Home Print this page Email this page Users Online: 84
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Reader Login
Export selected to
Reference Manager
Medlars Format
RefWorks Format
BibTex Format
  Most popular articles (Since June 15, 2013)

  Archives   Most popular articles   Most cited articles
Hide all abstracts  Show selected abstracts  Export selected to
  Viewed PDF Cited
Step-by-step dacryocystorhinostomy for beginners: An expert's view
Shrikant Deshpande, Anjaneya Agashe, Abhinav Loomba, Neha Dhiware
September-December 2014, 2(3):161-165
Chronic dacryocystitis occurs usually due to obstruction of lacrimal passage at the junction of the lacrimal sac and the nasolacrimal duct or within the bony nasolacrimal duct. Reconstruction of the lacrimal passages in such cases can be achieved by several surgical techniques, although external dacryocystorhinostomy (DCR), proposed by Ohm and by Dupuy-Dutemps and Bourguet in 1921, is still the most successful operation. Despite ease and decreased morbidity of endonasal DCR, external DCR is procedure of choice as it is more successful. Several ophthalmologists fear performing DCR because of bleeding and unfamiliarity of structure. This article tries to provide few tips to make DCR easy and stress-free. Proper case selection, pre-operative workup and adequate exposure go a long way in making DCR stress-free and successful. Excessive bleeding, a common hindrance in DCR surgery can be successfully tackled by proper positioning of patient, use of adrenaline, suction, and adjustment of nasal pack.
  72,959 3,175 -
Interpretation of magnetic resonance imaging of orbit: Simplified for ophthalmologists (Part I)
Barun Kumar Nayak, Savari Desai, Shailendra Maheshwari
January-April 2013, 1(1):29-35
Magnetic resonance imaging (MRI) has become an indispensable diagnostic tool in the field of radiology. Due to better soft tissue contrast resolution and no ionizing radiation, it has become the modality of choice in most cases of orbital / ocular pathologies. Ophthalmologists tend to neglect interpreting orbital MRI, and rely mainly on the reports provided by the radiologists. This article deals with the basics of MRI and the appearance of normal orbital structures on MRI. This knowledge will help ophthalmologists interpret the MRI orbital pathologies which will be published in the subsequent issue.
  48,778 3,771 -
Interpretation of autoperimetry
Barun K Nayak, Sachin Dharwadkar
January-April 2014, 2(1):31-59
Autoperimetry is an essential investigation for glaucoma management, which helps in the initial diagnosis as well as the follow up of glaucoma patients. The interpretation of autoperimetry is tricky and crucial. This article deals with the basics of autoperimtery explaining the various terminologies which are frequently used. This is followed by guidelines and algorithms for interpreting single field analysis. It also deals with the follow up strategies used in autoperimetry with emphasis on understanding the interpretation of "glaucoma progression analysis" (GPA) on Humphrey. This article will be of great help to comprehensive ophthalmologists as well as the post graduate student of ophthalmology, in understanding the intricacies of autoperimetry analysis which will be of great help in the management of glaucoma.
  43,494 3,179 5
Use of dyes in ophthalmology
Atul Kumar, MB Thirumalesh
January-April 2013, 1(1):55-58
Dyes are used in ophthalmology, both as diagnostic and therapeutic aid. The use of diagnostic dyes represents one of the most efficient, objective, non-invasive, and directly visible means we have of identifying and tracking ocular structures at the cellular level. They particularly are useful as both diagnostic modalities and as therapeutic adjutants in both anterior and posterior segment disorders.
  42,604 3,463 -
Special considerations for prescription of glasses in children
Ashwin Sainani
September-December 2013, 1(3):169-173
The most common cause of visual impairment in children is refractive error. All general ophthalmologists and most specialists come across children in their practice and treating a refractive error is the basic moral responsibility of any ophthalmic caregiver. Limited cooperation, low reliability, and risk of amblyopia make prescribing glasses for children more challenging than for adults. The basic rules of prescribing glasses take into account the visual needs according to age, strong accommodative elements, risk of amblyopia, age-related emmetropization, and associated conditions like strabismus, prior to prescribing glasses for children. This article focuses on the standard protocols of assessment and prescription of glasses for simple refractive errors as well as some special refractive situations in children.
  41,297 3,109 5
Is post mydriatic test necessary in children having compound myopic astigmatism?
Mihir Kothari, Ali Hussain
May-August 2015, 3(2):77-79
Purpose: To study the need of post mydriatic test (PMT) in children with mild to moderate compound myopic astigmatism. Materials and Methods: The children having mild to moderate compound myopic astigmatism presenting to the pediatric ophthalmology department underwent subjective refraction before, immediately after cycloplegia and 3 days after cycloplegia. The refractive error was analyzed using two-tailed paired t test by dividing the refractive-errors into sphere, cylinder and axis. Spherical equivalent was analyzed separately. Result: Eighty four eyes of 42 children aged 3 to16 years (Mean 9.6, SD 3.2) were included. Mean sphere was -0.9 diopter sphere (DS) (± 1.9) without cycloplegia and -0.4 DS (± 2.0) with cycloplegia compared to -0.9 DS (± 1.8) in the PMT. Mean cylinder was -1.3 diopter cylinder (DC) (± 1.2) without cycloplegia and -1.0 DC (± 1.5) with cycloplegia compared to -1.14 DC (± 1.3) in PMT. Mean spherical equivalent was -1.5 DS (± 1.6) without cycloplegia and -0.9 DS (± 1.8) with cycloplegia compared to -1.5 DS (± 1.6) in PMT. For spherical equivalent, the correlation coefficient (r) between non-cycloplegic refraction and cycloplegic refraction; non-cycloplegic refraction and PMT; cycloplegic refraction and PMT was 0.9. However, in comparison to cycloplegic refraction, PMT was closer to non-cycloplegic refraction and differed by only 0.01 DS (± 0.9) in sphere and 0.2 D (± 0.7) in cylinder. Conclusion: PMT is not warranted in children with compound myopic astigmatism.
  40,020 859 2
Computer vision syndrome: A review
Jatinder Bali, Naveen Neeraj, Renu Thakur Bali
January-April 2014, 2(1):61-68
Computers and mobile computing devices are being used by increasingly larger number of people today. This has led to an increase in the number of patients complaining about ocular and nonocular symptoms related to computer use. Eye-strain, tired eyes, irritation, burning sensations, redness of eyes, dry eyes, blurred, and double vision reported by the visual display unit users was termed "Computer Vision Syndrome" (CVS). It is a repetitive strain disorder characterized by one or more of the following symptoms - eyestrain, eye fatigue, burning sensations, irritation, redness, blurred vision, and dry eyes when associated with operating a computer and looking at a computer monitor in a temporal association. CVS has a multifactorial causation. Several factors have been linked to symptoms. Many treatment modalities have been described. Treatment needs to be tailored to the individual patient. However, a large body of work is still required to uncover gaps in our understanding of the problem. A specially designed ocular examination for computer users and associated counseling about the current good practices in computer use would go a long way in preventing loss of productivity and morbidity from the condition.
  33,631 3,949 15
Corneal topography and tomography
Sachin Dharwadkar, BK Nayak
January-April 2015, 3(1):45-62
Devices that evaluate corneal properties are an indispensible tool in a eye clinic nowadays. With the arrival of new technology in addition to placido based devices, the options available now are many. Cornea based refractive surgery in Indian eyes poses a challenge due to relatively thinner corneas. This is also compounded by lack of well defined, rigid and universal criteria for case selection for the same. In this article we attempt to look at the most common methods of corneal assessment in relation to the selection of candidates for corneal refractive surgery with a review of relevant literature. This is not meant to be exhaustive, but a primer to ease the clinician into understanding and taking up to learn and practice corneal evaluation.
  32,348 3,656 6
Tissue adhesives in ophthalmology
Sharadini Vyas, Sheetal Kamdar, Prateep Vyas
May-August 2013, 1(2):107-112
Tissue glue is increasingly becoming a choice of material as an adjuvant to surgical wound closure in ophthalmology. Each of the type of glue is unique in terms of its advantages as well as limitations and so is used in different indications. Although the presently available tissue adhesives are good enough for the procedures mentioned, there is still a demand for newer adhesives. The increasing acceptance of these adhesives by the clinicians promises this to be a standard procedure for surgical wound closure. The existing cyanoacrylate glue is mainly used as a corneal patch to seal acute corneal perforations and improve visual outcomes, with reduced enucleation rates and need for tectonic keratoplasty in many situations. Fibrin glue is a biological adhesive, which reduces the total surgical time. The multiple advantages has extended its use in all the superspeciality fields of ophthalmology like corneal and conjunctival surgeries; strabismus, cataract, refractive, glaucoma, and even retinal surgeries. A newer tissue adhesive like biodendrimers and photocrosslinkable ones has better biocompatibility, rapid sealing properties and increased binding forces. It promises to overcome the drawbacks and risks associated with the existing ones but still under research. The increasing acceptance of all these promises it to be a standard procedure for surgical wound closure and probably will introduce a newer modality for drug delivery. In this article, we tried to review the literature with internet and medlines search for the available adhesives, as well as the upcoming ones with promising applications in ophthalmology.
  19,421 2,142 3
Intravitreal injections: A review of pharmacological agents and techniques
Hasanain Shikari, Preetam M Samant
January-April 2016, 4(1):51-59
Over the past three decades, intravitreal delivery of pharmacotherapeutic agents has advanced tremendously with many drugs being developed solely for intravitreal use. Intravitreal injections have now become routine in the management of various ocular conditions, most commonly diabetic macular edema and age-related macular degeneration, with the benefits of targeted therapy far outweighing the risks of the procedure. Herein we review the variety of agents available and currently being used for intravitreal therapy of various retinal and intraocular conditions, their indications as well as the optimal technique that should be employed in their administration.
  18,049 1,798 9
Electrophysiology for ophthalmologist (A practical approach)
Deepak Bhatt
January-April 2013, 1(1):45-54
The article deals with the basic understanding of electrophysiological tests in clinical practice. Electrophysiological tests involves assessing the function of the rod-cone system and proximal visual pathway. Visual evoked potential (VEP) is performed to assess the function of the proximal optic nerve. Electro-oculogram (EOG) is used to study the photoreceptor-RPE junction. Electroretinogram (ERG) is used to assess the function of photoreceptor (a-wave) and the inner retina (b-wave). Pattern ERG is helpful to study the macular cone function and ganglion cell function. The a-wave in ERG is diagnostic of rod-cone or cone-rod dystrophy. The amplitude of b-wave in ERG helps us to distinguish inner retinal dysfunction from photoreceptor dysfunction. Hence ERG is not only helpful in making a diagnosis but is also helpful in studying the prognosis of the disease which eventually helps in counseling the patient. Pattern ERG when used in conjunction with pattern VEP helps to pinpoint the cause of an unexplained loss of vision. Multifocal ERG studies the focal responses at the posterior pole within the arcades. The most important use of a multifocal ERG is in the early detection of hydroxychlroquine toxicity. Visual acuity assessments with sweep VEP, focal ERG and multifocal VEP are the newer developments in electrophysiology.
  16,656 2,304 -
Tips and suggestions for appearing in post graduate examination
Anil Kulkarni, Krishna Prasad
January-April 2013, 1(1):59-61
The article provides practical tips to ophthalmic post-graduates who are appearing for their exit examination. The theory answer paper should be not just knowledgeable but also appropriate, succinct, and presentable. The article suggests ways to approach a question regarding disease, clinical entity or a surgical technique. It has ways to make the theory answer sheet more readable and presentable for the examiner. The practical and viva voce assessment requires the candidate to be suitably groomed, caring to the patient and demonstrate his /her clinical skills aptly.
  14,417 1,102 -
Ultrasound biomicroscopy: An overview
Deepak C Bhatt
May-August 2014, 2(2):115-123
Ultrasound biomicrosopy (UBM) is a technique used to visualize the anterior segment of the eye using high frequency ultrasound. It uses 35-50 MHz probe which has a resolution of 40 microns and a depth of penetration of 4 mm. UBM is used to study the status of desment's membrane in cases of corneal edema when slit-lamp examination cannot see the desment's clearly. In open angle glaucoma, UBM does not have any significant role. In closed angle glaucoma, UBM helps to rule out occludable versus nonoccludable angles. UBM plays a major role in diagnosis of plateau iris configuration and malignant glaucoma. UBM helps to visualize the tract and bleb in cases of failed trabeculectomy and also helps in ruling out episcleal scarring or tenon's cyst. UBM is the only modality which can easily diagnose pars plannits or cyclitic membranes noninvasively. In cases of unexplained hypotony, UBM helps to diagnose ciliary body atrophy or traction on the ciliary body. In cases of trauma, it helps to rule out angle recession or cyclodialysis cleft. UBM can assess the extent of damage to the zonules in cases of trauma and also sees the integrity of posterior capsule. This article is a short overview and an introduction to the use of UBM in the evaluation of anterior segment pathologies and usefulness in treatment management.
  13,302 1,490 3
Newer intraocular lens materials and design
Sanjay Argal
May-August 2013, 1(2):113-117
The continued development of new intraocular lens (IOL) material and design has provided cataract surgeons more lens-based options than ever before. Surgeons must carefully evaluate, which IOLs may be the best for their patients and their practices. The roles of refractive index, water content, optic coloration (blue- or violet-light-blocking), and design of acrylic IOLs are widely debatable among surgeons. Ease of use, availability, cost, and surgeon preference are also important factors that influence surgeons' IOL selection.
  13,110 1,404 7
Interpretation of magnetic resonance imaging of orbit: Simplified for ophthalmologists (Part II)
Barun K Nayak, Savari Desai, S Maheshwari, Divya Singh, Sanjay Sharma
May-August 2013, 1(2):101-106
The basics of orbital magnetic resonance imaging (MRI) has been discussed in the previous issue. This article is in continuation of the previous article, and deals with the systematic approach towards the diagnosis of various orbital pathological lesions. It starts with the concept of various compartments in the orbit with their boundaries, followed by the mention of different lesions occurring in those compartments. The representative pictures of MRI orbit is also being provided with their main features on MRI of some commonly occurring pathologies of orbit. The purpose of this article is to impart the skill amongst ophthalmologists of interpreting orbital MRI.
  11,638 1,578 1
Work up of neuro-ophthalmological cases - Examination – Investigations
Neha Shrirao, Rashmin A Gandhi
January-April 2013, 1(1):37-44
Importance of thorough history-taking, meticulous examination and tailored investigations cannot be underestimated in any branch in medicine, and the same goes for neuro-ophthalmology too. In patients presenting with visual loss, ocular motility disturbances, or simply headache, the ophthalmologist may be the first one to diagnose life-threatening conditions. Thus, before referring the patient to other services, it is essential to arrive systematically and rationally at a conclusive, problem-oriented diagnosis. This article gives a stepwise approach to work up patients with a potential neuro-ophthalmic condition. It gives a brief and helpful overview about history-taking in these patients and clears most ambiguities regarding examination techniques and the choice and timing of investigations. It may especially prove to be very useful and of special interest for training ophthalmologists.
  11,813 1,275 -
Optical coherence tomography in glaucoma-I
Sachin Dharwadkar, Barun K Nayak
January-April 2017, 5(1):51-63
It is a well-established fact that more than 40% ganglion cells are lost before the white-on-white perimetry shows defects. Hence, the importance of modalities which can image the structures of optic nerve and surrounding retinal nerve fiber layer in the early diagnosis of glaucoma cannot be overemphasized. However, the appropriate interpretation of these imaging modalities is of paramount importance. Out of the three machines such as HRT, scanning laser polarimeter (GDx VCC), and the OCT, the OCT has made a remarkable progress and can be incorporated judiciously in the clinical practice of glaucoma management. The purpose of this article is to explain the interpretation and its clinical application in an appropriate manner in the management of patients with glaucoma.
  11,497 1,291 2
Prevention and correction of residual refractive errors after cataract surgery
Jeevan S Ladi
January-April 2017, 5(1):45-50
Cataract surgery today has become more of a refractive surgery with high patient expectations and demand for independence from glasses. With advances in biometry, precise intraocular lens (IOL) power calculation is the most important step in achieving desired target refraction. Noncontact optical biometry has become the gold standard worldwide with a few exceptions where contact ultrasound biometry still needs to be performed. Although there is no single formula for IOL power calculation suitable for all eyes, our understanding of which formulae to use in specific situations is much better. Despite advances in biometry and cataract surgery techniques, unsatisfactory visual and refractive outcomes occur occasionally. Enhancement after cataract surgery is required in these cases. The common methods to treat such cases are corneal-based laser refractive surgery or lens-based procedures such as piggyback IOL and lens exchange.
  11,575 1,035 3
Glaucoma drainage devices
Parul Singh, Krishna Kuldeep, Manoj Tyagi, Parmeshwari D Sharma, Yogesh Kumar
May-August 2013, 1(2):77-82
Glaucoma drainage devices (GDD) occupy an important place in the surgical management of glaucoma that is not responding to medications and trabeculectomy operations. In certain conditions, such as neovascular glaucoma, pediatric glaucoma, iridocorneal endothelial syndrome, penetrating keratoplasty with glaucoma, glaucoma following retinal detachment surgery, it has become the preferred operation. GDD create an alternate aqueous pathway from anterior chamber by channeling aqueous out of the eye through a tube to subconjunctival space. Glaucoma drainage implants that have been used extensively include the non-restrictive and restrictive drainage devices. This article outlines history of implants, types of implant, surgical technique of implantation, various complications following GDD insertion and their management.
  10,361 1,533 3
Retinopathy of prematurity: Incidence, prevalence, risk factors, and outcomes at a tertiary care center in Telangana
Crystal Le, Laxman B Basani, David Zurakowski, Ramesh S Ayyala, Satish G Agraharam
September-December 2016, 4(3):119-122
Aims: To evaluate the incidence of retinopathy of prematurity (ROP), prevalence of pre-and postnatal risk factors for development of ROP, and treatment outcomes among preterm infants admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary care hospital located in Hyderabad. Materials and Methods: Retrospective chart review of all infants admitted to the NICU between 2008 and 2013, who met the criteria for ROP screening: (a) ≤34 weeks of gestation, (b) ≤1750 g of birth weight, (c) infants with significant risk factors including sepsis, respiratory distress syndrome, or long-term oxygen use. Treatment was offered to infants with Stage III ROP disease or Stage II in Zone II with plus disease. Qualified infants were treated with argon laser photocoagulation within 48 h of diagnosis. They were followed until the disease was successfully treated. Results: A total of 2910 infants were admitted to the NICU. Incidence of ROP was found to be 2.3% (n = 66), the majority of whom (71%) had Stage I ROP. Seventeen percent of the infants weighed <1000 g. The most prevalent prenatal risk factor was multiple gestations (17%). Prevalent postnatal risk factors included oxygen treatment (71%) and respiratory distress syndrome (58%). Twelve percent (8/66) of infants met the treatment threshold. Following argon laser, regression was observed in 100% of infants, with no recurrence with follow-up between 1 and 4 years after treatment. Conclusions: This is the first study to evaluate the incidence of ROP in Telangana. Argon laser photocoagulation appears to be effective in the treatment of infants in this population. We recommend screening infants ≤32 weeks of gestation and infants born ≤1700 g birth weight.
  9,174 2,540 10
Prevention of operative infection in ophthalmic surgery
Uday R Gajiwala, Rajesh U Patel, Rohan A Chariwala
May-August 2016, 4(2):107-115
Prevention of infection in ocular surgery is based on the science of asepsis and antisepsis not only depends on what we do pre-, intra-, and post-operatively but also depends on how we prepare our patient and personnel. Practicing no touch technique is extremely important in preventing sporadic infections, whereas breach in sterility many times is the cause of cluster infection - whether it is the presterile product purchased from the market, or items sterilized in the operation theater (OT) protocols (such as standard operating practices) play a key role in ensuring all these. There are several guidelines available to guide us. Many activities are done in the absence of the surgeon inside the OT such as cleaning and sterilization by our staff. Their understanding of the science of asepsis and antisepsis pertaining to the tasks performed by them is very important. All these needs to be monitored and continuous medical education need to be organized for our staff also. Written protocols help in achieving this. Everybody should be aware of the protocol and this should be strictly followed. No compromise at any cost should be accepted inside the OT.
  10,291 1,064 1
Atoll sign in posterior lenticonus: A case report of bilateral posterior lenticonus with review of literature
Pratyush Ranjan, Deepak Mishra, Madhu Bhadauria
September-December 2014, 2(3):152-154
Posterior lenticonus is a rare progressive disease characterized by protrusion of posterior lens capsule along with lens cortex into the vitreous cavity. Posterior lenticonus is more common but present unilaterally unlike anterior lenticonus, which presents bilaterally. Posterior lenticonus is a common cause of unilateral infantile cataract but is a very rare cause of bilateral cataract. Diagnosis is mainly clinical but can be difficult in asymptomatic patients; oil drop sign (in mild posterior lenticonus) and fish tail sign (lenticular cortex hanging in vitreous cavity after posterior capsular dehiscence) are described in posterior lenticonus. We are proposing an atoll sign in advanced case of posterior lenticonus with intact posterior capsule on slit lamp examination. The positive atoll sign will have more favorable prognosis since posterior capsule is intact, hence posterior chamber intraocular lens implantation will be more feasible with better visual prognosis as was the case with our patient.
  9,378 452 3
Use of topical meropenem in management of hospital acquired Pseudomonas ocular infections
Ranjana A Pande, Prajakta V Bhailume
January-April 2014, 2(1):23-25
We report a case series of four eyes of four patients where resistant strains of Pseudomonas aeruginosa in nosocomial ocular infections were treated with topical meropenem with a successful outcome. Pseudomonas infections are known to be very fulminant. We observed strains of P. aeruginosa in four eyes resistant to all routine drugs such as fluoroquinolones, aminoglycosides and cephalosporins. Three eyes presented with infective corneal ulcers and one eye had endophthalmitis. Culture sensitivity of corneal scrape and aqueous tap respectively of each patient showed P. aeruginosa (Gram-negative bacilli) sensitive to carbapenem (meropenem and imipenem) group of drugs. These patients were treated with a topical meropenem 50 mg/ml once in an hour and responded dramaticaly and we could salvage all eyes. Topical meropenem 50 mg/ml, which is not routinely used in ocular infections is thus an effective drug for management of hospital acquired resistant Pseudomonas ocular infections.
  8,191 590 4
Recent approach in diagnosis and management of anterior uveitis
Sushil Kumar Bajoria, Jyotirmay Biswas
January-April 2018, 6(1):36-41
This article aims to review the current literature to find the various current concepts in the diagnosis and management of anterior uveitis. It is important to go into the detailed history of the complaints. It will help in finding any systemic cause in most of the cases, if any. A thorough and detailed extraocular and ocular examination should be done. It will bring us closer as to which part of the uveal tissue is involved, i.e. anterior, intermediate, or posterior. It also highlights the various investigative and laboratory tests to be done, which will help in arriving at a diagnosis. Further aiding in diagnosis is radiological investigations such as computerized tomography of the chest which help in the diagnosis and management of systemic disorders such as tuberculosis or sarcoidosis. The primary modality of treatment in such cases is topical in the form of topical steroid and cycloplegics. The use of systemic steroids and immunosuppressants for treatment is reserved only for recalcitrant cases. The aim of the treatment is to preserve the vision of the patient and reduce the subsequent morbidity. To write this article, detailed search was carried out in the MEDLINE search. Published articles from various journals and national library of medicines MEDLINE were reviewed. Electronic database was also searched.
  7,758 804 -
Determinants of macular thickness in normal Indian eyes
Zia S Pradhan, Andrew Braganza, Lekha M Abraham
January-April 2013, 1(1):11-16
Purpose: To generate normative data for optical coherence tomography (OCT) estimated macular thickness in Indian eyes and to establish its determinants. Materials and Methods: In this cross-sectional, observational, hospital-based study, 189 healthy Indian individuals underwent a fast macula OCT scan. Macular thickness was measured in nine ETDRS (Early Treatment Diabetic Retinopathy Study) regions, and the effect of gender, age, laterality, diabetes, and hypertension status on it was determined. Results: Females had a significantly thinner fovea (176.71 ± 23.32 μm v/s. 193.24 ± 20.95 μm) and inner macula (p < 0.001) as compared to males. With advancing age, foveal thickness increases (p = 0.012) while the superior and inferior outer macula thins (p = 0.018-0.027). Diabetes in the absence of any clinical retinopathy did not affect macular thickness. Hypertensive individuals had a thinner macula in all regions except the fovea and nasal macula. Conclusions: The thinner macula in females and age-related thinning should be considered when interpreting OCT scans of the macula. Diabetics with good visual acuity and no evidence of clinical retinopathy had normal macular thickness. Sub-clinical attenuation of vessels might account for the thinner macula in individuals with hypertension.
  7,689 618 -