Evaluation of the ocular surface in asymptomatic glaucoma patients on topical medications and following trabeculectomy - A cross-sectional study

Purpose: This present prospective, cross-sectional study aims to comprehensively evaluate the ocular surface in asymptomatic patients with diffuse blebs after trabeculectomy versus chronic anti?glaucoma medication use and compare it with the age?matched normal population. Methods: Objective clinical evaluation was done by tear film break?up time (TBUT) and Schirmer’s test (ST) in the three groups– trabeculectomy >6 months with a diffuse bleb (Wurzburg bleb classification score ?10), chronic anti?glaucoma medication (AGM >6 months) group, and normal population. In all groups, tear film osmolarity was checked with the TearLab® device (TearLab Corp., CA, USA), and subjective evaluation was performed by administering Ocular Surface Disease Index (OSDI) questionnaire. Patients already on chronic lubricants or any other drug for the treatment of dry eyes (viz. steroids, cyclosporin) or having symptoms suggestive of an abnormal ocular surface, who had undergone refractive or intraocular surgery, and contact lens users were excluded. Results: In total, 104 subjects/eyes were recruited over 6 weeks. Thirty?six eyes recruited in the trab group were compared with 33 eyes studied in the AGM group, and both these groups were compared to 35 normal eyes. When compared to normals, TBUT and ST were significantly lower (P = 0.003 and 0.014) and osmolarity and OSDI were statistically significantly higher (P = 0.007 and 0.003) in the AGM group, whereas only TBUT was statistically significantly different (P = 0.009) when the trab group was compared to normals. Also, when the trab group was compared to the AGM group, ST was found to be higher (P = 0.003) and osmolarity was lower (P = 0.034). Conclusion: To conclude, ocular surface is affected even in asymptomatic patients on AGM but near normalcy is possible following trabeculectomy when blebs are diffuse.

An epidemiological study of menstrual hygiene practices in school going adolescent girls from urban slums of Nalgonda, Telangana

Background: Reproductive health of adolescent girls is crucial as it determines the health of future generations. School girls when experiencing menarche find themselves in a setting without water, toilets or a supportive female teacher to explain the changes happening in their body. Hence, the present study was conducted to assess knowledge and practices about menstruation in adolescent school girls of an urban slum and to find some socio-demographic determinants of menstrual hygiene.Methods: This was a descriptive cross-sectional study conducted among 6th to 10th class school going adolescent girls from an urban slum of Telangana state. A total of 300 girls participated.Results: The mean age of the students was 11.9±3.3 years. The mean age at menarche was 13.09 (95% CI: 12.07–14.11). 25.3% had acquired prior knowledge about attaining menarche. For majority (74.2%) the knowledge was imparted by their mothers. 96.9% of school girls used sanitary pads. Significant association observed between educational status and employment status of mother and usage of sanitary pads by respondent. Almost 90% of the young women faced physical complaints or health problems during menstruation. Majority (94.3%) had religious restrictions on them during the menstruation.Conclusions: Menstrual hygiene is an issue which needs to be addressed to all adolescents, with special emphasis in slum area. Lack of awareness is a roadblock in adopting safe and hygienic menstrual practices. More emphasis should be given on improving adolescent literacy for achieving hygienic menstrual practices.

Pyogenic Granuloma Of Upper Lip: A Case Report

Pyogenic granuloma is a common tumor-like growth of the oral cavity that is supposed to be non-neoplastic in nature. It is a reactional response to minor trauma or chronic irritation and due to hormonal changes. Clinically oral pyogenic granuloma is a smooth or lobulated exophytic lesion on a pedunculated or sessile base, which is mostly haemorrhagic. Although pyogenic granuloma is a non-neoplastic growth in the oral cavity, proper diagnosis, prevention, management and treatment is very important. This case report draws attention towards the uncommon location of the pyogenic granuloma on the upper lip. Surgical excision was done because of the cosmetic disfigurement and discomfort to the patient.

Small group facilitation skills in problem-based learning.

Medical schools are increasingly changing over to a problem-based system of learning. Students work in a small group to analyze a well-structured, clinically relevant patient case. Problem Based Learning (PBL) provides a logical approach in training students for practicing medicine in a complex environment by exposing them to simulated problems which may reflect real life situations. PBL requires a change in mindset on the part of both the learner and the teacher/facilitator. For tutors, metacognitive skills, i.e. the ability of active, positive, conscious monitoring and direction of activities carried out by the students who were confronted with a problem, clear communication, and awareness of the learning needs of the students are rated as important. The ‘knowledgeable’ teacher no longer dominates learning, and students and teachers became equal partners in the learning process. Teachers/facilitators are requested not to give answers but to provide students with more room for active self-learning. An effective PBL tutor has the ability to communicate informally with students and has an empathic attitude which creates an atmosphere in which open exchange of ideas is facilitated. Programmes to improve PBL facilitation skills have been carried out in various institutions in the South Asian region. The positive impact of these training programmes highlights the need for workshops to develop such facilitative skills among South Asian medical educators. Problem-based learning should gradually become the more important and more widely used method of learning compared to didactic lectures.

Cerebellar control of visceral responses-possible mechanisms involved.

It seems reasonable to assume that cerebellar autonomic control operates according to similar principles as those utilized in the somatomotor coordination. The unique and very uniform neuronal architecture throughout the cerebellum speaks in favour of such a view.

The beneficial effect of yoga in diabetes.

Twenty NIDDM subjects (mild to moderate diabetics) in the age group of 30-60 years were selected from the out patient clinic of G.T.B. hospital. They were on a 40 days yoga asana regime under the supervision of a yoga expert. 13 specific Yoga asanas < or = done by Type 2 Diabetes Patients included. Surya Namaskar, Trikonasana, Tadasana, Sukhasana, Padmasana, Bhastrika Pranayama, Pashimottanasana, Ardhmatsyendrasana, Pawanmuktasana, Bhujangasana, Vajrasana, Dhanurasana and Shavasana are beneficial for diabetes mellitus. Serum insulin, plasma fasting and one hour postprandial blood glucose levels and anthropometric parameters were measured before and after yoga asanas. The results indicate that there was significant decrease in fasting glucose levels from basal 208.3 +/- 20.0 to 171.7 +/- 19.5 mg/dl and one hour postprandial blood glucose levels decreased from 295.3 +/- 22.0 to 269.7 +/- 19.9 mg/dl. The exact mechanism as to how these postures and controlled breathing interact with somatoendocrine mechanism affecting insulin kinetics was worked out. A significant decrease in waist-hip ratio and changes in insulin levels were also observed, suggesting a positive effect of yoga asanas on glucose utilisation and fat redistribution in NIDDM. Yoga asanas may be used as an adjunct with diet and drugs in the management of Type 2 diabetes.

Effect of Yoga asanas on nerve conduction in type 2 diabetes.

Twenty Type 2 diabetic subjects between the age group of 30-60 years were studied to see the effect of 40 days of Yoga asanas on the nerve conduction velocity. The duration of diabetes ranged from 0-10 years. Subject suffering from cardiac, renal and proliferative retinal complications were excluded from the study Yoga asanas included Suryanamskar. Tadasan, Konasan, Padmasan Pranayam, Paschimottansan Ardhmatsyendrasan, Shavasan, Pavanmukthasan, Sarpasan and Shavasan. Subjects were called to the cardio-respiratory laboratory in the morning time and were given training by the Yoga expert. The Yoga exercises were performed for 30-40 minutes every day for 40 days in the above sequence. The subjects were prescribed certain medicines and diet. The basal blood glucose, nerve conduction velocity of the median nerve was measured and repeated after 40 days of Yogic regime. Another group of 20 Type 2 diabetes subjects of comparable age and severity, called the control group, were kept on prescribed medication and light physical exercises like walking. Their basal & post 40 days parameters were recorded for comparison. Right hand and left hand median nerve conduction velocity increased from 52.81 +/- 1.1 m/sec to 53.87 +/- 1.1 m/sec and 52.46 +/- 1.0 to 54.75 +/- 1/1 m/sec respectively. Control group nerve function parameters deteriorated over the period of study, indicating that diabetes is a slowly progressive disease involving the nerves. Yoga asanas have a beneficial effect on glycaemic control and improve nerve function in mild to moderate Type 2 diabetes with sub-clinical neuropathy.

Study of yoga asanas in assessment of pulmonary function in NIDDM patients.

Certain yoga asanas if practiced regularly are known to have beneficial effects on human body. These yoga practices might be interacting with various, somato-neuro-endocrine mechanisms to have therapeutic effects. The present study done in twenty four NIDDM patients of 30 to 60 year old, provides metabolic and clinical evidence of improvement in glycaemic control and pulmonary functions. These middle-aged subjects were type II diabetics on antihyperglycaemic and dietary regimen. Their baseline fasting and postprandial blood glucose and glycosylated Hb were monitored along with pulmonary function studies. The expert gave these patients training in yoga asanas and were pursed 30-40 min/day for 40 days under guidance. These asanas consisted of 13 well known postures, done in a sequence. After 40 days of yoga asanas regimen, the parameters were repeated. The results indicate that there was significant decrease in fasting blood glucose levels (basal 190.08 +/- 90.8 in mg/dl to 141.5 +/- 79.8 in mg/dl). The postprandial blood glucose levels also decreased (276.54 +/- 101.0 in mg/dl to 201.75 +/- 104.1 in mg/dl), glycosylated hemoglobin showed a decrease (9.03 +/- 1.4% to 7.83 +/- 2.6%). The FEV1, FVC, PEFR, MVV increased significantly (1.81 +/- 0.4 lt to 2.08 +/- 0.4 lt, 2.20 +/- 0.6 lt to 2.37 +/- 0.5 lt, 3.30 +/- 1.0 lt/s to 4.43 +/- 1.4 lt/s and 64.59 +/- 25.7 lt min to 76.28 +/- 28.1 lt/min respectively). FEV1/FVC% improved (85 +/- 0.2% to 89 +/- 0.1%). These findings suggest that better glycaemic control and pulmonary functions can be obtained in NIDDM cases with yoga asanas and pranayama. The exact mechanism as to how these postures and controlled breathing, interact with somato-neuro-endocrine mechanism affecting metabolic and pulmonary functions remains to be worked out.