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      Temporal trend of microsporidial keratoconjunctivitis and correlation with environmental and air pollution factors in India

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          Abstract

          Purpose:

          The aim of this study was to describe the correlation between the temporal pattern of presentation of acute microsporidial keratoconjunctivitis (MKC) with meteorological parameters such as environmental temperature, rainfall, humidity, windspeed, and air pollution.

          Methods:

          This cross-sectional hospital-based study included 182,789 patients presenting between January 2016 and December 2019 hailing from the district of Hyderabad. Patients with a clinical diagnosis of MKC in at least one eye with an acute onset (≤1 week) of presentation were included as cases. Correlation analysis was performed with the local environmental temperature, rainfall, humidity, and windspeed (Telangana State Development and Planning Society) and air pollution (Central Pollution Control Board, Government of India).

          Results:

          Overall, 84 (0.05%) patients were diagnosed with acute onset MKC from the district of Hyderabad. The mean monthly prevalence in this cohort was 0.05% with peak prevalence in the months of July (0.08%), August (0.09%), September (0.12%), and October (0.08%). The environmental parameters of rainfall ( r 2 = 0.87/ P = < 0.0001), humidity ( r 2 = 0.78/ P = 0.0001), windspeed ( r 2 = 0.38/ P = 0.0321) were significantly positively correlated and the air pollution parameters such as ground level ozone ( r 2 = 0.89/ P = < 0.0001), particulate matter PM 10 ( r 2 = 0.65/ P = 0.0013), PM 2.5 ( r 2 = 0.50/ P = 0.0095), nitrogen dioxide ( r 2 = 0.53/ P = 0.0071), and carbon monoxide ( r 2 = 0.69/ P = 0.0008) were significantly negatively correlated with the temporal pattern of MKC in the population.

          Conclusion:

          Parasitic infections like MKC show a distinct temporal trend peaking during the monsoon season in the population. An increase in humidity, wind speed, and especially rainfall contributes to a higher prevalence of MKC cases during the year. An increase in ground-level ozone seems to be protective against infection.

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          Most cited references 14

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          A power primer.

           Jacob Cohen (1992)
          One possible reason for the continued neglect of statistical power analysis in research in the behavioral sciences is the inaccessibility of or difficulty with the standard material. A convenient, although not comprehensive, presentation of required sample sizes is provided here. Effect-size indexes and conventional values for these are given for operationally defined small, medium, and large effects. The sample sizes necessary for .80 power to detect effects at these levels are tabled for eight standard statistical tests: (a) the difference between independent means, (b) the significance of a product-moment correlation, (c) the difference between independent rs, (d) the sign test, (e) the difference between independent proportions, (f) chi-square tests for goodness of fit and contingency tables, (g) one-way analysis of variance, and (h) the significance of a multiple or multiple partial correlation.
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            Integrated model of primary and secondary eye care for underserved rural areas: The L V Prasad Eye Institute experience

            Blindness is a major global public health problem and recent estimates from World Health Organization (WHO) showed that in India there were 62 million visually impaired, of whom 8 million are blind. The Andhra Pradesh Eye Disease Study (APEDS) provided a comprehensive estimate for prevalence and causes of blindness for the state of Andhra Pradesh (AP). It also highlighted that uptake of services was also an issue, predominantly among lower socio-economic groups, women, and rural populations. On the basis of this analysis, L V Prasad Eye Institute (LVPEI) developed a pyramidal model of eye care delivery. This article describes the LVPEI eye care delivery model. The article discusses infrastructure development, human resource development, and service delivery (including prevention and promotion) in the context of primary and secondary care service delivery in rural areas. The article also alludes to opportunities for research at these levels of service delivery and the amenability of the evidence generated at these levels of the LVPEI eye health pyramid for advocacy and policy planning. In addition, management issues related to the sustainability of service delivery in rural areas are discussed. The article highlights the key factors required for the success of the LVPEI rural service delivery model and discusses challenges that need to be overcome to replicate the model. The article concludes by noting the potential to convert these challenges into opportunities by integrating certain aspects of the existing healthcare system into the model. Examples include screening of diabetes and diabetic retinopathy in order to promote higher community participation. The results of such integration can serve as evidence for advocacy and policy.
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              Microsporidial keratitis: need for increased awareness.

              Since the devastation of the European silk worm industry in the 19th century, microsporidia have been recognized as important organisms. An enormous literature is available on their biology, phylogeny, classification, disease profile, diagnosis, and treatment; however, it is only recently that ophthalmologists have begun to take note of these organisms. The last two decades have seen several publications related to ocular microsporidiosis, in particular those forms affecting the cornea. Both immunocompetent and immunocompromised patients are at risk of developing corneal infections that may range from self limiting mild keratoconjunctivitis to severe stromal keratitis recalcitrant to medical treatment. Exposure to soil, muddy water, and minor trauma are possible risk factors. Although reliable prevalence data are lacking, recent studies indicate a high prevalence of microsporidial keratoconjunctivitis in the rainy season, especially in India and other countries with similar climates. For instance, a high prevalence has been documented in Singapore. We bring together the information available on ocular microsporidiosis.
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                Author and article information

                Journal
                Indian J Ophthalmol
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Wolters Kluwer - Medknow (India )
                0301-4738
                1998-3689
                May 2021
                30 April 2021
                : 69
                : 5
                : 1089-1094
                Affiliations
                [1 ]Department of EyeSmart EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
                [2 ]The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
                [3 ]Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India
                Author notes
                Correspondence to: Dr. Sayan Basu, Brien Holden Eye Research Center (BHERC), L V Prasad Eye Institute, Hyderabad - 500 034, Telangana, India. E-mail: sayanbasu@ 123456lvpei.org
                Article
                IJO-69-1089
                10.4103/ijo.IJO_1942_20
                8186659
                33913839
                Copyright: © 2021 Indian Journal of Ophthalmology

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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