA, 30097, USA, Tel +1 678 415 5315, Email sruthi.srinivasan@alcon.comPurpose: This study aimed to demonstrate the effectiveness of Systane iLux, a thermal pulsation device, in patients with MGD, over 12 months post-single treatment.Methods: This is a post-hoc analysis of a previous prospective, assessor-masked, parallel-group, multicenter study (NCT03956225) that compared the effectiveness and safety of iLux with LipiFlow in subjects with MGD. The original study included subjects with meibomian gland score (MGS) ≤ 12 in lower eyelids, Impact of Dry Eye on Everyday Life-Symptom Bother (IDEEL-SB) module score > 16, and non-invasive tear break-up time (NITBUT) < 10 seconds. Subjects were randomized (1:1) to receive a single bilateral treatment of iLux or LipiFlow. In this post-hoc analysis, mean changes in MGS, NITBUT (first break-up; seconds), IDEEL-SB module score, and corneal staining, from baseline to 12 months were analyzed post-single treatment with iLux.Results: Data from 119 patients (n=238 eyes) treated with iLux were analyzed. The mean±SD age of the subjects was 58.4± 13.4 years, with majority being female (79.0%). MGS (mean±SD) for both eyes improved significantly from baseline to 12 months (OD [baseline: 6.9± 3.69; month 12: 22.8± 11.31; change: 15.9± 11.57, p< 0.0001]; OS [baseline: 6.4± 3.66; month 12: 23.0± 11.33; change: 16.7± 11.40, p< 0.0001]). Similarly, significant improvements were observed in NITBUT (OD [baseline: 5.2± 1.97; month 12: 7.0± 3.68; change: 1.9± 3.69, p< 0.0001]; OS [baseline: 5.6± 1.96; month 12: 7.9± 4.58; change: 2.3± 4.59, p< 0.0001]) and IDEEL-SB score (p< 0.0001). Corneal staining reduced significantly from baseline to 12 months (OD [baseline: 2.1± 2.96; month 12: 0.7± 1.56; change: − 1.4± 2.65, p< 0.0001]; OS [baseline: 2.1± 2.94; month 12: 0.7± 1.44; change: − 1.4± 2.75, p< 0.0001]). Improvements in MGS, NITBUT, IDEEL-SB module score, and corneal staining were seen as early as week 2, and at months 1, 3, 6, and 9 (all p< 0.001).Conclusion: A single treatment with iLux significantly improved clinical parameters of MGS, NITBUT, and corneal staining, and patient-reported symptom assessment with IDEEL-SB in patients with MGD over 12 months.Keywords: corneal staining, meibomian gland dysfunction, meibomian gland score, tear break-up time

Sruthi Srinivasan, Ravaughn Williams Alcon Research LLC, Johns Creek, GA, 30097, USACorrespondence: Sruthi Srinivasan, Alcon Research LLC, 11460 Johns Creek Parkway, Johns Creek, GA, 30097, USA, Tel +1 678 415 5315, Email sruthi.srinivasan@alcon.comAbstract: Dry eye disease (DED) is a chronic condition of the ocular surface characterized by a loss of the tear film homeostasis and accompanied by symptoms such as eye discomfort and visual disturbances. DED is classified as aqueous deficient dry eye (ADDE), evaporative dry eye (EDE), and mixed dry eye etiologies. The mainstay treatment in the management of DED is artificial tear drops or lubricant eye drops that replenish the aqueous and/or lipid layer of the tear film. These are available as both lipid-based and non-lipid-based formulations, with/without preservatives. Lipid-based lubricant eye drops can stabilize the tear film lipid layer, reduce tear evaporation, and improve signs of EDE. In this review, we present the formulation components, mechanism of action, and summary of preclinical and clinical evidence on a lipid-based formulation – propylene glycol-hydroxypropyl guar (PG-HPG) nanoemulsion lubricant eye drops (SystaneTM Complete). These eye drops consist of the demulcent (lubricant), PG (0.6%). HPG forms a soft, thin, cross-linked in situ gel matrix with borate ions, when exposed to the tear film, which prolongs lubricant retention and provides ocular surface protection. Dimyristoyl phosphatidyl glycerol, an anionic phospholipid, helps in replenishing the lipid layer of the tear film. Moreover, the nanoemulsion formulation serves as a depot for delivery of dimyristoyl phosphatidyl glycerol to enhance ocular surface coverage. Preclinical and clinical evidence demonstrate that PG-HPG nanoemulsion lubricant eye drops are safe and effective in providing temporary relief of symptoms of DED, regardless of its subtypes. Specifically, it provides sustained reduction in dry eye symptoms, improves tear film stability/lipid layer grade, and improves ocular surface characteristics.Keywords: artificial tears, aqueous deficient dry eye, dry eye syndrome, evaporative dry eye, lipid-based eye drops, mixed dry eye

ObjectiveTransient tachypnea of newborn (TTN) and respiratory distress syndrome (RDS) are the most common causes of respiratory distress among preterm neonates. The aim of this study was to evaluate the accuracy of lung ultrasonography (LUS) for diagnosing and differentiating TTN and RDS in preterm neonates. MethodsThis was a prospective single center study. From January 2020 to June 2021 a total of 114 preterm neonates who were admitted to neonatal intensive care unit (NICU) with symptoms of respiratory distress within 6 hours of birth were subjected to clinical examination, laboratory testing, chest x-ray (AP and lateral view’s) and LUS. Their clinical course was closely monitored. On the basis of final diagnosis made on day three of admission they were divided into two groups, 37 diagnosed with TTN and 61 with RDS. Patients diagnosed with other conditions including neonatal pneumonia, meconium aspiration syndrome etc. were excluded from analysis. LUS findings in RDS and TTN were analyzed and compared to each other. Results Pulmonary edema manifesting as alveolo-interstitial syndrome, double lung point and less commonly as white out lungs in absence of consolidation had a 100% sensitivity and specificity in diagnosing TTN. A combination of three signs of consolidation with air or fluid bronchograms, white out lungs and absent spared areas has a 100% sensitivity and specificity for diagnosing RDS. Double lung point was seen only in infants suffering from TTN while consolidation with air or fluid bronchograms was only seen in cases of RDS. ConclusionLung ultrasound can accurately diagnose and reliably differentiate TTN and RDS in preterm neonates. Hence LUS can become an initial screening tool in NICU.

Srinjay Mukhopadhyay,1 Ravanth Baskaran,1 Movin Peramuna Gamage,1 Nishaanth Dalavaye,1 Wing Sum Vincent Ng,1 Sripradha Srinivasan,1 Sashiananthan Ganesananthan,2 Stephen Rutherford3 1School of Medicine, Cardiff University, Cardiff, UK; 2Department of Digestion, Metabolism and Reproduction, Imperial College London, London, UK; 3School of Biosciences, Cardiff University, Cardiff, UKCorrespondence: Sashiananthan Ganesananthan, Department of Digestion, Metabolism and Reproduction, Imperial College London, London, SW7 2AZ, UK, Email sashiganes96@yahoo.co.ukPurpose: The COVID-19 pandemic caused significant disruption to higher education, including medical studies. Online learner support became urgently necessary, and peer-support of learning was needed to supplement formal teaching. This study evaluates the impact and delivery media of OSCEazy, a student-led initiative supporting formal teaching across institutional and national boundaries.Methods: A survey was created on Google Forms and disseminated via the Zoom chat function to all the participants at the end of our event titled, “The Cardiology Station”.Results: A large proportion (99.5%) of the students have a Facebook account and (98.7%) use it to keep track of medical events (p=0.45 for comparison). However, a very small proportion of use their other social media to keep up with medical events (p< 0.0001 for comparison).Conclusion: It is evident from our results, that most of our participants used Facebook to keep track of medical events. The use of their other social media platforms (Instagram, etc) to keep track of medical events was limited. Thus, it is important for any organisation, such as ours, who conduct online events to evaluate which platform is most suitable for them to use to publicise their events.Keywords: clinical assessment, online, student perception, medical education, social media

Background: In the NPCDCS program of Government of India, capacity building of health professionals on palliative care is a key component in rehabilitaion of cancer and other NCDs. However as palliative care teaching is still not mandatory in undergraduate medical curriculum, a medical graduate lacks knowledge and confidence in providing palliative care. Understanding the existing levelof knowledge and perceptions of students towards palliative care can facilitate planning a need-based curriculum. Aim: To assess the knowledge and perceptions in palliative care among undergraduate medical students in Puducherry, South India. Methods: After ethical clearance, a semi structured questionnaire comprising 15 knowledge questions and seven perception statements on palliative care was administered to 265 pre-final and final year medical students. The data were analyzed using SPSS-23. Results: Cancer (88.6%), AIDS (28.6%), Spinal trauma (11.6%), XDR TB (5.6%) and Coma (4.5%) were mentioned as diseases that need palliative care. Improving quality of life (46.4%) and relief of pain (30.5%) were mentioned as the purposes of palliative care. Only 15.8% said palliative care starts from the time of diagnosis. About 54.7% students were unaware of main drugs in Step I & II in WHO Pain Ladder. Majority (90.2%) felt oral morphine relieves cancer pain and 47.5% felt it causes addiction. Nearly half of students (48.6%) felt that patients can be reassured during communication. Majority (83.4%) favored inclusion of palliative care teaching in undergraduate curriculum. Conclusion: The findings indicate the need for filling the knowledge gap by focussed training of undergraduate students in palliative care.

Aparna Rao,1,2 Prity Sahay,1,2 Munmun Chakraborty,1,2 Birendra Kumar Prusty,3 Sandhya Srinivasan,4 Gagan deep Jhingan,4 Pragyan Mishra Snr,2 Rahul Modak,2 Mrutyunjay Suar2 1Glaucoma Service, MTC campus, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, 751024, India; 2KIIT School of Biotechnology, Bhubaneswar, Odisha, India; 3Institute of Life Sciences, Bhubaneswar, Odisha, India; 4Vproteomics, Green Park, New Delhi, IndiaCorrespondence: Aparna Rao Email vinodini10375@yahoo.comPurpose: The key differences in cell death mechanisms in the trabecular meshwork (TM) in adult moderate and severe primary glaucoma remain still unanswered. This study explored key differences in cell death mechanisms in the trabecular meshwork (TM) in adult moderate and severe primary glaucoma.Design: In-vitro laboratory study on surgical specimens and primary cell lines.Methods: Select cell death-related proteins differentially expressed on mass spectrometric analysis in ex-vivo dissected TM specimens patients with severe adult primary open-angle (POAG) or angle-closure glaucoma (PACG) compared to controls (cadaver donor cornea) were validated for temporal changes in cell death-related gene expression on in-vitro primary human TM cell culture after 48 hours (moderate) or 72 hours (severe) oxidative stress with H2O2 (400– 1000 uM concentration). These were compared with histone modifications after oxidative stress in human TM (HTM) culture and peripheral blood of patients with moderate and severe glaucoma.Results: Autophagy-related proteins seemed to be the predominant cell-death mechanism over apoptosis in ex-vivo dissected TM specimens in severe glaucoma. Analyzing HTM cell gene expression at 48 hours and 72 hours of oxidative stress, autophagy genes were up-regulated at 48– 72 hours of exposure in contrast to apoptosis-related genes, showing down-regulation at 72 hours. There was associated increased expression of H3K14ac in HTM after 72 hours of oxidative stress and in peripheral blood of severe POAG and PACG.Conclusion: A preference of autophagy over apoptosis may underlie stage transition from moderate to severe glaucoma in the trabecular meshwork or peripheral blood, which may be tightly regulated by epigenetic modulators.Keywords: trabecular meshwork, cell death, autophagy, apoptosis, glaucoma

Sruthi Srinivasan, Venkiteshwar Manoj Clinical Development and Medical Affairs, Alcon Research, LLC, Johns Creek, GA, USACorrespondence: Sruthi SrinivasanClinical Development and Medical Affairs, Alcon Research, LLC, 11460 Johns Creek Parkway, Johns Creek, GA, 30097, USATel +1 678 415-5315Email sruthi.srinivasan@alcon.comAbstract: Dry eye disease (DED) is a multifactorial ocular condition characterized by a loss of homeostasis of the tear film resulting in ocular symptoms of discomfort, irritation, and visual disturbance, all of which significantly impact the patients’ social and occupational quality of life. While management of DED depends on the severity of symptoms and signs, use of artificial tear products (ATPs) that replace or supplement the deficient natural tear film is the mainstay treatment option. In this review, we present a decade of evidence on Systane Ultra® (polyethylene glycol [PEG]/propylene glycol [PG] with hydroxypropyl guar [HP guar]) in effectively managing DED. The active demulcents in Systane Ultra®—PEG, PG, along with HP guar gelling technology—provide optimal ocular surface protection and lubrication to heal damaged areas of the cornea caused by DED and, therefore, are recommended for patients with both aqueous and/or mucin layer deficiencies. Over the years, several clinical studies have shown that PEG/PG with HP guar provides long-lasting relief from dry eye and has often been chosen as a standard or comparator against other ATPs. Here, we describe the salient features of PEG/PG with HP guar—its constituents and their mechanisms of action. Furthermore, we summarize results from a systematic literature search that identified 23 relevant publications further emphasizing on the effectiveness and safety of PEG/PG with HP guar in alleviating the signs and symptoms of DED.Keywords: artificial tear products, dry eye disease, PEG/PG with HP guar

Sayali Savant, Shraddha Srinivasan, Anil Kumar Kruthiventi Arna Immuno Ingredients Private Limited, Mumbai, Maharashtra, IndiaCorrespondence: Anil Kumar KruthiventiArna Immuno Ingredients Private Limited, 1st Floor, 41/44, Minoo Desai Marg, Colaba, Mumbai, 400005, IndiaTel +91 954 550 0481Fax +91 22 674 900 001Email anil.kumar@arnaimmuno.comAbstract: SARS-CoV-2 infection has caused, and is continuing to cause, considerable human suffering. Studies on the viral pathogenesis has resulted in convergent findings from several lines of evidence on the entry and spread of the virus in the host. These studies have also revealed a strong association between innocuous inflammation, ageing and metabolic disorders, with SARS-CoV-2 infection and its prognosis. Diet helps modulate inflammation, and nutraceuticals can inhibit viral entry. Hence, we have collated literature on antiviral nutraceuticals effective against other similar coronaviruses. The objective of this study is to comprehensively review available information on the antiviral activity of nutraceuticals and to discuss the implications of these findings in designing a diet that would boost the innate immunity and act as preventive care against COVID-19. This review highlights the fundamental impact of nutraceuticals and diet on inhibition of viral entry and provides a new perspective on the prevention and treatment of COVID-19.Keywords: SARS-CoV-2, diet, plant protease inhibitors, polyphenols, bioactive peptides

Manal M Gabriel,1 Cynthia McAnally,2 Huagang Chen,2 Sruthi Srinivasan,1 Venkiteshwar Manoj,1 Renee Garofalo2 1Research and Development, Alcon Research, LLC, Johns Creek, GA, USA; 2Research and Development, Alcon Research, LLC, Fort Worth, TX, USACorrespondence: Renee Garofalo Research and DevelopmentAlcon Research, LLC, Fort Worth, TX, USATel +1 817 751 9321Email renee.garofalo@alcon.comAbstract: CLEAR CARE PLUS (CCP), also known as AOSEPT PLUS with HydraGlyde, is approved for use with gas permeable (GP) lenses, and the indication is supported by the scientific evidence that is reviewed in this article. Antimicrobial efficacy testing of CCP both as a stand-alone disinfectant and as part of a regimen shows that CCP exceeds the ISO 14729 criteria against bacteria, yeast, and mold. In real-world conditions, it is effective against clinically relevant bacterial strains isolated from adverse events and against the two forms, trophozoites and cysts, of resilient Acanthamoeba species. Compatibility tests of CCP with two types of GP lenses indicate that the physical and/or optical parameters of lenses are unaffected through 30 cycles of simulated use with CCP, and a clinical trial shows substantial equivalence of clinical performance with a commonly used GP multipurpose solution. These results indicate that CCP is well suited for cleaning and disinfection of GP contact lenses.Keywords: antimicrobial efficacy, CLEAR CARE PLUS, AOSEPT PLUS with HydraGlyde, gas permeable contact lenses, lens care

Steven Silverstein,1 Elizabeth Yeu,2 Joseph Tauber,3 Michel Guillon,4 Lyndon Jones,5,6 David Galarreta,7 Sruthi Srinivasan,8 Venkiteshwar Manoj8 1Silverstein Eye Centers, Kansas City, MO 64133, USA; 2Virginia Eye Consultants, Norfolk, VA 23502, USA; 3Tauber Eye Center, Kansas City, MO 64155, USA; 4Ocular Technology Group International, London SW1E 6AU, UK; 5Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, Waterloo, ON NL2 3G1, Canada; 6Centre for Eye and Vision Research Limited (CEVR), Hong Kong; 7Hospital Clinico Universitario de Valladolid, Valladolid Castilla y Leon 47011, Spain; 8Alcon Research, LLC, Johns Creek, GA, USACorrespondence: Steven SilversteinSilverstein Eye Centers, Kansas City, MO 64133, USATel +1 816.358.3600Fax +1 816.358.1887Email ssilverstein@silversteineyecenters.comPurpose: To evaluate symptom relief in patients with dry eye disease (DED) following a single drop of propylene glycol-hydroxypropyl guar (PG-HPG) nanoemulsion (Systane® Complete) lubricant eye drops.Methods: This was a Phase IV, multicenter, open-label, interventional study in adult patients with DED of aqueous-deficient, evaporative, and mixed subtypes. Patients instilled one drop of PG-HPG in each eye at Day 1. Endpoints included change from baseline in dry eye symptom and soothing sensation scores on Day 1 at 0, 4, and 8 hours post-dose. Symptom scores were assessed on a 0– 10 scale (0=no symptoms; 10=worst imaginable symptom). Tolerability of the drop was assessed based on assessment score on Day 1 following instillation for overall cohort and by DED subtype.Results: A total of 134 patients received treatment (mean age: 56.6 years; female: 75.4%). Median changes from baseline at Day 1 in dry eye symptom scores were − 1.0 (95% confidence interval [CI]:-3.0,-1.0), − 2.0 (95% CI:-3.0,-2.0), and − 2.0 (95% CI:-2.0,-1.0) at 0, 4, and 8 hours respectively. Subgroup analysis showed a median change from baseline in dry eye symptom score of − 2 (95% CI:-3.0,-1.0) for aqueous-deficient and evaporative subtypes and − 1 (95% CI:-3.0,-1.0) for mixed subtype at 8 hours. Median soothing sensation scores were 3 at 0 and 4 hours and 3.5 at 8 hours, with a range of 0– 10. Median (range) tolerability assessment scores were 0 (0– 8) for burning sensation, stinging sensation, blurring, and 0 (0– 10) for foreign body sensation. Tolerability assessment scores by DED subtype confirmed that the majority of patients reported scores in the range of 0– 5 for all components and in all subgroups analyzed.Conclusion: Our study demonstrated that PG-HPG nanoemulsion provided instant/immediate and sustained symptom relief for 8 hours post-single application and was well tolerated in patients with DED, demonstrated by their responses on each of the assessment scales.Keywords: aqueous-deficient dry eye, dry eye disease, evaporative dry eye, propylene glycol-hydroxypropyl guar nanoemulsion ocular lubricant, mixed dry eye

Elizabeth Yeu,1 Steven Silverstein,2 Michel Guillon,3 Marc-Matthias Schulze,4 David Galarreta,5 Sruthi Srinivasan,6 Venkiteshwar Manoj6 1Virginia Eye Consultants, Norfolk, VA 23502, USA; 2Silverstein Eye Centers, Kansas City, MO 64133, USA; 3Ocular Technology Group International, London SW1E 6AU, UK; 4Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario NL2 3G1, Canada; 5Hospital Clinico Universitario de Valladolid, Valladolid Castillay Leon 47011, Spain; 6Alcon Research, LLC, Johns Creek, GA 30097, USACorrespondence: Elizabeth YeuVirginia Eye Consultants, Norfolk, VA 23502, USATel +1 757-622-2200Fax +1 757-961-0011Email eyeu@vec2020.comPurpose: To evaluate the clinical efficacy and safety of propylene glycol/hydroxypropyl-guar (PG-HPG)-based nanoemulsion (Systane® Complete) lubricant eye drops in participants with dry eye disease (DED).Participants and Methods: In this phase IV, open-label, single-arm, interventional, multicenter study, adult participants with DED – subtyped into aqueous deficient, evaporative, and mixed dry eye – were instructed to instill one drop of PG-HPG in each eye twice a day for 28 days. Endpoints included change from baseline in tear film break-up time (TFBUT) (primary) and ocular discomfort visual analog scale (VAS) score at Day 14 and TFBUT at Day 28 (secondary). Safety was assessed throughout the study. Data were analyzed for overall patient cohort and by DED subtypes.Results: A total of 134 participants received treatment (mean age: 56.6 years; female: 75.4%). At Day 14, the mean (standard deviation [SD]) TFBUT increased from 2.6 (1.00) seconds at baseline to 4.2 (2.92) seconds (mean change: 1.5 [2.80] seconds); median change was 0.8 seconds (95% CI: 0.52, 1.19) for the overall cohort; the change was maintained at Day 28 (mean change: 1.4 (2.80) seconds, median change: 0.8 seconds (95% CI: 0.49, 1.17). Subgroup analysis showed a mean change (SD) from baseline in TFBUT of 1.1 (2.41) seconds for aqueous deficient, 2.4 (3.17) seconds for evaporative, and 1.2 (2.63) seconds for mixed dry eye at Day 14, respectively. The ocular discomfort VAS score improved (decreased) from baseline at Day 14 (mean [SD] change: − 17.3 [24.80]) for the overall cohort, − 22.0 [21.73] for aqueous deficient, − 17.6 [24.17] for evaporative and − 13.1 [27.49] for mixed dry eye subgroups). Adverse events (AEs) were reported in 9 (6.7%) participants. No serious AEs were reported during the study.Conclusion: Our study findings demonstrated that PG-HPG-based nanoemulsion lubricant eye drops were effective and well tolerated in participants with DED and all of its subtypes.Keywords: aqueous deficient dry eye, dry eye disease, evaporative dry eye, propylene glycol/hydroxypropyl guar-nanoemulsion ocular lubricant, mixed dry eye

Prema K Chande,1 Rajiv Raman,2 Preethi John,3 Sangeetha Srinivasan4 1Chitkara School of Health Sciences and Lotus College of Optometry, Mumbai, India; 2Sankara Nethralaya, Medical Research Foundation, Chennai, India; 3Chitkara School of Health Sciences, Chitkara University, Rajpura, Punjab, India; 4Vision Research Foundation, Chennai, IndiaCorrespondence: Prema K ChandeLotus College of Optometry, 13th North South Road, Vithal Nagar, Juhu, Mumbai, Maharashtra 400049, India, Tel +91-98-2016-4222Email prema@lcoo.edu.inPurpose: The purpose of this study was to assess contrast sensitivity and macular function test in prediabetes.Methods: Participants aged 25– 45 years with or without diabetes were enrolled and classified as normal, prediabetic, and diabetic based on their HbA1C values. They underwent a comprehensive eye examination, and those with diabetic retinopathy, cataract, glaucoma, and high myopia were excluded. Participants with best-corrected visual acuity of 0 logMAR were included. Contrast-sensitivity function (CSF) was measured using a Pelli–Robson chart, and photo stress–recovery time (PSRT) assessed using direct ophthalmoscopy for the 70 eligible participants. Mean values were compared among the three groups.Design: This was a cross-sectional observational study.Results: In the 70 participants, mean CSF was 1.71± 0.10, 1.64± 0.11, and 1.61± 0.08 log units in the normal, prediabetic, and diabetic groups, respectively (p< 0.001). Similarly, PSRT was found to be 35.80 seconds, 41.63 seconds, and 47.77 seconds in the normal, prediabetic, and diabetic groups, respectively (p< 0.001).Conclusion: The data suggested that reduced CSF and delayed PSRT seen in subjects with prediabetes could give valuable clinical insight into early changes before diabetes and microvascular damage is incurred. A future study with a larger sample could help substantiate the results.Keywords: contrast-sensitivity function, prediabetes, diabetes, HbA1C, photo stress–recovery test

The coronavirus disease 2019 (COVID-19) is highly infectious, with the current pandemic causing significant morbidity and mortality worldwide. As large numbers of frontline healthcare workers (HCWs) have also been infected and several have died, there is much global concern about protective measures for them, particularly those performing surgery or other procedures with close patient contact. Since the beginning of the pandemic, there has been and there remains a shortage in the supply of personal protective equipment (PPE), including the N95 filtering facepiece (FFP) respirator, for HCWs. N95 respirators have filtration efficiency of 95% of aerosol particles. Surgical N95 respirators are used where fluid resistance is also required together with respiratory protection, e.g. during surgery or interventional procedures. The shortage of N95 respirators may be overcome by extended use and reuse - comprising rotation and decontamination by approved techniques. The additional role of powered air-purifying respirators (PAPR) is also discussed.

Gary Jerkins,1 Jack V Greiner,2,3 Louis Tong,4– 6 Jacqueline Tan,7 Joseph Tauber,8 Ali Mearza,9,10 Sruthi Srinivasan11 1Advancing Vision Research, LLC, Nashville, TN, USA; 2Clinical Eye Research of Boston, Boston, MA, USA; 3Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; 4Singapore National Eye Center, National University of Singapore, Singapore; 5Singapore Eye Research Institute, Singapore; 6Duke-National University of Singapore Medical School, Singapore; 7University of New South Wales, Sydney, NSW, Australia; 8Tauber Eye Center, Kansas City, MO, USA; 9Imperial College Healthcare NHS Trust, London, UK; 10Ophthalmic Consultants of London, London, UK; 11Alcon Research, LLC, Johns Creek, GA, USACorrespondence: Gary JerkinsAdvancing Vision Research, LLC, Nashville, TN 37205, USATel +1 615-502-2871Fax +1 615-915-1825Email drjeyeguy@garyjerkins.comPurpose: The aim of this study was to compare the efficacy of two lipid-based lubricant eye drops in patients with lipid-deficient dry eye.Methods: This Phase IV, multicenter, prospective, double-masked study enrolled adults (aged ≥ 18 years) who had a tear film breakup time (TFBUT) of ≤ 15 seconds(s), and unanesthetized Schirmer I test of ≥ 3 mm to ≤ 12 mm in at least one eye, at both screening and baseline visits. Eligible patients (n=231) were randomized (1:1) and received either Systane® Balance (SYSB; n=117) or Refresh® Optive Advanced (RFO-Ad, n=114), four-times a day, for 35 days. The primary endpoint was non-inferiority for change from baseline in TFBUT at Day 35 (non-inferiority was established if the lower limit of the 95% confidence interval (CI) for the difference between the treatment groups was > – 1.0 s); secondary endpoints (test of superiority) were change in TFBUT and global ocular discomfort visual analog scale (VAS) score at Day 35. Other endpoints included the impact of dry eye on everyday life (IDEEL) treatment satisfaction scores (inconvenience and effectiveness) and safety.Results: At Day 35, the mean change from baseline in TFBUT was 0.998 s in the SYSB and 0.868 s in the RFO-Ad groups with a treatment difference: 0.130 s; (95% CI − 0.34, 0.60; P< 0.0001) demonstrating non-inferiority of SYSB to RFO-Ad. The global ocular discomfort VAS scores improved in both groups, with a mean change from baseline of – 9.7 and – 8.8 in SYSB and RFO-Ad groups (treatment difference – 0.8; P=0.62), respectively. No meaningful difference was observed in IDEEL treatment effectiveness and treatment inconvenience scores between SYSB vs RFO-Ad (P> 0.05 for treatment difference). Both treatments were well tolerated.Conclusion: SYSB lubricant eye drops were non-inferior to RFO-Ad for improvement in TFBUT in patients with lipid-deficient dry eye. Both lubricant eye drops improved TFBUT and ocular discomfort scores in patients with lipid-deficient dry eye.Keywords: dry eye, lipid-deficient, evaporative dry eye, lubricant eye drops, non-inferiority

Caroline A Blackie,1 Christy A Coleman,1 Kelly K Nichols,2 Lyndon Jones,3 Peter Q Chen,4 Ron Melton,5 David L Kading,6 Leslie E O’Dell,7 Sruthi Srinivasan3 1TearScience Inc., Morrisville, NC, 2School of Optometry, The University of Alabama at Birmingham, AB, USA; 3School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada; 4Clayton Eye Center, Morrow, GA, 5Charlotte Eye Ear Nose and Throat Associates, Charlotte, NC, 6Specialty Eyecare Group, Kirkland, WA, 7May Eye Care Center and Associates, Hanover, PA, USA Purpose: To evaluate the effect of a single vectored thermal pulsation (VTP) treatment in contact lens wearers with meibomian gland dysfunction (MGD) and dry eye symptoms.Methods: The prospective, nonsignificant risk, open-label, randomized, multi-center clinical trial included 55 soft contact lens (SCL) wearers with MGD and evaporative dry eye. Subjects were randomized to the single VTP treatment group or an untreated control. The controls received a crossover VTP treatment at 3 months (crossover treatment group). Primary effectiveness measures were meibomian gland secretion (MGS) score and Standard Patient Evaluation of Eye Dryness (SPEED) that were evaluated at baseline, at 1 and 3 months post-VTP treatment, and at 1 month post-VTP treatment in the crossover treatment group. Exploratory variables included fluorescein tear break-up time (TBUT), lid wiper epitheliopathy (LWE), lid parallel conjunctival folds (LIPCOF), ocular surface staining, frequency of over-the-counter (OTC) drop use, and hours of comfortable contact lens wear.Results: At 3 months, the treatment group showed significantly greater mean change from baseline in MGS (12.4±9.1 vs 1.4±6.4, p

No abstract available. Article truncated after 150 words. A 35-year-old lady with a history of depression and anxiety presented to the emergency room with worsening shortness of breath after receiving polymethylmethacrylate (PMMA) injections in her buttock for cosmetic purposes in Mexico. Immediately after the injection in the outpatient office, she became acutely short of breath, tachypneic, and tachycardic. She was brought to the emergency room where she was hypoxic with oxygen saturations in the low 80s on a non-rebreather, tachypneic with a respiratory rate in the 40s, and tachycardic with heart rates in 140s. She was emergently intubated. A CTA of the chest demonstrated bilateral ground glass opacities throughout, most pronounced in the upper lobes which progressed to significant bilateral airspace disease consistent with acute respiratory distress syndrome (Figure 1). Her neurological examination declined over the course of her hospitalization. An MRI of the brain with contrast demonstrated bilateral foci of susceptibility artifact throughout the entirety of the …

Basosquamous carcinoma (BSC) is an uncommon skin malignancy with significant invasive and metastatic potential. There are currently no clear management guidelines. This study evaluates the management and outcomes of patients diagnosed with BSC over a 7-year period. We present an evidence-based unit protocol for the management of BSC. All patients treated for BSC between 2009 and 2015 were reviewed. Data collected included patient demographics, tumour-specific information, management strategy, presence of recurrence or metastasis, and details of follow-up. 74 patients were identified, making this one of the largest cohorts of BSC patients reported. Mean age at diagnosis was 75.4 years, with a male:female ratio of 1.6:1. The most common tumour site was the head and neck (n=43, 58.1%). All tumours were graded at pT1 (n=51) or pT2 (n=23). Inadequate excision occurred in 17 patients (23%). Mean excision margins were >4mm peripherally and deep. Inadequately excised BSCs were further treated with wide local excision (n=6) or radiotherapy (n=5), or both (n=1). There were no cases of local recurrence or metastatic disease. This study demonstrates a cohort of patients with BSCs that appear less aggressive than previously reported. Current management with surgical excision appears to produce adequate results. However, an evidence-based guideline is still lacking.

Sree N Harsha,1 Bander E Aldhubiab,1 Anroop B Nair,1 Ibrahim Abdulrahman Alhaider,1 Mahesh Attimarad,1 Katharigatta N Venugopala,1 Saminathan Srinivasan,2 Nagesh Gangadhar,2 Afzal Haq Asif3 1Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia; 2Department of Pharmaceutics, East Point College of Pharmacy, Bangalore, India; 3Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia Abstract: Diabetes is considered one of the main threats to global public health in this era. It is increasing rapidly in every part of the world; the prevalence of the disease will grow to the point where 366 million people will be affected by 2030. The prevalence of diabetes mellitus (DM) in the Saudi population is high, and the majority of patients suffer from type 2 DM. Marketed oral antidiabetic drugs have indicated poor tolerability during chronic treatments, and this contributes to the moderately large proportion of type 2 DM patients that remain inadequately managed. Vildagliptin nanospheres were prepared with aminated gelatin using a spray-drying method; narrow particle-size distribution was seen at 445 nm. The angle of repose was found to be θ

Alicia Fernandez-Fernandez,1,2 Romila Manchanda,1,3 Denny Carvajal,1,4 Tingjun Lei,1,5 Supriya Srinivasan,1 Anthony J McGoron11Biomedical Engineering Department, Florida International University, Miami, FL, USA; 2Physical Therapy Department, Nova Southeastern University, Fort Lauderdale, FL, USA; 3Chemistry Department, Galgotias University, Greater Noida, UP, India; 4Mount Sinai Medical Center, 5Cirle, Miami, FL, USAAbstract: Near-infrared dyes can be used as theranostic agents in cancer management, based on their optical imaging and localized hyperthermia capabilities. However, their clinical translatability is limited by issues such as photobleaching, short circulation times, and nonspecific biodistribution. Nanoconjugate formulations of cyanine dyes, such as IR820, may be able to overcome some of these limitations. We covalently conjugated IR820 with 6 kDa polyethylene glycol (PEG)-diamine to create a nanoconjugate (IRPDcov) with potential for in vivo applications. The conjugation process resulted in nearly spherical, uniformly distributed nanoparticles of approximately 150 nm diameter and zeta potential -0.4±0.3 mV. The IRPDcov formulation retained the ability to fluoresce and to cause hyperthermia-mediated cell-growth inhibition, with enhanced internalization and significantly enhanced cytotoxic hyperthermia effects in cancer cells compared with free dye. Additionally, IRPDcov demonstrated a significantly longer (P

Studies are conducted in semicontinuous anaerobic reactors of 2 L Capacity with effective volume of 1.5 L. Experiments were carried out in the mesophilic temperature range maintained at 35°C in a thermostat, and parallel experiments were performed at ambient temperature on biogas production from the month of Februray to August. The reactors were operated with an organic loading rate of 0.5 gVS/L/d with 25 days HRT. The feed stock used for the study was vegetable market waste obtained from Koyambedu vegetable market. The specific biogas production was found to be 0.530 L gVS add-1 for the reactor operated at mesophilic temperature and in the range of 0.431 to 0.732 L gVSadd -1 for the reactor operated in the ambient temperature condition from the month of February to August. The daily biogas production was found to be similar (approximately 350 mL/d) when reactors were operated at mesophilic and ambient temperature except for the period of May and June wherein higher amount of daily biogas production (472 and 529 mL/d) was observed in the reactor operated at ambient temperature. The ratio of total VFA and alkalinity and propionic acid to acetic acid (PA/AA) was found to be in the range of 0.25 – 0.4 and 0.34 - 1.38 during the operation of the reactor for the entire period, which was within the range reported for digester stability.