The Ganesh朑rewal cystitome maker � A step in standardizing cataract surgery

A well-centered, adequately sized continuous curvilinear capsulorhexis (CCC) is a prerequisite for successful cataract surgery. A perfect capsulorhexis ensures safe and effective performance of various steps of surgery as well as a correctly positioned intraocular lens (IOL) with optimal rotational stability. Ganesh and Grewal (GG) cystitome maker is a step toward standardizing the creation of a cystitome to reduce variations and complications associated with the crucial step of CCC in cataract surgery. We conducted a study to measure the repeatability and precision of cystitomes made by the GG cystitome maker versus those made manually with a needle holder. The results showed that the cystitomes made with GG cystitome maker had a lesser degree of variation. This indicates a more repeatable cystitome, which will inadvertently help in reducing the error caused by the instrument in making a good CCC during cataract surgery.

Evaluation of Effects of Irradiation with 980 nm Diode Laser at 0.8 W, 1.2 W and 1.4 W, on Sheep Bone - An In Vitro Histological Study

Diode laser has been a boon to treat various periodontal diseases in the last decade. Literature cautions that contact of diode laser would be detrimental to bone and leads to bone resorption. However, till date no studies have documented bone damage at different power settings of laser. So, the objective of this study was to evaluate the effects of 980 nm diode laser irradiation on sheep bone under different power settings in continuous wave mode for fixed amount of time. MethodsA fresh femur of sheep devoid of any muscle and soft tissue was obtained. Three markings, each 10 mm long were made for the specimens. The specimens were categorized as sample A, B and C. 980 nm Diode Laser was used to irradiate the specimens with 0.8 W, 1.2 W and 1.4 W at continuous mode as the power settings for sample A, B and C respectively for 10 seconds in direct contact with bone in a brushing like pattern. ResultsThe depth of bone damage was measured using Haematoxylin and Eosin stain. Bone damage was minimum for group 1 followed by group 2 and 3. ConclusionsWhen the specimens were irradiated by a 980 nm diode laser in direct contact with the bone tissue, damage was seen both clinically and microscopically in all groups.

Obstetric outcome in elderly gravida

Background: Maternal age is an important determinant of the outcome of pregnancy. Advanced maternal age generally signify age after 35 years at the time of delivery. It is associated with decreased fertility and increased risk. Elderly gravida is associated with many complications during pregnancy, labour and also for the baby. In recent times women has changed their lifestyles such as pursuit of higher education and entry into work forces and career advancement outside the home.Methods: This was a retrospective study done in 57 elderly pregnant women more than 33 years age, over a period of 18 months, conducted in a multi-specialty hospital.Results: 57 elderly pregnant women were selected for the study. 47% were in age group of 33-35 years and 42% were in age group of 36-40 years. 61.40% patients were housewives and 38.59% were employed. 50.8% of patients had history of previous abortions and 35% were conceived after treatment for sterility. 64.9% of patients conceived spontaneously and 35% by assisted reproductive technology. Majority of patients (33.3%) required Invitro-fertilization. Multiple pregnancy was high- 21.05%. Hypertension was observed in 26.3% of patients, Antepartum haemorrhage in 4.34%,  Preterm delivery  49.1%, Induction of labour in 10.52%, Normal vaginal delivery only in14%. Majority of patients (80.7%) were delivered by caesarean section.Conclusions: Elderly pregnant patients have higher risks of specific pregnancy complications which contribute to a higher frequency of maternal morbidity and greater health care costs. The risks are due to Hypertension, diabetes, multiple pregnancy, preterm labour, antepartum haemorrhage, PROM, malpresentation, prolonged labour, increased caesarean section rate and postpartum haemorrhage.

Differential systemic gene expression profile in patients with diabetic macular edema: Responders versus nonresponders to standard treatment.

Introduction: Diabetic macular edema (DME) is a vision-threatening complication of diabetic retinopathy. The current practice of management is a” trial and error “method of using intravitreal antivascular endothelial growth factor (VEGF)’’ or steroids to treat the patient and watch the response. However, if the patient’s genetic profi le helps us choose appropriate medicine, it would help customize treatment option for each patient. This forms the basis of our study. Materials and Methods: A case-control, prospective, observational series, where DME patients were treated with bevacizumab and subclassifi ed as treatment naïve, treatment responders, and treatment nonresponders. Blood samples of 20 subjects were studied, with fi ve patients in each of the groups (nondiabetic- group 1, treatment naïve- group 2, treatment responder- group 3, and treatment nonresponder-group 4). Whole blood RNA extraction followed by labeling, amplifi cation and hybridization was done, and microarray data analyzed. Genes were classifi ed based on functional category and pathways. Results: The total number of genes upregulated among all three experimental groups was 5, whereas 105 genes were downregulated. There were no common genes upregulated between the responders and nonresponders. There was only one gene upregulated between the diabetic and diabetic responders postt reatment. There were 19 genes upregulated and 8 genes downregulated in the infl ammatory pathway in group 2 versus group 1. There were no downregulated genes detected in vascular angiogenesis and transcription group. There were identical numbers of genes up- and downregulated in the infl ammatory pathway. Seventeen genes were upreguated and 11 genes downregulated in receptor activity, which remained the predominant group in the group classifi cation. Discussion: In summary, this study would provide an insight into the probable signaling mechanisms for disease pathogenesis as well as progression. This type of study eventually would aid in developing or improvising existing treatment modules with a rational approach towards personalized medicine, in future addressing the diff erential responses to treatment.

Acute Respiratory Distress Syndrome as a paradoxical response to anti-tuberculosis and anti-retroviral therapy.

Paradoxical response or immune reconstitution inflammatory syndrome (IRIS) during the course of antituberculous therapy is being increasingly recognised among patients with and without HIV co-infection. A 40-year-old HIV infected male on anti-retroviral therapy (ART) presented with persistent fever and weight loss. He was diagnosed to have miliary tuberculosis and HIV co-infection. Following initiation of anti-tuberculous chemotherapy, the clinical course was characterised by development of acute respiratory failure (ARDS) as a paradoxical response/IRIS to treatment. This uncommon manifestation of paradoxical response (ARDS) in HIV and tuberculous co-infection following initiation of ART and anti-TB treatment is very scarcely reported in the past. With the increasing incidence of HIV/AIDS and TB co-infection along with liberal access to ART in the developing world, it is likely that paradoxical reactions will be encountered more frequently.

Evaluation of extended spectrum beta lactamase in urinary isolates.

BACKGROUND & OBJECTIVES: Urinary tract infection (UTI) remain the common infections diagnosed in outpatients as well as in hospitalized patients. Current knowledge on antimicrobial susceptibility pattern of uropathogens is mandatory for appropriate therapy. Extended spectrum beta lactamases (ESBL) hydrolyse expanded spectrum cephalosporins like ceftazidime, cephotaxime which are used in the treatment of UTI. ESBL producing bacteria may not be detectable by routine disk diffusion susceptibility test, leading to inappropriate use of antibiotics and treatment failure. Not much information on ESBL producing organisms causing UTI is available from India. An effort was therefore made to study the ESBL producing uropathogens and also the susceptibility patterns of ESBL and nonESBL producers. METHODS: Urinary isolates from symptomatic UTI cases attending or admitted to the Indira Gandhi Medical College and Hospital, Nagpur were identified by conventional methods. Antimicrobial susceptibility testing was done by Kirbey Bauer's disc diffusion method. Isolates resistant to cephotaxime were tested for ESBL production by double disc synergy test method. RESULTS: Of the 217 isolates, 87 were cephotaxime resistant Gram-negative bacilli. Of these, 42 (48.3%) were found to be ESBL producers. Escherichia coli, Klebsiella pnuemoniae and Acinetobacter were ESBL producing species. Multidrug resistance was found to be significantly (P<0.05) more in ESBL producing isolates (90.5%) than non ESBL producers (68.9%). INTERPRETATION & CONCLUSION: In the present study a large number of uropathogens were found to be ESBL producers. Most of the ESBL producing isolates were multidrug resistant. Monitoring of ESBL production and antimicrobial susceptibility testing are necessary to avoid treatment failure in patients with UTI.

Methicillin resistance among isolates of Staphylococcus aureus: antibiotic sensitivity pattern & phage typing.

Out of 3988 clinical specimens from hospital admitted patients 230 strains of Staphylococcus aureus were isolated, 45 strains (19.56%) were Methicillin resistance Staphylococcus aureus (MRSA). All MRSA strains were beta lactamase producers. Multidrug resistance was observed among MRSA strains more commonly than in methicillin sensitive strains of Staphylococcus aureus (MSSA). Maximum strains were resistant to penicillin (100%), co-trimoxa zole (97%) & chloramphenicol (93.33%). As least resistant to gentamicin & ciprofloxacin shown by MRSA, these drugs can be used in few situations after susceptibility test. All strains of MRSA were sensitive to vancomicin (100%). Majority of strains (34 out of 45) showed MIC values of 4 ug/ml. Twenty eight out of 44 strains were non typable using routine phages. Study revealed that MRSA with associated multidrug resistance is common in this region. There is need to develop local set of MRSA phages for improvement of typability.