Clinical study to evaluate the influence of incision site (superior vs superotemporal) on postoperative astigmatism in manual small incision cataract surgery.

Introduction: Small incision cataract surgeries may be performed using various surgical incisions, namely, superior, supero-temporal and temporal. Each method has its own advantages and disadvantages. Supero-temporal incision is considered the best as it produces least induced astigmatism. The purpose of this study was to compare the postoperative induced astigmatism in superior and superotemporal incision group in small incision cataract surgery. Material &Method- This study was conducted on cataract surgery patients admitted in M.R.A Medical College, Ambedkarnagar. Fifty patients were selected for study, out of which 30 received superior and 20 received superotemporal incision. Preoperative keratometric and post operative 6 weeks keratometric readings were analysed. Results-Superior incision is better for with the rule astigmatism and worst for against the rule astigmatism, while superotemporal incision is equally good for both with the rule and against the rule astigmatism. Conclusion-Superotemporal incision is better than superior as it produces least astigmatism with good visual acquity.

Achalasia cardia: A study of 113 patients managed with indigenous dilator.

BACKGROUND: Endoscopic dilatation of achalasia cardia is an effective nonsurgical management option. It requires costly pneumatic dilators which are used under fluoroscopic guidance. This study assesses the efficacy and safety of an indigenous pneumatic dilator used without fluoroscopic guidance. METHODS: Over a period of eleven years, 113 patients (69M, 44F) ofachalasia cardia underwent dilatation with indigenous pneumatic dilators without fluoroscopic guidance. The dilatation was performed under endoscopic vision. RESULTS: The procedure was successful in all patients. After six weeks following dilatation, there was significant improvement in the mean dysphagia score 3.63 + 0.61 to 0.53 + 0.93 (P<0.01). The response was still significant (0.78 + 1.03, P <0.05) at the end of one year. Excellent response with single dilatation was seen in 70.7% patients. After two dilatation sessions 92% of patients showed an excellent response. One patient had perforation. There was no mortality. CONCLUSION: Pneumatic dilatation under endoscopic vision without fluoroscopic assistance with the indigenous dilator is very effective and safe for short term treatment of achalasia carida.

Role of micro-nutrients and trace elements in carcinoma of larynx.

Cancer of the larynx is fourteenth most common cancer in the world. Evidence from case-control studies conducted in developed as well as developing countries suggest that specific micro-nutrients and trace elements have been implicated to be significantly associated with laryngeal carcinoma. The association of these micro-nutrients and trace elements with laryngeal cancer has been discussed in this review article.

Differential modulation of nociceptive responses to mu and kappa opioid receptor directed drugs by blood glucose in experimentally induced diabetes rats.

The study has evaluated the effect of diabetes associated hyperglycaemia on nociception and antinociception induced by morphine, buprenorphine and pentazocine in female albino rats. Rats were allocated into 3 groups of 20 each--group I consisted of control having normal blood glucose levels (BGLs), group II consisted of streptozotocin-induced diabetics (STZ-D) having hyperglycaemia and group III consisted of diabetic rats controlled with insulin treatment. Immediately before and 15, 30 min, 1, 2 and 3 hr after injection with test drugs, rats were subjected to a thermal noxious stimulus using tail withdrawal from hot water and tail-flick latencies (TFL) so generated were recorded. Similarly, before and 30, 45 min and 1 hr after injection with drugs rats were subjected to abdominal writhing with hypertonic saline and number of writhes were counted per 90 sec. In STZ-D animals (BGLs 317.95 +/- 3.8 mg/dl) a decreased TFL with an increase in the number of writhes compared to control and diabetes controlled with insulin treatment was observed. Percent maximum possible effect of morphine (5 mg/kg, s.c.) and buprenorphine (2 mg/kg, s.c.) was significantly lower when compared to control as well as STZ-D controlled with insulin treatment groups. Similarly percent protection from writhing of morphine (0.05 mg/kg, s.c.) and buprenorphine (0.01 mg/kg, s.c.) was significantly less in comparison to control and STZ-D controlled with insulin treatment group. However, percent maximum possible effect of pentazocine (20 mg/kg, s.c.) and percent protection from writhing of pentazocine (1 mg/kg, s.c.) was significantly high in STZ-D rats when compared to control and STZ-D rats controlled with insulin treatment groups. The results suggest that both mu and kappa--opioid receptors may be modulated by blood glucose levels possibly involving cellular energetics mediated change in potassium (KATP) channels in females rats, albeit differentially.

Utility of HemoCue in estimation of hemoglobin against standard blood cell counter method.

INTRODUCTION: There are various methods which have been recommended for haemoglobin (Hb) estimation for assessment of anaemia. Each method has it's advantages and limitations. OBJECTIVE: The present study was conducted to assess the utility of HemoCue, a recent method, in assessment of haemoglobin against the standard blood cell counter (BCC) method. METHODOLOGY: Eighty five venous blood samples were collected, Hb was assessed in each by utilising the HemoCue and BCC methods. The results were compared utilising the standard statistical methods. RESULTS: The HemoCue provided consistently higher value in comparison to BCC by a margin of 0.5 g/dl. It is known that the correlation coefficient is independent of change of origin but mean gets affected. Therefore, we can subtract 0.5 g/dl from the Hb estimates achieved by HemoCue through which all conditions regarding better agreement between both methods get satisfied. The two assays correlated well. CONCLUSION: The HemoCue method was found more rapid and easy in assessment of total hemoglobin as compared to blood cell counter method with an adjustment of 0.5 per dl.

Micronutrient deficiency disorders amongst pregnant women in three urban slum communities of Delhi.

OBJECTIVE: To assess the prevalence of three micronutrient deficiency disorders (MDDs), i.e., iron deficiency, iodine deficiency and vitamin-A deficiency individually and in combination amongst pregnant women. METHODS: A hospital based study was conducted amongst 829 pregnant women of II and III trimester attending antenatal clinic, Rural Health Training Center (RHTC), Najafgarh, New Delhi. Anemia was assessed by the presence of clinical signs and by hemoglobin levels. Iodine deficiency disorders (IDD) were assessed by clinical examination of thyroid gland and by urinary iodine excretion levels. Iodine content of the salt consumed by the pregnant women was also assessed by iodometric titration method. Vitamin A deficiency (VAD) was assessed by the presence of clinical symptoms of nightblindness. Current dietary intake, morbidity conditions on the day of survey and anthropometric measurements of pregnant women were also documented. RESULTS: Prevalence of anemia, IDD and VAD amongst pregnant women was 78.8%, 22.9% and 4.8%, respectively. One per cent of the pregnant women had concomitant presence of all the three MDDs. Pregnant women having combined prevalence of IDD and anemia, IDD and VAD, and VAD and anemia was 15.1%, 0.18% and 2.69%, respecively. Eighty nine per cent of the pregnant women were consuming salt with iodine content of more than 15 ppm which was recommended at household level. Results on dietary intake showed that 18%, 34%, 85% and 57% of the pregnant women were consuming less than 50% of calories, proteins, iron and b-carotene, respectively as compared to their RDA. Forty per cent of the pregnant women were suffering from various morbidity conditions on the day of survey. CONCLUSIONS: The prevalence of micronutrient deficiencies amongst pregnant women of urban slum communities is high.

Control of tachycardia and hypertension following coronary artery bypass graft surgery: efficacy and haemodynamic effects of esmolol.

Hypertension following coronary artery bypass grafting is not uncommon, especially in patients having good left ventricular function. It is often accompanied by tachycardia. The purpose of this study is to determine the efficacy of esmolol in the treatment of tachycardia and hypertension immediately following cardiopulmonary bypass and to study other haemodynamic effects of esmolol. Thirty patients undergoing elective [corrected] coronary artery bypass grafting were included in this prospective study. Morphine-based anaesthetic technique along-with standard bypass techniques were used in all the patients. The study was performed in the operating room about 30-45 minutes after the termination of cardiopulmonary bypass. Patients having a heart rate of more than 90 bpm and systolic blood pressure of more than 130 mm Hg without any inotropic support were included and randomly assigned to esmolol or control group. Esmolol was administered in a bolus dose of 500 micrograms/kg followed by infusion of upto 100 micrograms/kg/min. The patients in the control group were administered comparable volumes of normal saline. Baseline haemodynamic measurements were obtained just before the administration of esmolol or normal saline and were repeated after 5, 10, 15, 30 and 45 min. The baseline measurement in both the groups showed that patients were maintaining a state of hyperdynamic circulation with high systolic blood pressure (esmolol group 148 +/- 15 mm Hg, control group 140 +/- 8 mm Hg; p = NS), heart rate (esmolol group 128 +/- 17 bpm, control group 127 +/- 17 bpm; p = NS) and cardiac index (esmolol group 3.1 +/- 1 L/min/m2, control group 3.3 +/- 0.5 L/min/m2; p = NS). Esmolol decreased systolic blood pressure (p < 0.001), heart rate (p < 0.01) and cardiac index (p < 0.05) at five minutes. These changes persisted throughout the study period. The left ventricular stroke work index decreased at five minutes (p < 0.05) and remained so till 30 minutes. The maximum fall in heart rate (15%) and systolic blood pressure (16%) was observed at 45 minutes. There were no haemodynamic changes in the control group except that cardiac index, stroke volume and left ventricular stroke work index increased at five minutes. We conclude that esmolol lowers the indices of cardiovascular work in patients who demonstrated hyperdynamic circulation. This was achieved by decreasing the heart rate and systolic blood pressure which was accompanied by decrease in cardiac index and left ventricular stroke work index.

Haemodynamic effects of leg raising in patients undergoing coronary artery bypass grafting.

Twenty patients undergoing elective coronary artery bypass grafting were studied prospectively to evaluate the haemodynamic effects of passive leg raising. The patients were divided into two groups: those having good left ventricular function with ejection fraction of 0.50 or more (group I, n = 10) and those having poor left ventricular function with ejection fraction of upto 0.35 (group II, n = 10). Morphine-based anaesthetic technique was used and standard haemodynamic measurements were obtained at following stages: (1) control--20 to 30 min after induction of anaesthesia; (2) one minute, and (3) five min after raising both the legs; (4) one min, and (5) five min after the legs were repositioned. In group I, heart rate decreased from 71 +/- 9 to 66 +/- 8 beats/min (p < 0.001) at stage 1 and persisted throughout the study period. This was accompanied by a decrease in cardiac index, although, the statistical significance was achieved at stage 3 and 4 only. The haemodynamic changes observed in group II were of more severe magnitude. The heart rate decreased from 90 +/- 13 to 84 +/- 13 beats/min at stage 1 (p < 0.05) and persisted throughout the study with maximum decrease of 14 percent occurring at stage 3. The cardiac index decreased significantly from 2.4 +/- 0.3 to 2.0 +/- 0.5 L/min/m2 (p < 0.05) at stage 1. This persisted throughout the study except that it recovered at stage 4. The maximum decrease in cardiac index (20%) occurred at stage 2. In addition, systemic vascular resistance increased significantly from 1458 +/- 255 to 1830 +/- 420 dyne.sec.cm-5 (p < 0.05) at stage 1 and persisted throughout the study period. We conclude that passive leg raising should be undertaken with caution in patients with coronary artery disease especially in those who have poor left ventricular function.