A Study Of Ocular Disorders In School Going Children.

Background: Ocular disorders are often neglected in children. At the school going age. They find difficulties in their day to day activities. Refractive Error affects a large proportion of school going children. This can be easily diagnosed and corrected with spectacles. If not corrected, they become a major cause of low vision or even blindness. In India, children younger than 15 years constitute about 42% of the population and out of it 30% lose their eyesight partially due to amblyopia before the age of 20 years. So we have selected this study. Methodology: This was a cross sectional study. The study was conducted in Dhiraj Hospital & Eye camps for school children during November 2014 to October 2015. We have examined 350 children. We have used snellen’s distant vision chart, torch light, direct ophthalmoscope and ishihara’s colour vision chart in the camps. We referred children who needed detailed examination to Dhiraj hospital where we did cycloplegic refraction. They were examined with auto refractometer , direct and indirect ophthalmoscopy and they were called for Post mydriatic test and also for follow up of other ocular disorders. Results: Our study was conducted in schools of Vadodra district and in Eye Opd of Dhiraj Genral hospital attached with SBKS MIRC pipariya , dist. Vadodara in Gujarat state. We have examined 350 children and done their complete follow up. We found refractive error in 130 (37.14%) in children. Amongst them Refractive error -130 and other disorders like Lacrimal sac disorder – 6, Meibomian gland dysfunction (MGD) – 9, Conjunctivitis- 12 , amblyopia -3 ,squint -1, Others (Normal)- 189. P value was significant in case of refractive error. Conclusion: Ocular disorders in school going children vary from place to place, mal nutrition, lack of attendance from parents & teachers on their complains of eye disorders, in some areas where treatment facility in private or government set up is not available so their problems are neglected. Climate condition also play significant role. The present study indicates that the school age is a high risk group for developing refractive errors. Most of the children were unaware of their problem. Thus prevalence of undetected refractive error was more. Allergic conjunctivitis was another issue of concern. More studies, resources and manpower are needed to detect uncorrected refractive error and achieve the goal of vision 2020.

A comparative study of ossiculoplasty by using various graft materials.

Introduction: The use of ossicular graft material in the ossicular chain reconstruction has significantly improved the results in the hearing after the tympanoplasty and tympanomastoid surgery for the chronic otitis media. The ossicular chain transmits the vibration of tympanic membrane to the inner ear with impedance matching function failure to which results in > 50dB hearing loss of conductive variety. Material and Method: A Prospective study of 76 patients who underwent ossiculoplasty was done in the department of ENT & Head and Neck Surgery , Sir T. Hospital ,Bhavnagar, Gujarat between May 2007 to June 2009.Only patients with conductive hearing loss were included in study and underwent ossiculoplasty with using various graft material and assessment done by post operative closure of air bone gap. Most available graft material used are auto graft, cartilage and bone, and various biosynthetic materials like gold,Teflon,plastipore,titanium etc. Results: Majority of patients are middle age group with moderate conductive hearing loss. The comparison of hearing improvement between various graft materials at 2 month and 5 months post operatively were studied in the relation to the postoperative air bone gap closure shows that auto graft and gold prosthesis are cost effective with comparable results obtained as by expensive titanium and plastipore prosthesis. Discussion & Conclusion: The ossiculoplasty materials produce varying results. The titanium and plastipore are rather expensive for the Indian patients , particularly for the government hospital poor class patients. We have tried to evaluate the results using the economical and readily available graft materials like cartilage, bone and gold prosthesis for ossiculoplasty and compared its results with costly plastipore and titanium prosthesis. prosthesis

Home-based Rehabilitation of Severely Malnourished Children in Resource Poor Setting.

Objective: To evaluate the feasibility and outcome of home-based rehabilitation of severely malnourished children. Design: Prospective and observational. Setting: Rehabilitation at home (16 weeks) following initial assessment or/and stabilization at hospital. Participants: Thirty-four severely malnourished (weight for length <70% of WHO reference) children between the ages of 6 months to 5 years. Intervention: Initial assessment of the patient was done in hospital. Those with complications or loss of appetite were admitted in hospital and managed as per WHO guidelines. After discharge, they were managed at home using home based diets. Those without complications and with preserved appetite were directly eligible for home-based rehabilitation. Follow up was done in hospital up to 16 weeks. Dietary intake, anthropometry and morbidities were recorded during follow-up. Results: Of the enrolled 34 children, 19 children were admitted in hospital and 15 children were sent home after initial assessment in hospital. Five did not clear the initial stabilization phase (2 died, 3 left hospital). Finally 29 children qualified for home based rehabilitation out of which 26 completed 16 week follow-up. During the home based management phase, the reported mean (±SD) calorie intake increased from 100 (±5) kcal/kg/d at entry point to 243 (±13) kcal/kg/d at 16 weeks (P=0.000). Similarly, reported protein intake increased from 1.1 (±0.3) g/kg/d to 4.8 (±0.3) g/kg/d (P=0.000). During hospital stay (n=19), children had weight gain of 9.0 (±5.3) g/kg/d, while during home based follow up (n=29), weight gain was 3.2 (±1.5) g/kg/d only. During home based rehabilitation, only 3 (11.5%) children had weight gain of more than 5 g/kg/d by the end of 16 weeks. Weight for height percent increased from an average (±SD) of 62.9% (±6.0%) to 80.3% (±5.7%) after the completion of 16 weeks (P=0.000). Thirteen (45%) children recovered completely from malnutrition achieving a weight for length of >80% whereas 15 (51.7%) recovered partly achieving weight for length >70%. There was no death during the home stabilization. Conclusion: Home based management using home prepared food and hospital based follow up is associated with sub-optimal and slower recovery.