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Purpose: Myopia is the most common type of refractive error and the leading cause of functional visual loss. Increased risk of myopic maculopathy, retinal detachment, glaucoma and cataract has been seen with a myopia of as low as ?1D. This study was done to determine the effect of atropine 0.01% eye drops on the progression of myopia in children >5 years. Methods: This was a single?blind, prospective, randomized case–control study which included children of 5–15 years with myopia of >2D and were divided into treatment group (group 1) and placebo group (group 2). Children under treatment group were treated with application of 0.01% atropine at night. Children with history of any ocular surgery, chronic ophthalmic illness, squint and amblyopia were excluded from the study. The follow?up for myopia progression was done for two years. Results: This study showed a significant difference in increase of spherical equivalent and axial length among treatment and placebo groups after a duration of two years. Total duration of follow up was twenty?four months. Mean increase in axial length of group 1 and 2 was 0.115 mm and 0.32 mm, respectively. Mean increase in refraction of groups 1 and 2 was ?0.30 D and ?0.88 D, respectively, showing significant change in axial length and refraction (P < 0.0001). Conclusion: This study supports the use of atropine 0.01% eye drops in reducing the progression of myopia.
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Purpose: An unprecedented surge has been noted in rhino?orbital?Cerebral mucormycosis (ROCM) in times of current COVID?19 pandemic. The present prospective study aims to evaluate clinico?epidemiological profile, risk factors, management, and outcome of the cases of ROCM that presented to our tertiary care center during the study period from April to June 2021. Methods: All patients were subjected to complete history taking, ophthalmological examination, and imaging studies. The patients were staged and were treated with intravenous liposomal amphotericin B (AMB) and sino?nasal debridement of local necrotic tissue. Transcutaneous retrobulbar AMB (TRAMB), orbital decompression, and exenteration were instituted as indicated. All patients were followed up for a minimum of 6 months before arriving at the final outcome. Statistical analysis was performed. Results: A total of 49 patients presented during the study period, with a mean age of 42.2 years. The major risk factors included uncontrolled diabetes (89.8%), COVID?19 positivity (51.02%), and concurrent steroid use (38.77%). The most common presenting symptom was facial pain/swelling (43.65%), while the most common presenting sign was deterioration in vision (75.51%). Intravenous liposomal AMB was given to all patients along with sino?nasal debridement (85.71%), TRAMB (57.14%), orbital decompression (14.28%), and exenteration (12.24%). Overall, mortality at 6 months was 22.45% (11 patients). Age more than 60 years, intracranial extension, and HbA1c of more than 8.0% were observed to be statistically significant indicators of mortality. Conclusion: Early suspicion and timely diagnosis of mucormycosis at rhino?orbital stage is warranted in order to salvage life as well as visual function. TRAMB may prove as potentially favorable treatment modality in cases with limited orbital involvement.
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Background: Access to pain management has been recognized as a fundamental human right. Inadequate pain relief hampers the quality of life and has a physiological and psychosocial impact on the patient and caregivers. Inadequate pain relief remains the leading cause of suffering in hospitalized patients worldwide. Objective: The objective of this article is to provide adequate pain relief to hospitalized patients through proper assessment, treatment, and monitoring of pain by the trained health-care workers through a sustainable and effective institutional pain management policy. Methods: The formulation of pain management policy at a tertiary care teaching institute was conducted in three phases – Phase 1: need assessment by an open?label, uncontrolled, prospective observational study over 1 month period, Phase 2: teaching, training, and awareness of health?care workers, and Phase 3: constitution of the committee at the institute level with the formation of pain resource teams. Results: An open?label, prospective observational study conducted over 1 month revealed that among 814 hospitalized patients, 108 out of 235 (46%) patients in medical and 385 out of 579 (66.5%) patients in the surgical cohort had NRS score of ?3, implying an inadequate pain relief even at 24 h following medical or surgical intervention, respectively. Conclusion: The provision of effective and adequate pain relief to hospitalized patients requires trained health-care workers and a uniform and structured pain management policy at the institutional level. Recognition and addressal of the barriers and challenges while framing an institutional pain policy is of utmost importance.
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Introduction: In children uncorrected refractive errors have a profound effect on educational and psychosocial development hence it is necessary to estimate the prevalence both at the community and at the school level to aid planning and implementation of refractive error services in children. Objective: To determine the refractive status of 5 to 15 years old children attending government schools of rural areas of district Agra, Uttar Pradesh (UP), India. Method: Study conducted on 902 students of age group 5-15 years of randomly selected government schools of Bichpuri Block of district Agra. Children underwent visual acuity assessment and torch light examination, height and weight measurement. Children with VA ?6/9 were further examined and cycloplegic retinoscopy, fundus examination, slit lamp examination and post mydriatic refraction was done. On the basis of values of cycloplegic refraction and post mydriatic refraction, refractive error was classified as myopia, hypermetropia and astigmatism. Statistical Analysis was done by applying Chi square test. Results : Out of 902 children, 125 children (13.86 %) were having refractive error of which 76 were myopic (8.43%), 39 were astigmatic (4.32%) and 10 were hypermetropic (1.11%). There was an increase in the overall prevalence of refractive error with advancing age. There was no significant association of refractive error with gender and nutritional status. Conclusion: Vision screening of school children is very useful for early detection and correction of refractive errors. Screening of the refractive errors in school should be carried out periodically and regularly
ABSTRACT
India has a high share in the global burden of chronic terminal illnesses. However, there is a lack of a uniform system in providing better end-of-life care (EOLC) for large patients in their terminal stage of life. Institutional policies can be a good alternative as there is no national level policy for EOLC. This article describes the important aspects of the EOLC policy at one of the tertiary care institutes of India. A 15 member institutional committee including representatives from various departments was formed to develop this institutional policy. This policy document is aimed at helping to recognize the potentially non-beneficial or harmful treatments and provide transparency and accountability of the process of limitation of treatment through proper documentation that closely reflects the Indian legal viewpoint on this matter. Four steps are proposed in this direction: (i) recognition of a potentially non-beneficial or harmful treatment by the physicians, (ii) consensus among all the caregivers on a potentially non-beneficial or harmful treatment and initiation of the best supportive care pathway, (iii) initiation of EOLC pathways, and (iv) symptom management and ongoing supportive care till death. The article also focuses on the step-by-step process of formulation of this institutional policy, so that it can work as a blueprint for other institutions of our country to identify the infrastructural needs and resources and to formulate their own policies.