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Purpose: To describe the demographics and clinical profile of pseudoexfoliation syndrome (PXF or PES) in patients presenting to a multi?tier ophthalmology hospital network in India. Methods: This cross?sectional hospital?based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of PXF in at least one eye were included as cases. The data were collected using an electronic medical record system. Results: Overall, 23,223 (0.75%) patients were diagnosed with PXF. The majority of the patients were male (67.08%) and had unilateral (60.96%) affliction. The most common age group at presentation was during the seventh decade of life with 9,495 (40.89%) patients. The overall prevalence was higher in patients from a lower socio?economic status (1.48%) presenting from the urban geography (0.84%) and in retired individuals (3.61%). The most common location of the PXF material was the pupillary margin (81.01%) followed by the iris (19.15%). The majority of the eyes had mild or no visual impairment (<20/70) in 12,962 (40.14%) eyes. PXF glaucoma was documented in 7,954 (24.63%) eyes. Krukenberg’s spindle was found in 64 (0.20%) eyes, phacodonesis in 328 (1.02%) eyes, and lens subluxation in 299 (0.93%) eyes. Among the surgical interventions, cataract surgery was performed in 8,363 (25.9%) eyes, trabeculectomy was performed in 966 (2.99%) eyes, and a combined procedure in 822 (2.55%) eyes. Conclusion: PXF more commonly affects males presenting during the seventh decade of life from lower socio?economic status and is predominantly unilateral. A quarter of the affected eyes are associated with glaucoma and the majority of the eyes have mild or no visual impairment.
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Purpose: To evaluate the outcomes of lensectomy with a glued intraocular lens (IOL) in spherophakic eyes with secondary glaucoma and assess factors associated with failure. Methods: We prospectively evaluated outcomes of lensectomy with glued IOL in 19 eyes with spherophakia and secondary glaucoma (intraocular pressure (IOP) ?22 mm Hg and/or glaucomatous optic disc damage) between 2016 and 2018. The vision, refractive error, IOP, antiglaucoma medications (AGMs), optic disc changes, need for glaucoma surgery, and complications were assessed. Success was defined as complete when IOP was ?5 and ?21 mmHg without AGMs; qualified success as similar IOP with up to 3 AGM; the need for >3AGM/additional surgery for IOP control was considered a failure. Results: Preoperatively, the median (interquartile range: IQR) age was 18 (13.5–30) years. IOP was 16 (14–22.5) mmHg on a median of 3 (2,3) AGMs. Median postoperative follow up was 27.7 months (11.9, 39.7). Postsurgery, most patients achieved emmetropia, with significantly decreased refractive error from a median spherical equivalent of ?12.5D to + 0.5D, P < 0.0002. The complete success probability was 47% (95% confidence intervals (CIs): 29–76%) at 3 months and was 21% (8 ? 50%) at 1 year and 3 years. The qualified success probability was 93% (82–100%) at 1 year, which reduced to 79% (60–100%) in 3 years. None of the eyes had any retinal complications. The higher number of preoperative AGM was found to be a significant risk factor (p < 0.02) for the failure of complete success. Conclusion: One?third of the eyes had IOP control without the need for AGM postlensectomy with glued IOL. Surgery resulted in significant improvement in visual acuity. The higher number of preoperative AGM was associated with poor glaucoma control after glued IOL surgery
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Purpose: Our study aimed to evaluate the utility of the anterior segment morphometry for objectively assessing anterior segment architectural changes of corneal clouding in the mucopolysaccharidoses (MPS) cohort and to investigate whether these measurements correlate with the slit?lamp findings on the cornea and early diagnosis of glaucoma. Methods: This retrospective study involved 70 eyes of 35 children with cloudy cornea due to MPS variants. Anterior segment architectural alterations were measured using anterior segment imaging and biometry in MPS children and compared with controls. Results: Mean age of the cohort at the time of assessment was 7.9 ± 4.5 years. Males constituted two?thirds of the cohort. Variants of MPS with cloudy cornea were as follows: Type I (62%), Type IV (11%), and Type VI (22%). Morphometric measurements were available in 22 eyes of 11 MPS children and an age?matched healthy control group. There were significant differences between MPS cohort and controls in refraction in Diopters (5.03 ± 0.39 and 0.01 ± 0.04; P < 0.0001), axial length (AXL) in mm (21.39 ± 0.28 and 23.04 ± 0.28; P = 0.0002), average keratometry in Diopters (40.67 ± 0.44 and 42.83 ± 0.44; P < 0.0001), anterior chamber depth (ACD) in mm (2.92 ± 0.07 and 3.65 ± 0.07; P < 0.0001), and intraocular pressure (IOP) in mmHg (25.2 ± 2.0 and 14.1 ± 2.3; P = 0.0003). Secondary glaucoma was observed in 28% of the MPS cohort. Conclusion: The anterior segment morphometry in the cloudy cornea due to MPS provides an objective measurement of anterior segment architectural changes, thus diagnosing early?onset secondary glaucoma. These findings highlight that cloudy cornea due to MPS variants merits close monitoring throughout life
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Purpose: To describe the clinical features and treatment outcomes in spontaneous uveal effusion syndrome (UES). Methods: A 10?year retrospective chart review of UES patients from a tertiary eye center was carried out. Optical coherence tomography (OCT), fundus fluorescein angiography, and ultrasound biomicroscopy (UBM) scans were performed. UES was managed based on presenting best?corrected visual acuity (BCVA), symptoms, and fundus findings. Patients with secondary causes of uveal effusion were excluded. Results: Twenty?five eyes of 16 patients were included. Of the 16 patients, 14 (88%) were male and 9 (56%) had bilateral disease. Fifteen of 25 affected eyes had nanophthalmos (axial length (AL) <20.5 mm) and 6 had hyperopia with AL >20.5 mm. The presenting mean distance BCVA was 0.74 ± 0.64 logMAR (mean Snellen: 20/100). Eleven eyes had exudative retinal detachment, and 4 also had exudative choroidal detachment (CD). Choroidal thickness (CT) was increased in 11 eyes on B?scan ultrasonography, and the mean CT was 1.74 ± 0.38 mm. Sub?retinal fluid (SRF) and retinal folds were the most common OCT findings. UBM findings included shallow angles, peripheral CD, and supra?ciliary effusion. A combination of local and systemic corticosteroids was used to successfully treat 12 eyes, 6 needed surgery, and 7 were observed. Partial sclerectomy with anterior chamber maintainer?assisted SRF drainage was the favored surgery. The median period of follow?up was 6.5 months (0.1–76 months), and the mean distance BCVA at the last follow?up was 0.58 ± 0.42 logMAR (mean Snellen: 20/80). Conclusion: UES can be suitably managed both medically and surgically based on clinical presentation
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Justification: In India, there is a lack of uniformity of treatment strategies for aplastic anemia (AA), and many children are managed only with supportive care due to non-availability of hematopoietic stem cell transplantation (HSCT). Process: Eminent national faculty members were invited to participate in the process of forming a consensus statement in Hyderabad in July, 2016. Draft guidelines were circulated to all members, and comments received in a online meeting in October, 2020 were incorporated into the final draft. These were approved by all experts. Objective: To facilitate appropriate management of children with acquired aplastic anemia. Recommendations: Key recommendations are: i) A bone marrow biopsy is must to make a diagnosis of AA; ii) Rule out inherited bone marrow failure syndromes (IBMFS), connective tissue disorders, viral infections, paroxysmal nocturnal hemoglobinuria (PNH), drug or heavy metal induced marrow suppression in all cases of AA; iii) Conservative approach to transfusions should be followed, with a target to keep hemoglobin >6 g/dL in children with no co-morbidities; iv) HLA-matched sibling donor HSCT is the preferred choice of treatment for newly diagnosed very severe/ severe AA; v) In absence of HLA-matched family donor, a matched unrelated donor (MUD) transplant or immunosuppressive therapy (IST) should be considered as alternate choice based on physician expertise; vi) Fludarabine, cyclophosphamide and anti-thymocyte globulin (ATG) based conditioning with cyclosporine and methotrexate as graft versus host disease (GvHD) prophylaxis is the preferred regimen; vii) Horse ATG and cyclosporine are the recommended drugs for IST. One should wait for 3-6 months for the response assessment and consideration of next line therapy.
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Purpose: To evaluate Vitamin B12 levels in healthcare professionals at a tertiary eyecare centre in India. Methods: This was a cross?sectional study conducted among healthcare professionals working at a tertiary eyecare centre in India. The sample included 2,374 employees. Chemiluminescent immunoassay method (reference range, 211–911 pg/ml) was used to assess serum vitamin B12 levels. Effect of age and gender was analyzed in vitamin B12 normal and vitamin B12 deficient groups. To evaluate risk factors, questions related to vitamin B12 deficiency were asked to the study participants in a survey. Results: The mean age of employees was 29.2 ± 0.7 years. Around 26% of them were vitamin B12 deficient. The proportion of males in the vitamin B12 deficient group (61.2%) was significantly higher (P < 0.0001) than that of the vitamin B12 normal group (44.9%). There was no effect of age on vitamin B12 levels in both vitamin B12 normal and vitamin B12 deficient groups. Mean vitamin B12 levels in males (289.1 ± 22.2 pg/ml) was significantly lower (P < 0.0001) than that of females (338.7 ± 30.0 pg/ml). Conclusion: This is the first such study on eyecare professionals. One?fourth of the eyecare professionals were vitamin B12 deficient. The proportion of males was higher in the vitamin B12 deficiency group. Males had lower vitamin B12 levels than females. Annual blood tests for vitamin B12 are recommended for timely diagnosis and management of vitamin B12 deficiency, particularly in males.
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Purpose: To evaluate the outcomes of trabeculectomy, graft survival, and risk factors for failure in post penetrating keratoplasty (PK) and Descemet’s stripping endothelial keratoplasty (DSEK) eyes. Methods: We reviewed charts of eyes that underwent trabeculectomy for post keratoplasty glaucoma PK [25 eyes] and DSEK [14 eyes] between 1993 and 2019. The demographics, clinical features, and surgical outcomes were evaluated. Success of trabeculectomy was defined as complete when the intraocular pressure (IOP) was >5 and ?21 mmHg without antiglaucoma medications (AGM) and qualified with AGM. Clear and compact graft was considered for graft success. Results: Median (interquartile range [IQR] preoperative IOP in post?PK eyes and post?DSEK eyes was comparable, 32 (28–38) vs. 31.5 (25–36) mmHg, P = 0.38). Median number of preoperative AGMs was comparable (P = 0.78). Median postoperative follow?up was longer in post?PK, compared with post?DSEK, 2.5 (1.3–3.3) vs. 1 (0.3–2.9) years (P = 0.05). Kaplan–Meier survival estimates for complete and qualified success of trabeculectomy at 3 years were 23.7% and 73.3%, respectively, for PK and 45.8% and 71.6%, respectively, for DSEK. Kaplan–Meier survival estimates for graft survival were 91.8% up to 3 years for PK and 100% until 2 years and 77.8% at 3 years for DSEK. Higher IOP prior to trabeculectomy was a risk factor for failure of trabeculectomy (P = 0.03) and older age was a risk factor for graft failure (P = 0.05) in PK eyes. Number of prior corneal surgeries (P = 0.05) was associated with failure of trabeculectomy and graft failure in post?DSEK eyes. Conclusion: Trabeculectomy had moderate qualified success in post?PK and DSEK eyes at 3 years. Higher pretrabeculectomy IOP and higher number of prior corneal surgeries were significantly associated with failure of trabeculectomy in PK and DSEK eyes, respectively
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Purpose: To report the outcomes of pars plana insertion of Aurolab aqueous drainage implant (AADI) in adults with refractory glaucoma by the novel technique of making scleral tunnel instead of patch graft to cover the tube to prevent its migration. Methods: A retrospective study was done between April 2016 and April 2018 on patients with ?12 months of follow?up. The main outcome measure was a surgical failure at 12 months. The failure was defined as intraocular pressure (IOP) >18 mmHg or IOP ?5 mmHg on two consecutive follow?up visits after 3 months, reoperation for glaucoma, loss of light perception vision, or implant explantation. Alternate definitions of failure including IOP >21 and IOP >15 mmHg were also considered. Results: The study included 32 eyes of 32 patients. The mean age was 46.2 ± 17.5 years. The most common etiology is traumatic glaucoma (12 eyes, 37.5%). The mean preoperative IOP and anti?glaucoma medications were 43.3 ± 10.3 and 3.4 ± 0.5 mmHg, respectively; both the parameters at the final follow?up were reduced to 15.2 ± 8.1 and 1.6 ± 0.5 mmHg. The Kaplan–Meier survival estimates demonstrated that the cumulative probability of failure was 15.6% (95% CI; 6.8–33.5%) at 3 months, 18.7% (95% CI; 8.9–37.0%) at 6 months, and 25.0% (95% CI; 13.4–43.8%) at 12 months. Conclusion: Pars plana AADI implantation with a newer modification technique is a useful procedure in reducing IOP and the number of anti?glaucoma medications in the eyes with refractory glaucoma. The visual acuity may be stabilized with the concurrent treatment of posterior segment pathology
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Purpose: To describe the clinical spectrum and management of glaucoma in congenital aphakia. Methods: The demographics and clinical spectrum of eyes with congenital aphakia with and without glaucoma were compared, and management outcomes of congenital aphakia cases with glaucoma were studied retrospectively between April 2000 and June 2020. Results: There were a total of 168 eyes (84 subjects) with a diagnosis of congenital aphakia, of which 29 eyes of 18 subjects were diagnosed with glaucoma. Corneal opacity was the presenting complaint in 26/29 eyes with glaucoma and 139/139 eyes without glaucoma. The (interquartile range (IQR)) horizontal corneal diameter was 10.5mm (IQR, 9.0?12.5) and 8mm (IQR, 5?10) in eyes with and without glaucoma (P = 0.01), respectively. The median (IQR) axial length was 17.5mm (IQR, 13.5?19.5) and 15mm (IQR, 14?16) mm in eyes with and without glaucoma (P = 0.03), respectively. Nineteen eyes with glaucoma had adequate intraocular pressure (IOP) control with one medication. Three eyes underwent transscleral diode cyclophotocoagulation and maintained IOP without medications. Three eyes underwent trabeculectomy and trabeculotomy, trabeculectomy followed by penetrating keratoplasty, and trabeculectomy, respectively, of which two eyes became phthisical. At the last follow?up, the median (IQR) IOP was 14 mm Hg (IQR, 14?17) Hg. The median (IQR) follow?up duration was 4.53 months (IQR, 2.03? 48.06). Conclusion: One?fifth of the eyes with congenital aphakia had secondary developmental glaucoma. The corneal diameter and axial lengths were higher in the eyes with glaucoma compared to eyes without glaucoma. Medical management is the preferred short?term mode of IOP control. Transscleral cyclophotocoagulation may be preferred over surgical intervention.
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Purpose: To report the outcomes of trabeculectomy in eyes with refractory acute primary angle?closure attack. Methods: Patients with acute primary angle?closure attack and who underwent trabeculectomy for medically uncontrolled intraocular pressure within 2 months of presentation were retrospectively analyzed. Primary outcome was intraocular pressure (IOP). Secondary outcome measures were visual acuity, number of antiglaucoma medication (AGM), complications, and risk factors for failure of trabeculectomy. Results: Thirty?five eyes of 31 patients with median (interquartile range) follow?up of 3 (0.5, 9) years were included in the study. Median age at presentation was 55 (47, 60) years. Median duration of symptoms at presentation was 10 (4, 16) days and median time from presentation to surgery was 13 (6, 25) days. Median IOP reduced from 42 (36, 46) to 13 (12, 16) mmHg (P < 0.001) and median number of AGM reduced from 3 (1, 3) to 0 (0, 0) after trabeculectomy at the end of 1 year. The probability of complete and qualified success was 88% (95% confidence interval [CI]: 72%–95%) and was 97% (95% CI: 81%–99%) at 1 year, respectively. Failure was noted in six eyes. Subsequent cataract surgery was needed in 13 eyes (37%) with a median duration from trabeculectomy being 6.75 (1, 11) years. None of the preoperative, intraoperative, or postoperative factors tested were associated with failure (P > 0.10 for all associations on Cox proportional hazard regression analysis). Conclusion: In medically unresponsive cases of acute primary angle?closure attack, primary trabeculectomy seems safe and effective in Indian eyes
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Objective: The aim of this study was to assess the micro-push-out bond strength of a mineral-based root canal sealer, BioRoot RCS in canals prepared by K3XF rotary systems of two different tapers. Material and Methods: Eighty caries free maxillary central incisors were used in this study. The samples were allocated into 4 groups (n=20) according to the root canal sealer and taper of the rotary instruments. The samples were obturated using single cone obturation technique. From each root 1mm thick slices at coronal, middle and apical thirds were collected using hard tissue microtome under continuous water coolant. Push-out tests were done for these sections using a Universal testing machine (INSTRON 8801) at a crosshead speed of 1mm/min. One-way analysis of variance (ANOVA) was used to compare the bond strengths within groups and Tukey's multiple post hoc analysis was used for pair-wise comparison of bond strengths. Results: AH Plus exhibited higher micro-push-out bond strength than BioRootRCS though they did not differ significantly (p>0.05). Preparation of root canals with 6% taper rotary instruments showed higher bond strength than 4% though they did not differ significantly (p>0.05). Conclusion: There was no significant difference between micro-push-out bond strength values of BioRoot RCS and AH Plus. The bond strength values were high in 6% taper canals than 4% canals though the difference was not significant statistically.
Objetivo: El objetivo de este estudio fue evaluar la fuerza de unión por micro-expulsión de un sellador de conductos radiculares de base mineral, BioRoot RCS, en conductos preparados por sistemas rotativos K3XF con dos conos diferentes. Material y Métodos: En este estudio se utilizaron 80 incisivos centrales superiores libres de caries. Las muestras se distribuyeron en cuatro grupos (n = 20) de acuerdo al sellador del conducto radicular y al cono de los instrumentos rotativos. Las muestras se obturaron mediante la técnica de obturación de un solo cono. De cada raíz se recogieron rodajas de 1 mm de grosor en los tercios coronal, medio y apical utilizando un micrótomo de tejido duro con refrigeración continua por agua. Posteriormente, se realizó una prueba de expulsión para estas secciones utilizando una máquina de prueba universal (INSTRON 8801) a una velocidad del cabezal transversal de 1mm/min. Se utilizó el análisis de varianza unidireccional (ANOVA) para comparar las resistencias de la unión dentro de los grupos y el análisis post hoc multiple de Tukey se utilizó para la comparación por pares de las resistencias de la unión. Resultados: AH Plus exhibió una fuerza de unión de micro-expulsión más alta que BioRootRCS, aunque no difirieron significativamente (p>0,05). La preparación de los conductos radiculares con instrumentos rotativos ahusados al 6% mostró una fuerza de unión superior al 4%, aunque no difirieron significativamente (p>0,05). Conclusión: No hubo diferencias significativas entre los valores de fuerza de unión de micro-expulsión de BioRoot RCS y AH Plus. Los valores de la fuerza de unión fueron más altos en canales cónicos al 6% que en canales al 4%, aunque la diferencia no fue significativa estadísticamente.
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Humans , Root Canal Filling Materials , Root Canal Obturation/methods , Dentin-Bonding Agents , Flexural Strength , Resins, Synthetic , Analysis of Variance , Root Canal Preparation , Dental Pulp Cavity , Epoxy Resins/chemistry , MineralsABSTRACT
Background: Menopause is defined according to WHO as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. It is defined as uterine bleeding occurring after at least 1 year of amenorrhoea. Considering the high accuracy of hysteroscopy in evaluation of postmenopausal bleeding, the present study was carried out with an aim to evaluate hysteroscopic findings in women with postmenopausal bleeding in order to assess the causes of PMB and to determine their prevalence in our population.Methods: This was a prospective observation study, comprising of total number of 50 postmenopausal women attending gynae OPD at department of obstetrics and gynecology, Command Hospital (CH), Lucknow, Uttar Pradesh. The data obtained for the purpose of study was fed into computer using Microsoft excel 2013 software.Results: A total of 50 women with complaints of postmenopausal bleeding were enrolled in the study. Maximum number of women had achieved menopause between age 46 and 50 years. Hysteroscopy had an accuracy of 94% for detection of polyps. Hysteroscopy had an accuracy of 90% for detection of atrophy. For fibroid, hysteroscopy had an absolute sensitivity, specificity, positive predictive, negative predictive and accuracy value (100%).Conclusions: The findings of present study suggested that hysteroscopy has a useful role in evaluation of postmenopausal bleeding especially in the diagnosis of polyps and fibroids. Given fewer number of cases, the usefulness of hysteroscopy in evaluation of endometrial cancer and hyperplasia could not be established adequately. Further studies on larger number of sample size will help in providing more useful and confirmatory information.
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Background: White coat hypertension (WCH) is a common and well recognized phenomenon. It is also very prevalent amongst pregnant women and is often diagnosed as chronic/ gestational hypertension leading to unnecessary medications during pregnancy. ABPM is the gold standard for diagnosis of WCH. SBPM is an easy effective and reliable method to measure blood pressure but its efficacy needs to be tested and compared with ABPM in cases of WCH. It is important to compare the two methods in assessing WCH so SBPM can be utilized in cases of WCH, if found useful and efficacious.Methods: All pregnant women who presented to the ANC were screened for hypertension. Those who were diagnosed to be hypertensive in antenatal clinic and these patients were then admitted for ambulatory blood pressure monitoring (ABPM) for 24 hours and SBPM on 6 hourly bases for 5 days.Results: The ABPM and SBPB readings were noted, tabulated and compared. It was found that the prevalence of ‘WCH’ in this study using ABPM and SBPM were 47.368% (27/54) and 45.614% (26/54) respectively.Conclusions: The results in diagnosing WCH using ABPM and SBPM were comparable.
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Background: Emergency obstetric care in health care requires a linked referral system to be effective in reducing maternal morbidity and mortality. This review is aimed at summarizing the proportion of referrals from urban, rural and tribal areas of surrounding districts to tertiary care centre, King George Hospital, Visakhapatnam for a 6 month period; from May 2018 to October 2018.Methods: Retrospective study done at a tertiary care teaching hospital, including 3157 cases referred from the surrounding urban, rural and tribal areas.Results: Out of the 3157 referred cases, most of them (1658) were from rural areas, 1030 from urban and 469 from tribal areas. Referrals done in view of post caesarean pregnancies were more in urban and rural areas whereas more preeclampsia and anaemia cases were referred from tribal areas. Various indications of referral are documented. Majority of them were unbooked cases.Conclusions: Specific guidelines regarding whom to refer, how to refer and when to refer would be helpful in making timely referral. These would also help to decrease the burden on the tertiary care centers which deal with a huge caseloads in spite of limited infrastructure and manpower. Adequate attention and better care can be given to complicated cases if the total case load is reduced. Stringent documentation in referral slip and better co-ordination are required for a strong health care system.
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Background: White coat hypertension (WCH) is a common and well recognized phenomenon with significant prevalence amongst all age groups. This is also quite prevalent in the pregnant women with an intermediate long term prognosis between hypertensive and normo-tensive individuals. It is important to assess the true prevalence WCH in pregnant women and to prevent unnecessary medications to them during pregnancy but at the same time to keep a timely follow up and a watchful eye on these patients to identify complications at the earliest. Study was conducted at a peripheral secondary level hospital with a small obstetrics and gynecology OPD and ward. 54 patients were diagnosed to be hypertensive in Antenatal Clinic.Methods: All pregnant women who presented to the ANC were screened for hypertension. Those who were diagnosed to be hypertensive in antenatal clinic and these patients were then admitted for Ambulatory Blood Pressure Monitoring (ABPM) for 24 hours.Results: The ABPM tracings were checked and tabulated to arrive at the final diagnosis after 24 hrs. The prevalence of ‘WCH’ in this study was 48.15% as 26/54 patients were found to have their average BP < 140/90 mmHg after measurement by ABPM over 24 hours so they were diagnosed as ‘White Coat Hypertension’ patients.Conclusions: Many women who come to ANC in the early pregnancy are diagnosed to have hypertension. WCH is a well known phenomenon in pregnancy. WCH must be ruled out prior to starting these patients on anti-hypertensive medications.
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Background: Low birth weight is a socio, economic, cultural and community based health issue which reflects responsibility and commitment of local and national administrative authorities. It continues to be a cause of short and long term adverse perinatal outcome with a bearing on adult non communicable health risks.Methods: This is a prospective observational and analytic study to know the prevalence, risk factors and perinatal outcome of LBW, from July 2017 to December 2018 in department of Obstetrics and Gynecology, MIMS Medical College, Andhra Pradesh, India. Maternal risk factors and outcomes associated with LBW were defined through risk ratios.Results: 721 infants including 116 LBW and 605 NBW born during study period were included in the study. Prevalence of LBW was 16%. Preterm birth accounted for 35%, FGR for 13.8% and SGA for 51.2% of them. Maternal factors like age <20 years and >35years, social status II to IV, below higher secondary education, house maker, primi gravida, grand multi para, BMI <18.5kg/M2 or >24.9kg/M2, Hb<11 gm% were having higher RR for LBW. LBW infants showed frequent association with oligo or polyhydramnious and hemorrhagic or turbid amniotic fluid. They had higher risks for non reassuring fetal heart rate changes, for induced delivery or an elective caesarean section. More often they needed NICU care for longer duration and showed a higher risk for malformations and neonatal mortality. Overall perinatal mortality was 5.54 per 1000 live birth.Conclusions: LBW is a risk factor for neonatal morbidity and mortality; which can be minimised by institutional delivery. High prevalence PTB (35%) warrants obstetricians to be more vigilant about indentifying the risk factors and adequate management planning. Constitutionally small baby at birth probably needs redefining normal birth weight for different ethnicity.
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Background: This study was conducted to determine the drug utilization pattern among geriatric inpatients in general medicine department of the hospital.Methods: An observational, prospective study was conducted for a period of six months (November 2016 to April 2017) among 200 geriatric patients; demographic details, education, occupation, diagnosis and drug details were recorded. The drugs were categorized by anatomical therapeutic classification (ATC) and defined daily dose (DDD) was calculated. The World Health Organization (WHO) prescribing indicators were assessed.Results: The majority of the patients (59%) were in age group of 60-69 years. Cardiovascular diseases were common among geriatrics. Most commonly prescribed drug was Pantoprazole (81.7%). Drugs were assigned with ATC/DDD codes according to the guidelines of WHO. Drugs prescribed by their generic names were 56.64% and 43% of drugs that were included in the National Essential Medicines List.Conclusions: Clinical pharmacist have to collaborate and work together with physicians in selecting and adjusting the dose among geriatric population in order to reduce development of potential adverse drug reactions, serious drug related complications and drug interaction.
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The efficiency of 0.75% Ropivacaine as a single shot epidural anaesthetic in comparison to 0.5% Bupivacaine is less studied. Our study focuses on comparing the efficiency of sensory block between 0.75% ropivacaine and 0.5% bupivacaine for epidural anaesthesia. Methods: The study was done with 0.75% Ropivacaine and 0.5% Bupivacaine in epidural anaesthesia in orthopedic hip surgeries given as a single shot technique for which 60 patients of ASA I/II each were chosen and 15ml of the drug was given. Onset of the sensory sensations at T12 and regression at the same level were measured with the aid of response to pin prick and thus duration of epidural anaesthesia was calculated individually in group B and group R respectively. Results: Onset of sensory block was faster in group R than in group B and regression was slower in group R than in group B. Conclusion: It can be concluded that duration of epidural anaesthesia was prolonged and longer with 0.75% Ropivacaine than 0.5% Bupivacaine.
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Justification: Despite having standard principles of management of hemophilia, treatment differs in various countries depending onavailable resources. Guideline for management of hemophilia in Indian setting is essential.Process: Indian Academy of Pediatrics conducted a consultative meeting on Hemophilia on 18th September, 2016 in New Delhi, whichwas attended by experts in the field working across India. Scientific literature was reviewed, and guidelines were drafted. All expertcommittee members reviewed the final manuscript.Objective: To bring out consensus guidelines in diagnosis and management of Hemophilia in India.Recommendations: Specific factor assays confirm diagnosis and classify hemophilia according to residual factor activity (mild 5-40%,moderate 1-5%, severe <1%). Genetic testing helps in identifying carriers, and providing genetic counseling and prenatal diagnosis.Patients with hemophilia should be managed by multi-specialty team approach. Continuous primary prophylaxis (at least low-doseregimen of 10-20 IU/kg twice or thrice per week) is recommended in severe hemophilia with dose tailored as per response. Factorreplacement remains the mainstay of treating acute bleeds (dose and duration depends on body weight, site and severity of bleed).Factor concentrates (plasma derived or recombinant), if available, are preferred over blood components. Other supportive measures(rest, ice, compression, and elevation) should be instantly initiated. Long-term complications include musculoskeletal problems,development of inhibitors and transfusion-transmitted infections, which need monitoring. Adequate vaccination of children withhemophilia (with precautions) is emphasized