Evaluation of Scheimpflug imaging system as an added tool in improving the accuracy of reference marking (as compared to the slit lamp marking system) for toric intraocular lens implantation

Purpose: To assess the role of Scheimpflug imaging in improving the accuracy of reference marking for toric IOL implantation. Methods: In this prospective, randomized, clinical trial all patients with cataract and pre-existing significant regular corneal astigmatism, who required implantation of a toric IOL were included in the study, and patients with any ocular pathology or abnormality were excluded. Patients were divided into two groups: For one group of patients, Group I (GI), reference marking was finalized using slit lamp only, and for the second group, Group II (GII), after slit lamp marking, the reference marks were checked using Goniometer of Scheimpflug imaging. The primary outcome was to determine the axis of toric intraocular lens (IOL) postoperatively (within 1 hour) and compare it with the desired axis of placement. Results: We found a statistically significant difference in the two groups (P < 0.001) suggesting Group II (4 step technique) is better than Group I (3 step technique). Conclusion: Scheimpflug imaging, an extra step preoperatively, is an effective measure to reduce errors in reference marking and thereby improving the refractive outcome of toric intraocular lens.

Adiponectin correlates with obesity: A study of 159 childhood acute leukemia survivors from India.

BACKGROUND: Acute lymphoblastic leukemia survivors are predisposed to obesity. However, the exact underlying mechanisms are not known. AIMS: The study was done to assess the role of biomarkers of obesity in acute leukemia survivors. SETTINGS AND DESIGNS: This is a cross‑sectional study conducted at All India Institute of Medical Sciences in survivors of acute leukemia who had completed treatment at least 1 year before enrollment in this study. MATERIALS AND METHODS: Obesity was studied by determining the body mass index. Potential biomarkers were studied by assessing serum leptin, resistin, and adiponectin by enzyme‑linked immunosorbant assay, and the results were compared in obese versus nonobese survivors. STATISTICAL ANALYSIS: Descriptive analysis for baseline demographic factors and Student’s t‑test for comparing the mean levels of biomarkers among the obese and nonobese survivors. RESULTS: One hundred and fifty‑nine acute leukemia patients were enrolled in this study with a median follow‑up of 36.8 months. The median age was 10 (range: 3–18) years, and 123 (77.3%) patients were males. The overall prevalence of overweight/obesity was 26.4%, and this was similar in acute myeloid leukemia and acute lymphoblastic leukemia sub‑groups (26.2% vs. 27.3%, P = 0.9). Mean serum leptin and resistin were similar in obese and nonobese leukemia survivors (3.7 vs. 2.85 pg/mL, P = 0.064; 8.01 vs. 9.33 ng/mL, P = 0.36). However, mean serum adiponectin was significantly lower in obese leukemia survivors (7.97 vs. 11.5 μg/mL, P = 0.023). CONCLUSIONS: Obese leukemic survivors had lower serum adiponectin levels than nonobese survivors. However, serum resistin and leptin levels were similar in the two groups.

Atypic Drainage Pattern of Posterior Intercostal Veins Into the Azygos Venous System.

The azygos venous system vary greatly in theirmode of origin, course,tributaries, anastomoses and termination which resulst predominantly due to its complex embryological development. Azygos venous system develops as right and left azygos venous lines. Right azygos venous line develops into vertical part of azygos vein whereas the left one develops into accessory hemiazygos and inferior hemiazygos veins. These are connected by subcentral/ transvertebral veins. In the present case, we found an atypic drainage pattern of posterior intercostal veins into azygos venous system, left being more variable. Right superior intercostal vein formed by 2nd and 3rd posterior intercostal veins whereas left superior intercostal vein was found to be absent. 2nd, 3rd, 4th& 5th left posterior intercostal veins thus drained into accessory hemiazygos vein. Sixth and seventh left PICVs formed a common trunkwith accessory hemiazygous vein and drained into the azygous vein at T6 level. Eighth one united with the hemiazygos vein and formed a common trunkwhich drained into azygos vein at T8 level. Such variations of the azygos venous system are important for a clinician during mediastinal surgeries to prevent inadvertent hemorrhagic complications.

Anthropometric measurements of hand length for estimation of stature in North Indians.

Stature or body height is one of the important and useful anthropometric parameter that determines the physical identity of an individual. The present study was done in department of Anatomy, Sri Guru Ramdas Institute of Medical Sciences and Research, Amritsar on 400 (200 males and 200 females) healthy, asymptomatic medical subjects belonging to various regions of North India. The subjects were measured for stature and hand length of left side with standard anthropometer and a sliding caliper respectively and data was subjected to statistical analysis for deriving regression equations. The regression equations were derived both for male and female North Indians separately by means of which living stature can be accurately estimated when fragmentary or mutilated portion of upper extremity is recovered. The present study showed significant (p< 0.001) positive correlation between stature and hand length.

Chromosomal instability in the lymphocytes of breast cancer patients.

Genomic instability in the tumor tissue has been correlated with tumor progression. In the present study, chromosomal aberrations (CAs) in peripheral blood lymphocytes (PBLs) of breast tumor patients were studied to assess whether chromosomal instability (CIN) in PBLs correlates with aggressiveness of breast tumor (i.e., disease stage) and has any prognostic utility. Cultured blood lymphocyte metaphases were scored for aberrations in 31 breast cancer patients and 20 healthy age and sex-matched controls. A variety of CAs, including aneuploidy, polyploidy, terminal deletions, acentric fragments, double minutes, chromatid separations, ring chromosome, marker chromosome, chromatid gaps, and breaks were seen in PBLs of the patients. The CAs in patients were higher than in controls. A comparison of the frequency of metaphases with aberrations by grouping the patients according to the stage of advancement of disease did not reveal any consistent pattern of variation in lymphocytic CIN. Neither was any specific chromosomal abnormality found to be associated with the stage of cancer. This might be indicative of the fact that cancer patients have constitutional CIN, which predisposes them to the disease, and this inherent difference in the level of genomic instability might play a role in disease progression and response to treatment.

Ultrasound evaluation of thyroid size: a large nationwide study of schoolchildren in India.

BACKGROUND: Ultrasound assessment of thyroid volume is considered a more objective method than clinical palpation for the diagnosis of goitre. We used ultrasonography to establish normal reference cut-off points of thyroid volume in schoolchildren of different socioecomonic groups in India and compared the results with international norms. METHODS: In a cross-sectional study, we clinically examined 27,250 children from the lower and higher socioeconomic strata (SES) from all over India to determine their goitre staging. A single sonologist, using ultrasonography, assessed the thyroid volume in a subset of 15,986 children (8463 from the lower and 7523 from the higher SES). Students were recruited from at least one school each representing the higher and the lower SES, from cities located in 5 zones of India. Children with known thyroid disorders were excluded from the study. RESULTS: Clinical evaluation revealed a mean goitre prevalence of 19.9% (23.2% in girls; 16.5% in boys; 17.1% in the higher SES; 23.5% in the lower SES). The thyroid volume as assessed by ultrasonography was significantly higher in children from the lower SES (mean 5.65 ml, SE 0.02) compared with those from the higher SES (mean 5.02 ml, SE 0.02) after adjusting for the imbalance in body surface area (p < 0.001). Using international norms (WHO 2004), the prevalence of goitre in various body surface area categories among children who had no goitre on clinical examination ranged from 48.2% to 75.1% for boys and 23.2% to 67.4% for girls. CONCLUSION: The striking discrepancy in the prevalence of goitre assessed by using clinical examination and ultrasound techniques suggests that the norms recommended by WHO based on ultrasound techniques are not appropriate for India.

Hyperleukocytosis associated pulmonary leukostasis in acute leukaemia.

Leukostasis is a fatal complication in granulocytic leukaemia. Brain and lung are most commonly involved organs in leukostasis. In the lung, the clinical presentation simulates infections and haemorrhagic complications of acute leukaemia. Being a medical emergency, early recognition of leukostasis and initiation of therapy prevents mortality.

Acute disseminated encephalomyelitis--a case series.

Acute disseminated encephalomyelitis(ADEM) is an uncommon inflammatory demyelinating disease involving central nervous system white matter. A series of seven cases seen over a period of one year have been described. The patients presented with acute onset of focal neurological deficit (3 patients), alteration of sensorium(3) and ataxia(1). CT scan showed non specific hypodensity in 4 cases and was normal in 3 patients . MRI showed characteristic radiological changes. Complete recovery was seen in 3 patients , one died and 3 were left with sequelae.

Poisoning: an unnatural cause of morbidity and mortality in rural India.

BACKGROUND: Ninety-nine percent of fatal poisonings occur in developing countries, particularly among agricultural workers. In a particular area, it is important to known the magnitude and pattern of acute poisonings, as it is important for early diagnosis and treatment and also for preventive measures. METHODS: Hospital records of all unnatural causes of deaths were reviewed at Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra during the five years period, 1997-2001. Autopsy records in fatal poisonings were studied for age, sex, residence, marital status, type of poison and manner of poisoning (accidental, suicidal or homicidal). Admission and death rates of acute poisonings were compared with those from other unnatural causes. RESULTS: Acute poisoning is the leading most cause of unnatural deaths and third common cause of emergency hospitalizations in this rural part of India. Of all fatal cases, 67% were males, 63% married, 83% with rural residence and 63.4% suicides. Responsible poison could not be ascertained in 16% of clinical and 9.9% of fatal cases. Insecticides were responsible for 35% of clinical and 55.4% of fatal cases. CONCLUSIONS: Young married males of rural background with agricultural occupation and failure of monsoon are the risk factors associated with poisoning cases.

Leiomyosarcoma of pancreas: imaging features.

Leiomysosarcoma of the pancreas is rare. Radiological findings of four patients with this condition were reviewed. CT scan appearances were those of a predominantly homogenous, large, solid, enhancing mass with few areas of necrosis. A cystic appearance with thickened and nodular enhancing walls was seen in one case. A constellation of imaging findings including large size at presentation, greater vascular enhancement and absence of biliary dilatation should suggest leiomyosarcoma.

Cytohormonal evaluation of vaginal smears by phase contrast microscopy with special reference to progesterone deficiency pattern during early pregnancy as predictor of abortion.

Cytohormonal profile of unstained vaginal smears were studied under phase contrast microscope to define various cell morphologies in detail and build up of smear pattern serially in various stages of menstrual cycle and first trimester of pregnancy. The findings were correlated clinically and found comparable to Papanicolaou stained smears. The maturation index was calculated more objectively by phase contract microscopy because of the refractile appearance of the pyknotic nuclei of superficial cells. The prognostication of abortion was done by combining abnormal maturation index and the presence of syncytiotrophoblasts in vaginal smears. Under phase contrast microscope, the sensitivity of abnormal smear was 87.5%, the specificity was 95%, the positive predictive value was 96.55% and the overall accuracy was 90% as compared to positive Papanicolaou smear whose sensitivity though 93%, had low specificity of 50% only. Phase contrast study appears to offer certain distinct advantage over the conventional light microscopy for quick, comprehensive and quantitative assessment of the study material. It allows the physician to detect changes in the material obtained from the patients without detour of laboratory fixation and staining. It is technically easy as errors in interpretation due to unsatisfactory fixation, staining and artefacts are obviated. Thus phase contrast microscopy offers an alternative and easy method of cytohormonal evaluation of wet and unstained smears.

Ultrasonic variables in the diagnosis of intrauterine growth retardation.

Ultrasonic biparietal diameter (BPD), femur length, abdominal circumference, femur length/abdominal circumference ratio, estimated fetal weight, ponderal index, estimated fetal length were measured within 72 h of delivery of 30 small-for-date (SFD) and 174 non-SFD newborns. Evaluation of each ultrasound variable in the antenatal diagnosis of SFD fetus was assessed. Abdominal circumference and estimated fetal weight were the best predictors in confirming SFD in 73.3 and 76.6 per cent respectively, followed by BPD (63.3%). Other variables (femur length, femur length/abdominal circumference ratio, estimated fetal length and ponderal index) were less accurate in diagnosis of SFD babies. For all variables studied negative predictive value was high (almost 90% or above). However, positive predictive value for abdominal circumference and estimated fetal weight were satisfactory. This study demonstrates the usefulness of abdominal circumference and estimated fetal weight in recognising SFD. It also shows that various growth variables could be used to rule out the diagnosis of IUGR with reasonable accuracy (negative predictive value greater than or equal to 90).

Fetal ponderal index in predicting growth retardation.

Fetal ponderal indices were calculated by ultrasound examination and compared with the neonatal ponderal indices in 154 pregnancies. No significant difference was found between the prenatal and postnatal values of weight, length and ponderal indices of the entire sample as well as in babies with intrauterine growth retardation (IUGR). The fetal ponderal index had a sensitivity and specificity of 56.7 and 84.6 per cent respectively. These data suggest that fetal ponderal index could be used to rule out IUGR with reasonable accuracy (negative predictive value: 86%).

Ultrasonic intrauterine growth curves.

Intrauterine growth was studied by serial ultrasonic measurements of biparietal diameter (BPD), femur length (FL) and abdominal circumference (AC) in 241 normal low risk obstetric patients. These measurements were used to construct normal ultrasonic fetal weight and length curve. The data correlate well with the already established, postnatal weight and length curves after 28 weeks of gestation. The fetal ponderal index curve was compared with postnatal ponderal index curves available. Antenatal recognition of fetal weight, length and ponderal index can be used to evaluate pregnancies at risk for altered fetal growth.