Dyslipidemia in Primary Open Angle Glaucoma

Glaucoma is the leading cause of irreversible blindness worldwide. Primary Open Angle Glaucoma (POAG) isusually asymptomatic till advanced stages of the disease. Intraocular pressure (IOP) is the primary risk factorfor development of POAG. But in spite of control of IOP, some cases progress which strengthens the viewthat there must be other independent risk factors in the pathogenesis of glaucoma. Serum lipids have beenfound to be associated with glaucoma in few studies. We conducted a study to assess the relation betweendyslipidemia and glaucoma on 100 cases of glaucoma and 100 age-matched controls. Detailed ophthalmicexamination was done in all subjects and fasting lipid profile was compared between cases and controls.Levels of total cholesterol, total triglycerides and LDL were significantly higher in cases than in controls witha p value < 0.0001. We conclude that dyslipidemia is an independent risk factor for POAG.

An evaluation of hyperbaric ropivacaine with magnesium as an adjuvant in lower abdominal surgeries among the north Indian subjects: a double-blind randomized trial

Background: An evaluation of intrathecal hyperbaric ropivacaine without adjuvant and with adjuvant magnesium for lower abdominal surgeries.Methods: This was a prospective, randomized, double-blind study conducted among the patients aged 18 to 60 years planned for lower abdomen surgeries under spinal anaesthesia and ASA grade I or II. Patients were randomly allocated to two groups (30 in each): ropivacaine Group (R group): spinal anesthesia with 3ml of 0.6% hyperbaric ropivacaine (18mg )+ 0.5ml NS. hyperbaric ropivacaine + Magnesium Group (R+M group ):   spinal anesthesia with 3ml of 0.6% hyperbaric ropivacaine (18mg) + 0.5ml magnesium sulphate (50 mg).  All the patients scheduled for operation were given oral tablets ranitidine 150 mg and Alprazolam 0.25mg in the night before surgery.Results: There was no significant difference in the basic characteristics between the groups. The mean HR, MAP and SpO2 in both the groups decreased over the periods as compared to baseline. However, the trend of HR over the periods remains similar in both R and R+M groups. The bromage levels were significantly (p=0.0001) higher among the patients of Group R compared with R+M.  The 2 segment sensory regression (min), Sensory regression S2 (hr), motor recovery (hrs) and long term mobilization after spinal anesthesia were significantly (p=0.0001) lower among the patients of Group R compared with R+M. The complications were lower in Group R+M than R.Conclusions: Magnesium may be more suitable drug in surgeries in which muscle relaxation has greater value in lower abdominal surgeries.

Effects of Various Anaesthetic Techniques on Haemodynamic Stability and Inflammatory Cytokine (IL-6) Level in Patients Undergoing Breast Cancer Surgery

Introduction: Multimodal anaesthesia techniques includeregional anaesthesia in the form of paravertebral block andvarious anaesthetic drugs which acts on different sites of painpathway with different mechanism of action, results in goodquality of analgesia with minimal side effects. They improverecovery along with early mobilization and rehabilitationand early resumption. This technique lowers the level ofinflammatory cytokines. Due to this we aim to evaluate theeffects multimodal anaesthesia technique on level of IL-6inflammatory cytokines in breast carcinoma surgery.Material and Methods: Patients were randomized intofollowing three groups (n=30 in each group) using a computergenerated random number tables. Group I: paracetamol 10 mg/kg, Group II: paracetamol at 10 mg/kg and dexmedetomidine0.5μg/kg, Group III: paracetamol 10 mg/kg, dexmedetomidine0.5 μg/kg and paravertebral block with levobupivacaine.Fentany (2 μg/kg) with general anaesthesia were common inall three groups. Statistical Analysis: All the categorical datawas compared by using student “t” test, chi-square test andparametric data by analysis of variance (ANOVA).Results: Patients of group III was haemodynamically morestable as compared to group II and I. IL-6 level was 358.15, ingroup I, 354 in group II and 346.65 in group III preoperativelywhile 324.85 in group I, 320.95 in group II, 278.35 in group IIIafter 2 hour surgery. IL-6 level was significantly different ingroup III as compared to group II and group I postoperatively.Conclusion: Multimodal approach is a better anesthetictechnique in terms of hemodynamic stability with decreasedlevels of IL-6 inflammatory cytokines.

Comparison of postoperative analgesia and sedation responses of intravenous dexmedetomidine and esmolol during laparoscopic cholecystectomy

Background: Although, the concept of laparoscopic surgeries has revolutionised the surgical practice and has markedly reduced the incidence of complications especially postoperative pain. However, the menace of postoperative pain still remains challenge, especially in first 24 hours. The present study was conducted to comparatively analyse the postoperative pain and sedation using intravenous dexmedetomidine and intravenous esmolol during laparoscopic cholecystectomy.Methods: Study was conducted on 90 adult patients aged 18-60 years of ASA grade I or II of both genders, scheduled for laparoscopic cholecystectomy under general anaesthesia. Patients were randomized into three groups of 30 patients each. Patients of group A received esmolol infusion (loading: 1 mg/kg and maintenance: 5-15 µg/kg/min), patients of group B received dexmedetomidine infusion (loading: 0.7 µg/kg and maintenance: 0.4 µg/kg/hour) and group C (control group) received normal saline infusion. During the post-operative period of 24 hours, patient were monitored for sedation using Ramsay sedation score like pain, using visual analogue score (VAS), incidence of post-operative nausea and vomiting and use of any drug for pain, vomiting and any other side effect.Results: Frequency of pain was highest in group C at all post periods, followed by group A and was least in group B. The mean sedation score of group B was comparatively higher as compared to both group C and group A.Conclusions: The inference authors drew was that dexmedetomidine is better analgesic with aurousable sedation.

Trypan Blue Dye as an Adjunct to Cataract Surgery.

The current study was done to evaluate the utility and safety of Trypan Blue staining of the anterior capsule for enhancing visualization of capsulorrhexis in mature and hypermature cataracts.This study included 100 eyes of 100 patients with a unilateral mature or hypermature cataract. In all these cases 0.2ml of 0.1% Trypan blue dye was used to stain the anterior capsule in cataract surgery. In all 100 eyes the Continuous Curvilinear Capsulorrhexis (CCC) was completed. Successful cataract surgery with intraocular lens (IOL) implantation was performed in all eyes. Adverse reactions related to the dye such as raised intraocular pressure or anterior chamber inflammation was not observed in the immediate postoperative period or at the end of mean follow-up of 3 months.Trypan blue dye staining of the anterior capsule was found to be an effective and safe technique that helps in completion of Continuous Curvilinear Capsulorrhexis (CCC) in mature and hypermature cataracts.

Invasive Mole presenting as Acute Abdomen.

We present a rare case of invasive mole presenting as pain abdomen and bleeding per vaginum with subsequent hemoperitoneum. Emergency hysterectomy confirmed the presence of molar pregnancy perforating through the fundus.

Prenatal Diagnosis of Meckel-Gruber Syndrome with Dandy Walker Malformation

We report a 38 week old female fetus affected by Meckel-Gruber syndrome. Polycystic dysplastic kidneys, oligohydroamnios, symmetrical IUGR, hydrocephalus with Dandy-Walker cyst was observed on ultrasonographic (USG) examination. Small occipital encephalocele with polydactly was noted after delivery of child.