Prospective Case Study Research Articles

Evaluating the 1-year success and safety of ab interno canaloplasty in combination with cataract surgery in glaucoma patients

PurposeTo evaluate the treatment success and safety of ab interno canaloplasty (AbiC) combined with cataract surgery in glaucoma patients.MethodsThe prospective case study included 43 eyes that received an AbiC combined with cataract surgery (age 73.3 ± 8.2 years). The 360° microcatheterization and viscodilatation of the Schlemm’s canal was conducted using VISCO 360 (Sight Sciences, CA, USA). The observation period was 12 months with visits at 2 and 6 as well as 12 months, 7 eyes were lost to follow up.ResultsThe preoperative IOP was 19.8 ± 4.9 mmHg and was reduced to 14.5 ± 2.8 mmHg 12 months after AbiC (p < 0.0001). The relative IOP reduction was 23.6 ± 23.1% after 12 months. Topical glaucoma medication was also reduced from 2.4 ± 1.1 drugs to 1.1 ± 1.4 (p < 0.001) after 12 months. The complete surgical success rate (defined as IOP < 18 mmHg without topical therapy) was 31.6% whereas the qualified surgical success was 89.5% (IOP < 18 mmHg, with local therapy) There were no relevant intra- or postoperative complications.ConclusionAbiC in combination with cataract surgery is a safe and effective procedure to achieve a significant reduction of IOP and local glaucoma medication 12 months after surgery.

Effects of sleeve gastrectomy and Roux-en-Y gastric bypass on pharmacokinetics of lamotrigine and valproate: A cohort study

BackgroundBariatric surgeries may affect the pharmacokinetics of medications through alterations of the gastrointestinal physiology. Pharmacokinetic changes of first-line antiseizure medications such as lamotrigine and valproate following bariatric treatment have received little research attention so far. MethodsIn our prospective case study we included lamotrigine- or valproate-treated patients undergoing bariatric surgery at hospitals in Central Norway. Lamotrigine and valproate concentrations were assessed using serial blood samples over a dose interval, before and one, six and twelve months following surgery. Primary outcomes included changes in area under the time-concentration curve (AUC) with secondary outcomes comprising full pharmacokinetic profiling. ResultsSix lamotrigine-treated obese patients undergoing Roux-en-Y gastric bypass (RYGB) (n = 3) and sleeve gastrectomy (SG) (n = 3), as well as two valproate-treated patients (one undergoing RYGB and one SG) were included. Largest changes for dose-adjusted AUC values after surgery were seen in RYGB-treated patients on lamotrigine (average increases of 38 % one month and 32 % 12 months postoperatively). In the patients on valproate, AUC values were decreased by 22 % after 6 months and by 30 % after 12 months. The interindividual variation was high. Formal statistical testing was not done due to few cases. ConclusionPostoperative pharmacokinetic changes for lamotrigine and valproate were modest, but for lamotrigine changes may be larger in patients undergoing RYGB than in those undergoing SG. Given the substantial interindividual variation, therapeutic drug monitoring should be used to capture pharmacokinetic changes and guide dose adjustments after bariatric surgery.

Covering corneal stromal lenticule for macular hole in pathological myopia.

To evaluate the clinical effect of a new surgery technique (covering corneal stromal lenticule, CSL) for macular hole (MH) in pathological myopia. This was a prospective non-randomized series case study. Fourteen eyes of 14 patients whose axial length were more than 29 mm and suffered from MH and macular hole retinal detachment (MHRD) were included in this study. All cases were treated with 25-gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, covering CSL and C3F8 gas tamponade. These cases were followed for 6mo, and the best-corrected visual acuity (BCVA), healing status of MH, the reattached rate of retinal detachment (RD), and reoperation rate were analyzed. All cases were successfully performed the surgery and the postoperative follow-up was completed. After surgery, MHs were healed in all 14 eyes (100%, 14/14) after assessed by optical coherence tomography. The reattachment of retina was achieved in all 6 eyes (100%, 6/6) with MHRD. BCVA was improved in 12 eyes (85.71%, 12/14), and had no significant change in 2 eyes (14.29%, 2/14). The overall mean BCVA was improved from 1.80±0.77 to 0.82±0.46 logMAR (F=10.46, P<0.01). No serious complications occurred in all cases. The new surgery technique (covering CSL) has high reattached rate of RD and high healing rate of MH in pathological myopia in the preliminary study. And it can effectively improve the visual function of patients. This new technique offers meaningful new ideas for treating refractory MH in pathological myopia.

A regionalized social life cycle assessment of a prospective value chain of second-generation biofuel production

The German Bioeconomy focuses on innovation and in particular on the smart mobilization of resources to produce high-value-added bio-based products, processes and services. In the case of the production of biofuels, the demand for reducing fossil fuel utilization has placed the focus on second-generation biofuel value chains, which mobilize residual streams as their main biomass feedstocks. However, while the environmental impacts of these value chains have been studied using life-cycle approaches, little attention has been given to their social implications. This work aims to fill this gap by assessing the potential social hotspots associated with the production of second-generation biofuel through a prospective case study in Eastern Germany. We use the RESPONSA framework, a regionalized social life cycle assessment developed specifically for assessing value chains of the German Bioeconomy. The results for 22 social indicators reveal that while biofuel production generates employment opportunities, aspects such as working conditions, support for professional qualification, and workers’ participation have an overall poor social performance. The results lead to conclude that socioeconomic issues related to advanced biofuel production persist, exhibiting a socioeconomic disparity, with employment creation being the only area of socioeconomic benefit. Yet, there is a contradiction between job creation and addressing broader social issues in the biofuel industry, which underlines the need for a balanced approach to reconcile environmental objectives with social development. These results provide an opportunity to discuss how to mitigate the negative social impacts of second-generation biofuel production in the region.

Bioresorbable Scaffold Use in Coronary Chronic Total Occlusions: A Long-Term, Single-Center Follow-Up Study.

Background and Objectives: Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is often associated with longer total stent length. Our aim was to evaluate the long-term safety and effectiveness of bioresorbable scaffold (BRS) implantation in CTO to avoid using a full metal jacket. Materials and Methods: We conducted a single-center prospective longitudinal case study including 34 patients who underwent PCI of CTO with at least one BRS and drug-eluting stent (DES) implantation (n = 27) or BRS-only at the Latvian Centre of Cardiology between 2016 and 2018. Quantitative coronary angiography (QCA) and intravascular ultrasound were performed during the index procedure and long-term follow-up. Results: Of 34 patients with a mean age of 60.6 ± 9.5 years, 76.5% were male. The most common CTO artery was the right coronary artery (73.5%, n = 25). The median length of occlusion was 23.0 mm (interquartile range (IQR) = 13.9-32.7), with a total mean BRS/DES length of 49.6 ± 20.4 mm. During the median follow-up of 5.6 years (IQR = 5.0-5.9), the primary endpoint of target vessel re-occlusion occurred in 5.9% (n = 2) of patients. Target lesion revascularization (TLR) was performed in 35.3% (n = 12) of patients, with a mean time to TLR of 62.5 (95% confidence interval (CI), 53.9-71.2) months. Through QCA, there was a statistically significant increase in median residual diameter stenosis (20.1-31.4%, p < 0.01) and residual length of stenosis (5.2-7.1%, p = 0.04) compared with the index procedure. Conclusions: Our study demonstrates that BRS is a safe and feasible option for PCI of CTO, allowing for the avoidance of long segment stenting and ensuring long-term patency of the coronary artery.

Nursing Care for the Discomfort Disorder in 'S' Diagnosed with Dyspepsia in the Sanur Room, Sumber Kasih Hospital, Cirebon City

Dyspepsia is a non-communicable disease that is common around the world, including Indonesia. This disease is often accompanied by discomfort or pain in the upper abdomen which can interfere with the patient's quality of life. This study aims to evaluate the effectiveness of nursing care in patients with dyspepsia diagnosis, especially in meeting the need for a sense of security and comfort through relaxation techniques. This study uses a qualitative method with a prospective case study approach. Data collection techniques include observation, interviews, and documentation studies, which are then comprehensively analyzed. The results showed that after 2x24 hours of nursing treatment with relaxation therapy in patient "S" diagnosed with dyspepsia, a decrease in the pain scale was found from 4 to 2. This shows that relaxation techniques are effective in reducing pain and improving patient comfort. The study implies that the application of relaxation techniques can be one of the effective non-pharmacological interventions in pain management in dyspepsia patients. These findings can be used as a reference in nursing practice to improve the quality of care for patients with similar conditions.

Functional outcomes and complications of anatomical plate and screw fixation in closed olecranon fractures: A prospective case study

Functional outcomes and complications of anatomical plate and screw fixation in closed olecranon fractures: A prospective case study

Perception of optometrists on causes of professional discordance among eye care professionals and its impact on refractive error service delivery in Kenya.

To evaluate the perception of optometrists on causes of professional discordance among eye care professionals and its impact on refractive error service delivery in Kenya. This was a prospective qualitative case study conducted between January and June 2022 among optometrists registered with the Optometrists Association of Kenya. The data was collected through telephonic interviews. Purposive sampling was used to recruit the participants. Descriptive statistics were presented using frequency, percentages and with p values. Thematic analysis was carried out for qualitative data using the NVivo Software, Version 11. It was an iterative process consisting of both deductive and inductive processes. Out of the 100 respondents, 37 (37%) were female. The mean age for the participants was 30.5years with majority being in the age group 30-34years. There was no statistically significant difference between the ages of males and females (p = 0.132) Most participants 82 (82%) had practiced for more than 4years. The participants reported; mistrust among eye care professionals, employment sector, specialty, undermining the potential of other cadres within the eye care ecosystem, confusion and misconception and negative attitude as the perception of optometrists on causes of professional discordance among eye care professionals on refractive error service delivery. All of the optometrists agreed that professional discordance exists among eye care professionals in Kenya which potentially impacts negatively on refractive error service delivery. Professional discordance remains an underrated barrier which negatively impacts on refractive error service delivery. However, to achieve effective refractive error coverage, a strengthened team approach among eye care professionals is desirable in a country with limited human resource such as Kenya.

#2972 Comparison cTPE &amp; DFPP in PIDC patients for procedure time, clinical, biological tolerance and microcosting estimation: lymphapheresis study

Abstract Background and Aims Therapeutic plasmapheresis (TP) is an established therapy in different pathology according to international guidelines. There is different method of TP such as single plasma exchange (SPE) and Double plasmafiltration (DFPP) defined as non selective or semi selective method. Centrifugal (cSPE) and Filtration-membrane based (mSPE) are two different methods of SPE. These methods were already compared but few data exist about comparison of cSPE and DFPP. Objective of this ancillary study is to compare procedure time, biological variation and microcosting of patients treated with cSPE vs DFPP in a prospective single case study (Moranne O BMC neurology 2022). Method Lymphapheresis study included 5 patients with idiopathic CIPD treated with chronic TP with regular interval time and clinically stable. Vascular access was central venous catheter (CVC) for 2 patients and peripheral venous access (PVA) for 3 others. cSPE or DFPP was randomized at inclusion then patient was alternatively treated for 6 consecutive session by SPEc (Comtec, FMC KABI) or DFPP (HF 440 Infomed) sessions for a total of 30 session. The target plasma TPV) volume to be processed was 1.5 of total plasma volume and was not modified during the study. Anticoagulation was non fractionated heparin for DFPP with CVC and regional citrate for others. For each session replacement fluid was 100% human serum albumin (HSA) 4% for cSPE and 500 mls HSA for DFPP. We compare cSPE and DFPP considering each patient for (i) time session (including time preparation, time device and time before living) (ii) clinical tolerance (iii) biological tolerance (variation before and after session of Hb, Platelet, Fibrinogen) and (iv) microcosting. Quantitative values were described with median interquartile and compared with mixed model regression analysis. Results Patients have median age of 62 [56-68] years with 100% male and a BMI of 27 [23-31]. Patients were treated alternatively with 15 session of cSPE and 15 session of DFPP without difference of TPV between session (4500 mls) but significant higher blood volume process because of lower plasma fraction filtration with DFPP. Time session was not different between TP method but depend on vascular access. No difference was observed for clinical tolerance and Hemoglobin variation between methods. However a significant higher decreased of platelet and fibrinogen was observed during session with cSPE vs DFPP. The quantity of SHA infused during session was significantly higher with cSPE vs DFPP (180 g vs 20 g). Finally according to hospital's perspectives the cost is not very different between cSPE and DFPP but depends on specific material resources and pharmaceutical products of methods. Conclusion We show some differences between methods.

Insights into drug development with quantitative systems pharmacology: A prospective case study of uncovering hyperkalemia risk in diabetic nephropathy with virtual clinical trials

The quantitative systems pharmacology (QSP) approach is widely applied to address various essential questions in drug discovery and development, such as identification of the mechanism of action of a therapeutic agent, patient stratification, and the mechanistic understanding of the progression of disease. In this review article, we show the current landscape of the application of QSP modeling using a survey of QSP publications over 10 years from 2013 to 2022. We also present a use case for the risk assessment of hyperkalemia in patients with diabetic nephropathy treated with mineralocorticoid receptor antagonists (MRAs, renin-angiotensin-aldosterone system inhibitors), as a prospective simulation of late clinical development. A QSP model for generating virtual patients with diabetic nephropathy was used to quantitatively assess that the nonsteroidal MRAs, finerenone and apararenone, have a lower risk of hyperkalemia than the steroidal MRA, eplerenone. Prospective simulation studies using a QSP model are useful to prioritize pharmaceutical candidates in clinical development and validate mechanism-based pharmacological concepts related to the risk-benefit, before conducting large-scale clinical trials.

Association between White Matter T2 Hyper-Intense Signals in Fetal Brain Magnetic Resonance Imaging and Neurodevelopment of Fetuses with Cytomegalovirus Infection.

An association between subtle changes in T2 white matter hyper-intense signals (WMHSs) detected in fetal brain magnetic resonance imaging (fbMRI) and congenital cytomegalovirus (CMV) infection has been established. The research aim of this study is to compare children with congenital CMV infection with neurodevelopment outcome and hearing deficit with and without WMHSs in a historic prospective case study cohort of 58 fbMRIs. Of these, in 37 cases, fbMRI was normal (normal group) and WMHSs were detected in 21 cases (WMHS group). The median infection week of the WMHS group was earlier than the normal fbMRI group (8 and 17 weeks of gestation, respectively). The proportion of infants treated with valganciclovir in the WMHS group was distinctly higher. Hearing impairment was not significantly different between the groups. VABS scores in all four domains were within normal range in both groups. The median score of the motor skills corrected for week of infection was better in the WMHS group. A multivariate analysis using the week of infection interaction variable of WMHS and valganciclovir treatment showed better motor score outcomes in the valganciclovir treatment group despite an earlier week of infection. WMHSs were not associated with neurodevelopmental outcome and hearing deficit. In our cohort, valganciclovir treatment may have a protective effect on fetuses with WMHSs by improving neurodevelopmental outcome.

Emerging potential of Matra Basti in facilitating engagement of fetal vertex in primigravidae: A case series

Abstract Although the association between fetal head engagement and normal vaginal delivery is debated, reports indicate that nulliparous women with an unengaged fetal head at term are more likely to require a cesarean section. Acknowledging that engagement is the first step in the mechanism of labor, it is clear that labor cannot progress without passing through the engagement phase. The aim and objective of this study are to evaluate the role of Matra Basti in the engagement of fetal vertex in primigravidae women. A prospective case study was carried out with five primigravidae women who presented at a gestational age of 34 weeks or more with a floating fetal vertex, with five-fifths to four-fifths part of the fetal head palpable above the pelvic brim, and who met the inclusion criteria. The cephalic presentation was confirmed with recent ultrasound findings, while the engagement of the vertex was assessed clinically by abdominal in fifths. Matra Basti with Shudha Bala (Sida cordifolia Linn.) Taila was administered to the five enrolled cases after the completion of 35 weeks of gestation, as per protocol. All five cases showed fetal head engagement following the administration of a minimum of one to a maximum of three sittings (average of 2) of Matra Basti at an average gestational age of 37 weeks. All the cases resulted in uneventful vaginal deliveries without any intrapartum or postpartum feto-maternal complications. The present study offered a favorable outcome in terms of engagement of the fetal vertex and subsequent uneventful vaginal delivery, suggesting the potential of Matra Basti in facilitating the engagement of an unengaged vertex in primigravidae.

Estimating Asymptomatic and Symptomatic Transmission of the COVID-19 First Few Cases in Selenge Province, Mongolia.

Following the first locally transmitted case in Sukhbaatar soum, Selenge Province, we aimed to investigate the ultimate scale of the epidemic in the scenario of uninterrupted transmission. This was a prospective case study following the locally modified WHO FFX cases generic protocol. A rapid response team collected data from November 14 to 29, 2020. We created a stochastic process to draw many transmission chains from this greater distribution to better understand and make inferences regarding the outbreak under investigation. The majority of the cases involved household transmissions (35, 52.2%), work transmissions (20, 29.9%), index (5, 7.5%), same apartment transmissions (2, 3.0%), school transmissions (2, 3.0%), and random contacts between individuals transmissions (1, 1.5%). The posterior means of the basic reproduction number of both the asymptomatic cases and the presymptomatic cases (1.35 [95% CrI 0.88-1.86] and 1.29 [95% CrI 0.67-2.10], respectively) were lower than that of the symptomatic cases (2.00 [95% Crl 1.38-2.76]). Our study highlights the heterogeneity of COVID-19 transmission across different symptom statuses and underscores the importance of early identification and isolation of symptomatic cases in disease control. Our approach, which combines detailed contact tracing data with advanced statistical methods, can be applied to other infectious diseases, facilitating a more nuanced understanding of disease transmission dynamics.

STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOMES OF OPEN REDUCTION AND INTERNAL FIXATION OF PROXIMAL HUMERUS FRACTURES WITH PROXIMAL HUMERUS LOCKING PLATE

Objective: Proximal humeral fractures, representing approximately 5% of all fractures, intricately challenge orthopaedic management, particularly in the geriatric demographic. Displaced variants, frequently encountered in the elderly, prompt surgical intervention to mitigate notable morbidity. The introduction of angular stable proximal humerus locking plates heralds a pivotal shift, purveying biomechanical robustness in osteoporotic contexts. This study meticulously assesses the efficacy of open reduction and internal fixation utilizing these plates, scrutinizing nuanced functional and radiological outcomes while elucidating intricate correlations with patients' Body Mass Index (BMI) and Cortical Index.&#x0D; Methods: A prospective case study involving 31 adult patients with proximal humerus fractures unfolded over 1.5 y within the bastions of the Department of Orthopaedics at BARC Hospital. Inclusion criteria encompassed specific fracture morphologies, while exclusion criteria diligently precluded medically infirm subjects and isolated tuberosity fractures. Radiographic scrutiny encompassed parameters such as cortical index, fracture classification, neck-shaft angle, GT to AS distance, and medial hinge reduction. Functional assessments, including QuickDASH and Constant-Murley scoring, were conducted postoperatively at 3 and 6 mo. Correlation analyses interfacing with BMI and cortical index engendered a profound understanding.&#x0D; Results: Demographic analysis revealed a preponderance of participants (32.3%) within the 61-70 age bracket, with 54.8% manifesting Neer 2-part fractures. The cohort exhibited an average BMI of 26.27 (SD = 4.29), coupled with a Cortical Index averaging 0.216 (SD = 0.012). Significantly improved QuickDASH scores, dwindling from 25.54±6.74 at 3 mo to 13.16±8.57 at 6 mo (p&lt;0.0001), underscored noteworthy clinical advancement. Complications, while relatively infrequent, manifested in 6.5% as screw penetration and 9.7% as superficial infection.&#x0D; Conclusion: This study offers profound insights into the efficacy of angular stable proximal humerus locking plates for proximal humerus fractures. The discerned stability in anatomical metrics, coupled with substantial functional amelioration and a judiciously low complication milieu, emphatically underscores the procedural effectiveness. Correlation analyses unmask intricate associations with BMI and cortical index. Despite auspicious outcomes, ongoing research imperatively seeks refinement of understanding and the delineation of prophylactic measures for complications.

Lessons learned from implementation of four HIV self-testing (HIVST) distribution models in Zambia: applying the Consolidated Framework for Implementation Research to understand impact of contextual factors on implementation

BackgroundAlthough Zambia has integrated HIV-self-testing (HIVST) into its Human Immunodeficiency Virus (HIV) regulatory frameworks, few best practices to optimize the use of HIV self-testing to increase testing coverage have been documented. We conducted a prospective case study to understand contextual factors guiding implementation of four HIVST distribution models to inform scale-up in Zambia.MethodsWe used the qualitative case study method to explore user and provider experiences with four HIVST distribution models (two secondary distribution models in Antenatal Care (ANC) and Antiretroviral Therapy (ART) clinics, community-led, and workplace) to understand factors influencing HIVST distribution. Participants were purposefully selected based on their participation in HIVST and on their ability to provide rich contextual experience of the distribution models. Data were collected using observations (n = 31), group discussions (n = 10), and in-depth interviews (n = 77). Data were analyzed using the thematic approach and aligned to the four Consolidated Framework for Implementation Research (CFIR) domains.ResultsImplementation of the four distribution models was influenced by an interplay of outer and inner setting factors. Inadequate compensation and incentives for distributors may have contributed to distributor attrition in the community-led and workplace HIVST models. Stockouts, experienced at the start of implementation in the secondary-distribution and community-led distribution models often disrupted distribution. The existence of policy and practices aided integration of HIVST in the workplace. External factors complimented internal factors for successful implementation. For instance, despite distributor attrition leading to excessive workload, distributors often multi-tasked to keep up with demand for kits, even though distribution points were geographically widespread in the workplace, and to a less extent in the community-led models. Use of existing communication platforms such as lunchtime and safety meetings to promote and distribute kits, peers to support distributors, reduction in trips by distributors to replenish stocks, increase in monetary incentives and reorganisation of stakeholder roles proved to be good adaptations.ConclusionHIVST distribution was influenced by a combination of contextual factors in variable ways. Understanding how the factors interacted in real world settings informed adaptations to implementation devised to minimize disruptions to distribution.

Unveiling denture-induced oral lesions: A comprehensive study on classification and pain assessment.

Denture-induced oral Lesions (DIOLs) often manifests shortly after the placement or adjustment of new or realigned dentures, frequently resulting in severe pain and discomfort. This study aimed to classify DIOLs placing a particular emphasis on assessing the associated pain. A prospective case study was conducted involving 126 patients who were fitted with a total of 193 dentures of various types at the Hadassah School of Dental Medicine. All patients underwent comprehensive intra-oral examinations within 1-8 weeks following denture delivery, completed symptom questionnaires and had their medical records reviewed. Key variables documented included age, gender, overall health status, denture type, and a detailed description of the DIOLs. The description encompassed factors such as lesion location, shape, colour, size, border characteristics, ulcerative appearance, membrane coverage, 3D morphology (elevated, immersed and flat) and patient-reported Verbal Pain Score (VPS) when touching the DIOLs, when wearing the denture, and when not wearing the denture. Notably, 25.4% of denture wearers required no adjustments, while 14.4% necessitated more than three revisions. A majority (71.8%) of DIOLs cases were associated with mandibular complete dentures, primarily situated on the alveolar ridge. The mean VPS indicated a pain intensity of 7 ± 2.1, with temporary dentures in both jaws causing the most discomfort. Implant-supported overdentures were particularly painful when placed in the mandible. Additionally, VPS scores were higher among older individuals and those with prior prosthetic experiences. A significant correlation was observed between pain intensity and presence of chronic health condition (0.036). This study revealed distinct characteristics of DIOLs and highlighted the multifactorial nature of pain experienced following the development of DIOLs. Insights into the influence of patient and denture characteristics on DIOLs and pain intensity can guide healthcare professionals in optimising patient comfort and satisfaction.

REFRACTIVE OUTCOMES COMPARISON IN LIMBAL RELAXING INCISION BASED ON INCISION DEPTH IN MANAGING CORNEAL ASTIGMATISM DURING CATARACT SURGERY

Abstract&#x0D; Introduction &amp; Objectives : Introduction: Prevalence of clinically significant astigmatism of more than 1D can be found in 20 to 50% population those undergo cataract surgery. During phacoemulsification surgery, astigmatism could be corrected by toric intraocular lens (IOL) or incisional technique such as limbal relaxing incision (LRI). LRI are safe and inexpensive procedures thus results in satisfying outcomes with surgeon’s precise phacoemulsification incision and accurate LRI arc position, which most appropriate treatment choice for surgeons in rural area that has problematic access towards IOL supply. Objectives: To compare refractive outcomes of LRI technique with incision depth of 500um and 600um using diamond knife corresponding with phacoemulsification cataract removal.&#x0D; Methods : Prospective cumulative interventional case study included 30 eyes of consecutive cataract corneal astigmatic patients power &gt;1.0D those undergoing LRI and phacoemulsification. Length, numbers, and arc position of LRI were calculated on LRI Calc application to obtain best results in minimal astigmatism residual. Uncorrected visual acuity, intraocular pressure, and keratometric cylinder were also analysed before surgery, Day-1, Day-7, and 1-Month post-operation.&#x0D; Results : Day-1 follow-up keratometry shown that corneal astigmatism was still fluctuated, day-7 follow-up was even better with significant improvement in visual acuity. 1-Month post-operation has reached target correction. Moreover, visual acuity and residual astigmatism was better in 600um incision depth.&#x0D; Conclusion : When toric IOLs are not available or contraindicated, LRI could be a good option in correcting astigmatism with better refractive outcomes trend in 600um incision depth. LRI results better be evaluated in day-7 and 1-Month post-LRI, which may due to more stable corneal surface.

REFRACTIVE OUTCOMES COMPARISON IN LIMBAL RELAXING INCISION BASED ON INCISION DEPTH IN MANAGING CORNEAL ASTIGMATISM DURING CATARACT SURGERY

Introduction &amp; ObjectivesIntroduction: Prevalence of clinically significant astigmatism of more than 1D can be found in 20 to 50% population those undergo cataract surgery. During phacoemulsification surgery, astigmatism could be corrected by toric intraocular lens (IOL) or incisional technique such as limbal relaxing incision (LRI). LRI are safe and inexpensive procedures thus results in satisfying outcomes with surgeon’s precise phacoemulsification incision and accurate LRI arc position, which most appropriate treatment choice for surgeons in rural area that has problematic access towards IOL supply. Objectives: To compare refractive outcomes of LRI technique with incision depth of 500um and 600um using diamond knife corresponding with phacoemulsification cataract removal.&#x0D; Methods : Prospective cumulative interventional case study included 30 eyes of consecutive cataract corneal astigmatic patients power &gt;1.0D those undergoing LRI and phacoemulsification. Length, numbers, and arc position of LRI were calculated on LRI Calc application to obtain best results in minimal astigmatism residual. Uncorrected visual acuity, intraocular pressure, and keratometric cylinder were also analysed before surgery, Day-1, Day-7, and 1-Month post-operation.&#x0D; Results : Day-1 follow-up keratometry shown that corneal astigmatism was still fluctuated, day-7 follow-up was even better with significant improvement in visual acuity. 1-Month post-operation has reached target correction. Moreover, visual acuity and residual astigmatism was better in 600um incision depth.&#x0D; Conclusion : When toric IOLs are not available or contraindicated, LRI could be a good option in correcting astigmatism with better refractive outcomes trend in 600um incision depth. LRI results better be evaluated in day-7 and 1-Month post-LRI, which may due to more stable corneal surface.

Using Myofascial Therapy to Improve Psychological Outcomes, Quality of Life, and Sexual Function in Women with Chronic Pelvic Pain—A Case Series

(1) Background: Chronic pelvic pain represents a prevalent condition afflicting women. Research has highlighted the presence of psychological distress and sexual dysfunction in these individuals. Regrettably, myofascial pelvic pain often goes unnoticed and untreated despite its integral role in chronic pelvic pain. (2) Methods: By employing a longitudinal case series design, we studied eighteen women afflicted with chronic pelvic pain. Over a 12-week period, these participants underwent 15 sessions of myofascial therapy. Data encompassing sociodemographic particulars, the Hospital Anxiety and Depression Scale, the Medical Outcomes Study Short Form 12 questionnaire, and the Female Sexual Function Index were collected at baseline, 12 weeks post-intervention, and again at the 24-week mark. (3) Results: After a span of 12 weeks subsequent to the intervention, the participants demonstrated noteworthy enhancements (p &lt; 0.001) in their depression and anxiety scores, their overall Mental Component scores in the Medical Outcomes Study Short Form 12, as well as sexual function. Importantly, these gains were sustained at the 24-week juncture post-therapy. (4) Conclusions: The findings stemming from our prospective case study underscore the potential utility of myofascial therapy for women grappling with chronic pelvic pain. This form of intervention yields significant advancements in alleviating anxiety, depression, health-related quality of life, and sexual function.

Management of the Diabetic Microalbuminuria with Ayurvedic intervention- A Case Report

Background: One of the most prevalent side effects of diabetes, diabetic nephropathy causes Hypoalbuminemia, chronic kidney damage and end-stage renal failure worldwide. This study was performed for the effectiveness of the Ayurvedic treatment in the patient presented with the complications of Diabetic Microalbuminuria with special reference of Kaphaja Shotha. A 67-year-old, male patient consulted to the Ayurveda hospital with generalized body swelling, difficulty in breathing on the rest, Fatigue for 2 years, following secondary prevention for two years. Design: Single Case report. Materials and Methods: In this prospective case study, conducted on a subject experiencing edema as a complication of diabetic nephropathy for two years, the individual was admitted to the Indoor Patient Department of Medicine. Over a period of three months, the subject was assessed every 15 days. The intervention involved the administration of oral medications including mainly Gokshuradi guggulu, Punarnavadi guggulu, Hingwastak Churna, Triphala Churna, Syrup Neeri KFT, and Gomutra Haritaki. The edema reduced progressively, and there was an alleviation of associated symptoms such as difficulty in breathing and fatigue. Additionally, the subject showed improvement in renal function parameters and reported an enhanced sense of well-being. Results: Laboratory investigation showed protein in urine and hypoalbuminemia with normal blood urea and S. Creatinine., which was corrected after treatment, increased serum albumin from 1.9 (g/dl) to 3.9(g/dl) and serum globulin from 1.7(g/dl) to 2.7 (g/dl). After 18 days, a significant improvement was noted in all the clinical features, blood investigations, Chest X ray of the patient and no any unwanted effects were noted during the study period. The case was managed without encountering any adverse effects, following the treatment regimen for Shotha. Keywords: Diabetic Microalbuminuria, Hypoalbuminemia, Kaphaja Shotha