Incidence of vitreous loss and visual outcome following cataract surgery by surgeons with various levels of experience at a tertiary eye care center in North India

Purpose: To determine the incidence of vitreous loss and visual outcome after a vitreous loss during cataract surgery performed by surgeons with various levels of experience in adults >40 years of age at a tertiary eye care center in North India. Methods: The study was conducted at a tertiary eye care center in North India. This was an observational, retrospective, cross-sectional study of patients who underwent cataract surgery from August 1, 2011 to July 31, 2014. All adult cataract cases who were operated on from August 1, 2011 to July 31, 2014 and who experienced vitreous loss during their surgery were included in the study. The visual outcomes of these patients who experienced vitreous loss during cataract surgery in uncomplicated cataract and were managed using standard automated vitrectomy techniques were assessed for different cataract surgical techniques (extracapsular, small-incision, and phacoemulsification) as well as at different levels of skill of the operative surgeon (consultant, short term fellow, and long-term fellow). Details of the postoperative period and best-corrected visual acuity (BCVA) were collected from patient records by the principal investigator on day 1, 1 week, 4 weeks, 6 weeks, and 3 months post cataract surgery. Results: Vitreous loss occurred in 374 out of 18,430 patients who underwent cataract surgery from August 1, 2011 to July 31, 2014. The overall incidence of vitreous loss in our study was found to be 2.03% with consultants having a rate of 1.66%, short-term fellows at 5.19%, and long-term fellows at 2.02%. Two hundred eighty-eight patients of the 374 cases followed up for 3 months at the hospital and 75.69% of these patients had a final visual acuity of ?6/18. Conclusion: In an institute with a structured training program for residents/trainees, the vitreous loss rate is low during cataract surgery. Early intervention and proper management with the standard microsurgical technique by experienced hands can improve the final visual outcome in eyes with vitreous loss. Cystoid macular edema and corneal edema were the most common causes of poor postoperative vision

Incidence and risk factors for post-penetrating keratoplasty glaucoma

Purpose: To carry out a prospective study to analyze the incidence and various preoperative, intraoperative, and postoperative risk factors for the development of PPKG. Methods: A total of 207 patients were analyzed prospectively, who were operated for penetrating keratoplasty (PK) in a tertiary eye care hospital between the time period of August 1, 2017 and February 28, 2018 and were followed up till the sixth month. Each patient was analyzed at every visit to determine the factors responsible for post?keratoplasty glaucoma. Results: Out of 207 eyes, post?PK glaucoma developed in 84 cases, which yielded an incidence of 41%. Incidence of PPKG (Post PK glaucoma) in various conditions was as follows: in repeat PK 62%, in perforated corneal ulcer 33%, in nonperforated corneal ulcer 29%, in corneal scar including adherent leukoma 37.2%, and in pseudophakic bullous keratopathy and aphakic bullous keratopathy, 14% and 80%, respectively. In age? and sex?adjusted multivariate analysis, the significant risk factors were age (P?value? 0.006), presence of PAS (P?value 0.001), and fellow eye glaucoma (P?value 0.04). Aphakia and combined surgery were not found to be significant. Conclusion: Our study recommends a meticulous examination of the fellow eye to assess the presence of glaucoma as it can increase the suspicion of glaucoma in the eye to be operated. The presence of PAS and age are important risk factors for developing PPKG. The risk of developing PPKG increases exponentially as the number of risk factors increases, but the presence of more than three risk factors does not add to the development of PPKG

Paediatric ovarian torsion: a case report and review of literature

Ovarian torsion is a surgical emergency, can result in ovarian loss, intra-abdominal infection and even death. Paediatric ovarian torsion is a rare condition, requires high clinical suspicion and prompt diagnosis. Diagnosis is a challenge since signs and symptoms are similar to those of other causes of acute abdominal pain such as appendicitis, gastroenteritis, urinary tract infection, renal colic or other conditions of acute abdominal and pelvic pain. Here, authors describe a case of a 4-year-old girl with a presentation of acute abdominal pain, treated empirically elsewhere. After investigations, a provisional diagnosis of ovarian torsion was made and patient was taken up for surgery. Intraoperatively, ovary was found to be necrosed. Detorsion was tried but ovary was unsalvageable. Right sided salpingectomy with oophorectomy was performed. Conservative surgery by laparoscopic detorsion can be tried in cases of ischemia but if necrosis has already set in, then salpingo-oophorectomy has to be performed.

Conventional TBNA with 19 G TBNA Needle in Diagnosis of Mediastinal Lymph Nodes – Diagnostic Yield and Safety with 19G TBNA Needle

Introdution: As the practice of TBNA becomes more widelyaccepted, it has also revived a longstanding question on theoptimum size of needle and whether larger needle with corebiopsy is of any additional benefit. In routine practice 19Gneedle is rarely used even in large nodes as it is perceivedto be technically difficult and likely to give a poor yield ofrepresentative tissue. We report our experience with yield andsafety using 19G needle for Conventional TBNA.Material and methods: Eighteen patients with largemediastinal nodes (short axis > 25 mm) underwent 19GConventional TBNA and station 4R and/or stations 7 werepunctured respectively.Results: Out of Eighteen patients, core biopsy material wasinadequate or unrepresentative in 14 / 18 cases and cytologymaterial was unrepresentative in 2 patients. A diagnosiswas reached in 16 of 18 patients by smear cytology and in14 cases by histology. Out of eighteen patients, 12 patientshad Granulomatous etiology, 2 had poorly differentiatedadenocarcinoma, 1 had Malignant Round Cell Tumor, and onepatient had reactive lymphadenitis.Conclusion: The 19G TBNA procedure is effective and safe,and can be a cost-saving alternative to surgical mediastinalexploration. It should be performed after careful case selectionduring initial diagnostic bronchoscopy and familiarizationwith the technique should not be neglected in trainingprogrammes and workshops.

Successful outcome of pregnancy in a case of systemic lupus erythematosus : a case report

Systemic lupus erythematosus (SLE) is a multisystem, auto immune connective tissue disease that commonly affects women of reproductive age and may coexist with pregnancy. The autoantibodies and immune complexes lead to damage of various organs and tissues. Pregnant woman with SLE have increased risk of spontaneous abortion, preterm delivery, intrauterine growth retardation, preeclampsia, neonatal lupus, stillbirth and intrauterine fetal death. The therapeutic intervention with anticoagulants, steroids, immunosuppressive agents pose a high risk to both mother and fetus. A multidisciplinary approach and close medical, obstetrical and neonatal monitoring leads to optimal outcome. Authors describe a successful management of an antenatal patient with positive antinuclear antibody, anti-ds DNA antibody and antiphospholipid antibody with bad obstetric history. She underwent an emergency cesarean section and delivered a healthy female child.

Clinical efficacy of oral and topical acyclovir in herpes simplex virus stromal necrotizing keratitis.

Purpose: To evaluate the efficacy of systemic and topical antiviral therapy in the treatment of active herpes simplex virus (HSV) necrotizing stromal keratitis (NSK). Design: Prospective interventional case series. Methodology: Patients with a diagnosis of HSV NSK based on history and clinical findings were enrolled in the study. A standard protocol was used for microbiologic investigations. Ten weeks regime of systemic acyclovir and 2 weeks of topical acyclovir was given. Complete ophthalmic examination was performed at every visit. Outcome measures were a reduction in the area of infiltration and improvement in visual acuity. Results: Fifteen patients were enrolled in the study. The mean age of presentation was 51.53 years. The duration of symptoms at presentation ranged from 2 to 8 weeks. HSV1 DNA polymerase chain reaction was positive in 70% cases of those tested. Area of infiltration at trial entry and at the end of 2 weeks of antiviral treatment reduced significantly (P = 0.007). All patients showed a complete resolution of keratitis at the end of study. Conclusion: Topical and systemic acyclovir for treatment of NSK facilitates healing of ulceration. Topical steroids after initial antiviral therapy are safe and decreases inflammation and improve visual recovery. Early initiation of therapy has better outcomes as compared to late presentations.

Acute myeloid leukemia with t(4;12)(q12;p13): A morphological dilemma.

Cytogenetics has a pivotal role in risk stratification of acute myeloid leukemia (AML). We report a case of AML with a t(4;12)(q12;p13). To the best of our knowledge, there are about 24 cases of t(4;12) reported in AML which are usually misdiagnosed as lymphoproliferative disorders on morphological assessment. This case showed specific clinical, morphological, and immunophenotypic features such as (1) pseudo lymphoid morphology, (2) dysplasia in granulocytic series, (3) an immature immunophenotype with positivity for CD34 and CD117, and (4) poor treatment response.

Aneurysmal Bone Cyst of Mandible: A Case Report.

Aneurysmal bone cysts are rare benign lesions of bone tissue, infrequent in the craniofacial skeleton about other structures like long bones or the spine. The rare jaw lesions encountered in the mandible and maxilla. On the other side, it is at the same time very exciting in terms of its differential diagnosis with other types of mandibular or maxillary bone lesions. We present the case of a 45-year-old female patient with an aneurysmatic cyst located at the left angle of the mandible describing the treatment for the same i.e. surgical excision and hemi mandibulectomy with reconstruction. We have focused on the differential diagnosis, mainly with the malignancies, which can be found at this location, along with therapeutic options classically described for these kinds of pathologies. In our patient, the surgical excision and hemi mandibulectomy allowed a complete removal of the lesion and recon plate was placed for rehabilitation.

Rare Case of Non-Parasitic Chyluria in Pediatric population treated with dietary modification in a Four-year-old Male Child

Chyluria is the passage of milky urine composed of albumin, chylomicron, and fibrin in various proportions due to the leakage of lymph into the urinary tract as a result of communication between the lymphatics and the urinary system. Intermittent mild proteinuria and hematuria may be found at routine urinalysis, The conventional diagnostic approach involves confirmation of chyle in urine and the demonstration of lymphaticourinary fistulae by radiological study. It occurs predominantly in adults and is rare in children, We present an unusual case of a four-year-old male child with proteinuria, hematuria and milky urine which was subsequently diagnosed as idiopathic non-parasitic chyluria with spontaneous remission. The child recovered with dietary management for about five weeks after starting a low-fat, high-fiber diet

Meibomian gland dysfunction in a case of ichthyosis follicularis with alopecia and photophobia syndrome.

We are reporting an interesting case of ichthyosis follicularis with alopecia and photophobia syndrome in a daughter and father from the Indian subcontinent associated with Meibomian gland dysfunction. A three‑year‑old female child presented with pain, redness and severe photophobia in both eyes since one month. Cutaneous examination revealed ichthyosis, absence of hair all over the body including eyebrows, scalp and angular cheilosis. Ocular examination revealed bilateral severe meibomianitis, multiple superficial punctate keratitides in right eye and corneal epithelial defect in the left eye. Other systemic features were prominent high forehead and large ears. Her father had similar symptoms. Her symptoms improved after adequate treatment of meibomian gland dysfunction. She is asymptomatic at present.

Predictors of Readmission after Inpatient Plastic Surgery

BACKGROUND: Understanding risk factors that increase readmission rates may help enhance patient education and set system-wide expectations. We aimed to provide benchmark data on causes and predictors of readmission following inpatient plastic surgery. METHODS: The 2011 National Surgical Quality Improvement Program dataset was reviewed for patients with both "Plastics" as their recorded surgical specialty and inpatient status. Readmission was tracked through the "Unplanned Readmission" variable. Patient characteristics and outcomes were compared using chi-squared analysis and Student's t-tests for categorical and continuous variables, respectively. Multivariate regression analysis was used for identifying predictors of readmission. RESULTS: A total of 3,671 inpatient plastic surgery patients were included. The unplanned readmission rate was 7.11%. Multivariate regression analysis revealed a history of chronic obstructive pulmonary disease (COPD) (odds ratio [OR], 2.01; confidence interval [CI], 1.12-3.60; P=0.020), previous percutaneous coronary intervention (PCI) (OR, 2.69; CI, 1.21-5.97; P=0.015), hypertension requiring medication (OR, 1.65; CI, 1.22-2.24; P or =30) (OR, 1.43; CI, 1.09-1.88, P=0.011) to be significant predictors of readmission. CONCLUSIONS: Inpatient plastic surgery has an associated 7.11% unplanned readmission rate. History of COPD, previous PCI, hypertension, ASA class 3 or 4, bleeding disorders, and obesity all proved to be significant risk factors for readmission. These findings will help to benchmark inpatient readmission rates and manage patient and hospital system expectations.

Alkaptonuria in 17-month-old female child: a case report

Alkaptonuria is a rare inborn metabolic disorder with Mendelian recessive inheritance characterized by triad of homogentisic aciduria, arthritis and ochronosis. The incidence is one per 0.25 - 1 million persons. A 17-month- old female child of non-consanguineous parents presented with darkening of clothes / diapers moistened with urine when left unwashed for hours. There was no other medical problem in the family. Physical examination including joints revealed a healthy child with normal growth parameters. There was no pigmentation of the sclera, conjunctiva and cornea and ear cartilage. Her urine appeared normal colored on voiding. However, it turned black on standing at room temperature. Regular laboratory investigations were within normal range and skeletal survey showed no degenerative changes. Urine for alkalization and reducing substances was positive. Urine organic acidogram-chromatogram study showed [1137.87%] 2845-fold increase in homogentisic acid and confirmed the diagnosis of alkaptonuria. She was started on Vitamin C [0.5 gm twice a day]. She is now asymptomatic over a 13-month follow-up period

An Epidemiological Investigation of A Multisource Outbreak of Crimean-Congo Hemorrhagic Fever in Gujarat.

It all started with the report from Shalby Hospital, Ahmedabad of two deaths with unusual presentation on Jan 18, 2011. Immediately investigations were carried out; to identify the etiological agent, source of outbreak, and mode of transmission, as well as, to propose a control measure based on the findings of the investigation. Extensive literature search, discussion with various scientific institutions, scientists and laboratory diagnosis suggested it to be case of Crimean-Congo Hemorrhagic Fever (CCHF). Accordingly a Case definition was worked out to further investigate the episode/outbreak. Door-to-door survey was carried out and hospital records were scrutinized. Collected data was analyzed in terms of time, place, and person. Laboratory investigation reports of case patients were also collated. We conducted environment investigation to find out the source of Infection. A total 13 case patients of CCHF were identified out of which 9 are positive for CCHF virus, 2 were negative for CCHF virus and in 2 instances, samples could not be taken because of early deaths of the cases. Among these 13 cases, 30.76 % mortality rate was noted. Cases were reported in middle age group only. Environmental investigation also confirmed the presence of CCHF virus in Ticks. The outbreak was due to CCHF virus. State wide sero surveillance in animals is needed to identify prevalence of disease in Gujarat.

Conjunctival Geographic Ulcer and Blepharitis in Primary Ocular Herpes.

Conjunctival geographic ulcer is a rare manifestation of ocular herpes simplex. Geographic ulcers are formed when sloughing of the epithelium occurs in the areas between the dendrite and a broad area of epithelial involvement with irregular angulated borders is formed .We hereby report a case of Primary ocular herpes with blepharitis and geographic ulceration of the conjunctiva in a 8 year old boy with no corneal lesion. To the best of our knowledge only 4 cases of conjunctival herpetic dendritic ulcerations and a single case of herpetic geographical ulcer has been reported in literature till date.

Clipping versus coiling for ruptured intracranial aneurysms after the international subarachnoid aneurysm trial. United Kingdom experience

The International Subarachnoid Aneurysm Trial [ISAT] was designed as the first multi-central international prospective randomized trial aiming to compare the safety and efficacy of the 2 available treatments for ruptured intracranial aneurysms; endovascular coiling and surgical clipping. The initial results were published in the Lancet [2002], and it showed clearly a superiority of coiling over clipping in the treatment of ruptured intracranial aneurysms; 22.7% of coiled patients were dependent or dead compared with 30.6% in the surgical group with absolute risk reduction of 6.9%. The results of the ISAT drew huge attention from both scientific authorities and lay media. Despite criticisms, the study has made a significant impact on the treatment of aneurysmal subarachnoid hemorrhage, especially in the United Kingdom and Europe. Since their initial results, the ISAT group has published further papers and updates covering more interesting results regarding the risks of rebleeding, repeat procedures, epilepsy, and the cost effectiveness of both treatments

Effect of liver disease on maternal and fetal outcome--a prospective study.

BACKGROUND: Liver disease in pregnancy can have serious consequences. Its prevalence, profile and effect on outcome of pregnancy have not been documented systematically in India. We prospectively determined the frequency, causes and outcome of liver disease in pregnant women. SETTING: Tertiary-care teaching hospital. METHODS: Consecutive pregnant women with liver disease attending the inpatient or outpatient services of the Departments of Gastro-enterology and Obstetrics and Gynecology between December 2002 and October 2004 were evaluated and followed up till 2 weeks postpartum or death. RESULTS: Liver disease was found in 107 (0.9%) of 12,061 pregnancies. Of these, fifty six (52.3%) had pregnancy-specific liver disorders (pregnancy-induced hypertension [PIH]-associated liver dysfunction 36--including HELLP syndrome 22 and pre-eclamptic liver dysfunction 14; intrahepatic cholestasis of pregnancy 10; hyperemesis gravidarum 7; acute fatty liver of pregnancy 3). Liver disorders not specific to pregnancy included hepatitis E (16), hepatitis B, non A-E hepatitis and chronic liver disease (5 each) and others (14); in 6 patients no cause could be found. Ninety-six patients completed follow up. Overall maternal and perinatal mortality rates were 19.7% and 35.4%, respectively. CONCLUSIONS: PIH-associated liver dysfunction was the most common cause of liver disease in pregnancy. This is associated with significant maternal and perinatal morbidity and mortality.

Aspergillus iris granuloma in a young male: a case report with review of literature.

Endogenous aspergillosis is a rare occurrence. Endogenous Aspergillus endophthalmitis is a rare but devastating infection usually associated with disseminated aspergillosis or with intravenous drug abuse. We report a case of an isolated Aspergillus iris granuloma in a young immunocompetent male patient with review of the literature.