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Purpose: To identify the facial anthropometric parameters that predict the difficulty during femtosecond (FS) laser. Methods: This was a single?center observational study was conducted on participants between the ages 18 and 30 years who were planned for FS?LASIK (femtosecond laser?assisted laser in situ keratomileusis) or SMILE (small incision lenticule extraction) at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. The front and side?facing images of the participants were analyzed using Image J software to measure different anthropometric parameters. The nasal bridge index, facial convexity, and other parameters were measured. The difficulty faced by the surgeon during docking was recorded for each subject. The data were analyzed on Stata 14. Results: A total of 97 subjects were included. The mean age was 24 (±7) years. Twenty?three (23.71%) subjects were females while the rest were males. Difficulty in docking was seen in 1 (4.34%) female and 14 (19%) males. The mean nasal bridge index was 92.58 (±4.01) in subjects with deep?set eyes and 89.72 (±4.30) in normal subjects. The mean total facial convexity was 129.28 (±4.24) in deep?set eyes, and 140.23 (±4.74) in normal subjects. Conclusion: Total facial convexity appeared as the most important feature, with the value being less than 133° in most subjects with unfavorable facial anthropometry
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Purpose: Extraction of tear protein from Schirmer’s strip is a prerequisite for the proper identification and screening of biomarkers in dry eye disease. The study compares different methods of extraction of tear proteins from the Schirmer’s strip. Methods: Reflex tear was collected from healthy controls (HC; n = 12), Stevens–Johnson syndrome (SJS; n = 3) and dry eye disease (DED; n = 3) patients using capillary tube. This tear was used to measure the volume absorbed by Schirmer’s strip per microliter. Different buffers (6) were used to compare the protein yield from the Schirmer’s strip in four different conditions. The tear proteins extracted using the highest protein yield buffer were analyzed by mass spectrometry. Results: A linear relationship between the tear volume and wetting length was observed (r = 0.0.997, n = 6). The highest yield was observed after incubation of the Schirmer’s strip in 100 mM ammonium bicarbonate (ABC) with 0.25% Nonidet P?40(NP?40) at 4°C for an hour (P < 0.00005). The in?solution digestion of tear eluted in the above condition 100 Mm ABC + 0.25% NP?40 with one?hour incubation yielded a total of 2119 proteins in HC, SJS, and DED. The unique protein observed in SJS and DED was 0.6% and 17.9%, respectively. The significantly expressed proteins are associated with innate immune response, proteolysis, wound healing, and defense response. Conclusion: A method for extraction of protein from Schirmer’s strip was optimized for increase in protein yield from the tear sample. SJS and DED tear samples have unique protein signature. The study will aid in better design of tear protein?based experimental study.
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Purpose: To compare the outcomes of papillomacular bundle (PMB) sparing internal limiting membrane (ILM) peeling (group LP) and conventional ILM peeling (group CP) for treatment of idiopathic macular hole (MH) of ?400 ?m. Methods: Fifteen eyes were included in each group. In group CP, conventional 360° peeling was done, while in group LP, ILM was spared over PMB. The changes in peripapillary retinal nerve fiber layer (pRNFL) thickness and ganglion cell?inner plexiform layer (GC?IPL) thickness were analyzed at 3 months. Results: MH was closed in all with comparable visual improvement. Postoperatively, retinal nerve fiber layer (RNFL) was significantly thinner in the temporal quadrant in group CP. GC?IPL was significantly thinner in the temporal quadrants in group LP, whereas it was comparable in group CP. Conclusion: PMB sparing ILM peeling is comparable to conventional ILM peeling in terms of closure rate and visual gain, with the advantage of less retinal damage at 3 months.
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“Life well spent is long”, is well stated by Leonardo Da Vinci. A person's quality of life throughout all of those years of survival, rather than how many years they live, is what defines a long-life span. Superior constitution, great bodily components, excellent soul, adoption of a wholesome diet, and living a healthy lifestyle are the factors of this longevity. The lifespan of the individual should be checked by the doctor before any other aspects such as ailment, season, bio-fire, age, mental agility, homologation, constitution, medication, and location are examined. The attributes of Deerghayu that is long life span, along with Aahara (eating habits) and vihara (routines) to preserve longevity of life with the highest quality, have been outlined by Acharya Charaka after the Namakarana (naming ceremony) and Sushruta in Jatisutriya adhyaya in their description of life span. The present study analyzes the characteristic features of Deerghayu and the maintenance of these characteristics playing an important role in a long and healthy life.
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OBJECTIVE@#To examine data from studies supporting the clinical efficacy of medical approaches from India traditional systems of medicines like Ayurveda, Unani, Siddha, and Homeopathy for psoriasis using outcome indicators employed in clinical practice and research.@*METHODS@#Searches were conducted between December 2019 and September 2020 in databases PubMed, Scopus, Web of Science and Ovid Medline using search terms including traditional, complementary, psoriasis, Kushtha, Ayurveda, Siddha, Unani, Homeopathy and clinical. Controlled trials, case series and case reports published from India were included.@*RESULTS@#Data of 17 selected studies were extracted. Treatment efficacy in terms of improvement in Psoriasis Area and Severity Index (PASI) score or/and percentage reduction in score (PASI 50, PASI 75 and PASI 90) or/and patient-reported outcomes using instruments like Dermatology Life Quality Index and Psoriasis Disability Index were noted. All studies reported good improvement as per the study specific outcome. However, study characteristics, including study design, sample size, follow-up period, inclusion and exclusion criteria were heterogeneous, and the choice of outcome measures was not adequate to conclude the effectiveness of intervention. The use of some herbs as common ingredients in several formulations across different systems of medicines were noted in analyzing individual formulation.@*CONCLUSIONS@#Future studies must incorporate a comprehensive study design with specific outcome measures like PASI, PASI 75, PASI 90, quality of life parameters, compliance to medications, adverse reactions, remission period, relapse rate and cost-effectiveness with long term follow-up. The currently available evidence on the roles of these herbs at molecular level in psoriasis is preliminary.
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Humans , Quality of Life , Psoriasis/drug therapy , Treatment Outcome , Severity of Illness IndexABSTRACT
ABSTRACT Objective: To assess the awareness about COVID-19 among dental patients and determine the association between COVID-19 awareness and perceived stress among dental patients. Material and Methods: A selfadministered knowledge, attitude and practices (KAP) questionnaire and perceived stress scale (PSS) were employed to assess the knowledge and attitude among dental patients visiting the outpatient department. A p-value of ≤ 0.05 was considered statistically significant. An independent t-test was used to compare the KAP and PSS scores based on age, gender, occupation and the responses to unscorable questions. Spearman's correlation was employed to assess the association between KAP and PSS scores. Results: The older participants (mean KAP score = 16±2.2), the participants who answered that the Coronavirus outbreak changed their daily routine (mean KAP score = 15.8±2.2) and the participants who answered that they changed their plans due to the Coronavirus outbreak (mean KAP score = 16±2.14) had significantly higher KAP scores when compared to their respective counterparts. The Spearman's correlation value of -0.45 suggested a moderate negative association between the KAP and PSS scores, but this correlation was not statistically significant. Conclusion: The participants had a moderate to good level of knowledge related to COVID-19 and were positive in their approach and outlook on overcoming the pandemic.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Stress, Psychological/psychology , Health Knowledge, Attitudes, Practice , Dental Care , COVID-19/drug therapy , Cross-Sectional Studies/methods , Surveys and Questionnaires , Statistics, Nonparametric , India/epidemiologyABSTRACT
Purpose: To analyze the structural features of subretinal hyper-reflective material (SHRM) in posterior uveitis using swept-source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (SS-OCTA). Methods: In this observational study, subjects with quiescent posterior uveitis and the presence of SHRM on SS-OCT were subjected to SS-OCTA to identify the presence of an intrinsic choroidal neovascular (CNV) network. OCT features were compared for SHRM harboring CNV (vascular SHRM) with those without CNV network (avascular SHRM) to identify clinical signs pointing toward the presence of CNVM inside SHRM. Results: Forty-two eyes of 33 subjects (18 males; mean age: 29.52 ± 12.56 years) were evaluated. Two-thirds (28/42) of eyes having SHRM on SS-OCT harbored intrinsic neovascular network (vascular SHRM). Increased reflectivity of SHRM (P < 0.001) and increased transmission of OCT signal underlying SHRM (P = 0.03) were suggestive of the absence of CNVM. The presence of intra/subretinal fluid (P = 0.08) and pitchfork sign (P = 0.017) were important markers of vascular SHRM. Conclusion: SHRM is an important OCT finding in eyes with posterior uveitis. Meticulous assessment of SHRM characteristics on SS-OCT can aid in identifying the underlying intrinsic neovascular network.
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Purpose: The study sought to describe the clinical presentation pattern of pediatric cataracts and factors leading to delay in surgery at a tertiary care center in North India. Methods: A cross?sectional, interview?based study was conducted from January 2020 to October 2020, that included pediatric patients <12 years, with unilateral or bilateral congenital or developmental cataract. A pre?validated questionnaire was used to record data. The parameters recorded were age at first symptoms, age at diagnosis of cataract, age at surgery, laterality of cataract, first symptom, first family member noticing the abnormality, the morphology of cataract, association of perinatal complications, family history, systemic diseases, and cause (s) of delay in surgery. Results: A total of 89 patients were included. The mean age of subjects was 4.75(±3.51) years. A white pupil was the most common symptom (64.04%) and appeared in infancy in 30.3% of cases. Parents first detected the problem in 60.67%, and the pediatrician was the first medical contact in 11.23% of cases. The median (IQR) delay period between diagnosis of cataract and cataract surgery was 4 (3–6) months, the major causes were long GA waiting (30.33%), and delay due to systemic ill health (14.61%). Conclusion: Parental education on cataract detection is recommended to help in the timely detection and hence, improved outcomes of pediatric cataract surgery. Pediatricians, consulted for any systemic illness, have the role of the second most important contact in the detection of pediatric cataract.
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Medicinal plants are considered as a rich resources of ingredients which can be used in drug development either pharmacopoeial, non- pharmacopoeial or synthetic drugs. A part from that, these plants play a critical role in the development of human cultures around the world. Traditional Indian medicine (Ayurveda) is becoming increasingly popular, with many chronic conditions responding to it well. Most patients begin to take conventional medications as soon as their diagnoses are made, so Ayurvedic treatments are usually undergone alongside and/or after conventional medical approaches. WHO (World Health Organization) estimated that 80 percent of people worldwide rely on herbal medicines for some aspect of their primary health care needs. According to WHO, around 21,000 plant species have the potential for being used as medicinal plants. Elaborate description of the plant and its therapeutic action are explained by our Acharyas in Vedas, Puranas, and Samhitas and in the later Nighantus. Tejovati is such a drug which is widely available and is having many mentioning in the classics for its effectiveness in many diseases. Tejovati does not have any controversies in any of the literatures or classics regarding its identification or usage. The current article is to highlight the importance of drug and references has been collected from Vedas, Puranas, Samhita kala, Nighantu kala. Synonyms, Gana Varga, Vernacular names etc has been collected and arranged systematically.
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Purpose: The COVID?19 pandemic has brought medical and surgical training to a standstill across the medical sub?specialties. Closure of outpatient services and postponement of elective surgical procedures have dried up opportunities for training vitreoretinal trainees across the country. This “loss” has adversely impacted trainees’ morale and mental health, leading to feelings of uncertainty and anxiety. Therefore, there is an urgent need to redraw the surgical training program. We aimed to describe a systematic stepwise approach to vitreoretinal surgical training. Methods: We introduced a three?pronged approach to vitreoretinal surgical training comprising learn from home, wet lab and simulator training, and hands?on transfer of surgical skills in the operating room in our institute. Results: Encouraging results were obtained as evaluated by feedback from the trainees about the usefulness of this three?pronged approach in developing surgical skills and building their confidence. Conclusion: The disruption caused by the COVID?19 global pandemic should be used as an opportunity to evolve and reformulate surgical training programs to produce competent vitreoretinal surgeons of the future.
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The present study was conducted to observe the effect of percoll density gradient centrifugation on quality of semen. Ejaculates were collected by AV method from Sahiwal bulls. X-sperm enrichment was done by percoll density gradient method i.e. 7 layers (70-10%). Centrifugation was done at 750 g (22-24°C) for 15 min. The pellets obtained were diluted in EYC medium. Semen quality was evaluated in fresh semen (Control), in pellet of normal centrifugation (Group I), supernatant of centrifugation in percoll density gradient (Group II) and pellet of centrifugation in percoll density gradient (Group III). To assess the quality of enriched semen pH, mass motility, progressive motility, live spermatozoa %, abnormal spermatozoa %, HOST % and intact acrosome % were evaluated. Number of progressively motile sperms in pellet of X- enriched semen were non-significantly increased and significantly (P<0.05) decreased in supernatant. The abnormal spermatozoa (%) were decreased in G III as compared to G II Live spermatozoa (%) were increased in enriched semen (pellet). Number of Intact sperms decreased significantly (P<0.05) in supernatant of percoll density gradient centrifuged Sahiwal semen. HOST responsive sperms number was not affected after percoll density gradient centrifugation. Thus, the semen quality of X-sperm enriched semen by percoll density gradient method (7 layer 70%) was not affected hence it can be used to increase female calves’ birth after A.I.
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Spermatogonial stem cells (SSCs) have the unique ability of both self-renewing and to produce progeny that undergoes differentiation to spermatozoa. As SSCs exist in very low numbers, therefore efficient in vitro expansion of SSCs is important prior to their clinical applications. In this study, we tried to improve the functionality of putative SSCs (pSSCs) during culture using poly-D-lysine (PDL) coating. For this, plates were coated with 0.01% PDL with different coating time interim treatments (5, 30 and 60 min) while control remained uncoated. The adequate amount of pSSCs of the goat was isolated and enriched using two-step enzymatic digestion and differential plating methods. Further, the functionality of pSSCs was evaluated by cell growth analysis, cell proliferation, senescence, and the presence of pluripotency (alkaline phosphatase, OCT-4) and SSC related (PGP-9.5) markers. The number and size of pSSCs colonies in 0.01% PDL coating groups were significantly (P <0.05) higher than in the control group. Similarly, pSSCs on uncoated plates expressed significantly (P <0.05) higher
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Purpose: Marfan syndrome (MFS) is a genetic disorder associated with considerable morbidity and mortality. Presently, well?documented information on this condition is not available in India. Methods: In this retrospective cohort study, we recruited patients with clinically diagnosed MFS who presented to the outpatient department using revised Ghent nosology. We retrieved complete ophthalmic information, including vision, anterior and posterior segments, exported from electronic medical records, and relevant investigations, surgical details, and follow?up data were obtained in a specific, pretested format. Results: Our cohort consisted of 86 eyes of 43 patients and had a male preponderance. The prevalence was 20.5 per 100,000 individuals. The mean age of the patients was 23.9 years. All eyes were treated either optically with refraction or surgically using lensectomy and vitrectomy with suture supported scleral fixated intraocular lens (IOL), which significantly affected the visual outcome (P = 0.000). Conclusion: Although considered a rare disease, MFS is commonly found in the ophthalmological setting. Refraction and surgery (lensectomy with scleral fixated IOL) may improve the vision significantly
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Background & objectives: Polio, measles, rubella, influenza and rotavirus surveillance programmes are of great public health importance globally. Virus isolation using cell culture is an integral part of such programmes. Possibility of unintended isolation of SARS-CoV-2 from clinical specimens processed in biosafety level-2 (BSL-2) laboratories during the above-mentioned surveillance programmes, cannot be ruled out. The present study was conducted to assess the susceptibility of different cell lines to SARS- CoV-2 used in these programmes. Methods: Replication of SARS-CoV-2 was studied in RD and L20B, Vero/hSLAM, MA-104 and Madin–Darby Canine Kidney (MDCK) cell lines, used for the isolation of polio, measles, rubella, rotavirus and influenza viruses, respectively. SARS-CoV-2 at 0.01 multiplicity of infection was inoculated and the viral growth was assessed by observation of cytopathic effects followed by real-time reverse transcription–polymerase chain reaction (qRT-PCR). Vero CCL-81 cell line was used as a positive control. Results: SARS-CoV-2 replicated in Vero/hSLAM, and MA-104 cells, whereas it did not replicate in L20B, RD and MDCK cells. Vero/hSLAM, and Vero CCL-81 showed rounding, degeneration and detachment of cells; MA-104 cells also showed syncytia formation. In qRT-PCR, Vero/hSLAM and MA-104 showed 106 and Vero CCL-81 showed 107 viral RNA copies per ?l. The 50 per cent tissue culture infectious dose titres of Vero/hSLAM, MA-104 and Vero CCL-81 were 105.54, 105.29 and 106.45/ml, respectively. Interpretation & conclusions: Replication of SARS-CoV-2 in Vero/hSLAM and MA-104 underscores the possibility of its unintended isolation during surveillance procedures aiming to isolate measles, rubella and rotavirus. This could result in accidental exposure to high titres of SARS-CoV-2, which can result in laboratory acquired infections and community risk, highlighting the need for revisiting biosafety measures in public health laboratories
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A 70-year-old man presented with generalized weakness, easy fatigability, and early satiety of 2-month duration. On examination, he had severe pallor and massive splenomegaly. Hematological investigations revealed bicytopenia with hypergammaglobulinemia and acute kidney injury. Bone marrow aspiration cytology was suggestive of plasma cell dyscrasia. Monoclonal protein peak (due to heavy chain of IgG type) was found on serum protein electrophoresis, and lambda light chains and IgG heavy chains were elevated on immunofixation. The patient was diagnosed as a case of multiple myeloma and was started on bortezomib杔enalidomide杁examethasone regimen. After 7 months of chemotherapy, his spleen had regressed, and the patient had become asymptomatic. Presentation with massive splenomegaly is usually a feature of Waldenstrom抯 macroglobulinemia. However, rarely multiple myeloma may have extramedullary manifestations such as splenomegaly as the primary presenting feature.
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INTRODUÇÃO: Pessoas que vivem em terrenos íngremes com carga cíclica anormal podem levar à degeneração da cartilagem óssea. A terapia a laser de alta intensidade (TLAI) e a fonoforese trazem inúmeros benefícios aos pacientes com osteoartrite de joelho (OAJ). No entanto, ainda não está claro qual tratamento é eficaz entre eles na reabilitação de pacientes com OAJ. OBJETIVO: Verificar se a TLAI de 8 semanas não é pior que a fonoforese em gel de ibuprofeno (FGI) no tratamento de pacientes com osteoartrite de joelho que vivem em terreno montanhoso. MATERIAIS E MÉTODOS: Um total de 108 indivíduos com OAJ serão recrutados por amostragem aleatória simples para participar de um estudo randomizado, duplo-cego e controlado. Os indivíduos recrutados com OAJ serão divididos aleatoriamente em dois grupos, grupo TLAI (grupo experimental) e grupo FGI (grupo controle). A duração do tratamento de TLAI e FGI será de 8 minutos em uma sessão/articulação do joelho para cada dia, por 3 dias/semana até 8 semanas, além de seus exercícios convencionais por 30 minutos. O Western Ontario and Mc Master Universities Osteoarthritis Index, o algômetro digitalizado de pressão de dor e o questionário de 36 itens Short-Form Health Survey são as medidas de resultado que serão registradas ao término, no final do período pós-intervenção de 8 semanas. PERSPECTIVAS: Os resultados deste ensaio contribuirão para recomendações baseadas em evidências para a implicação clínica de que o TLAI não é pior que o FGI juntamente com a intervenção de exercício para tratar indivíduos com OAJ que vivem em terreno íngreme.
INTRODUCTION: People living in hilly terrain with abnormal cyclic loading could lead to bone cartilage degeneration. High-intensity laser therapy (HILT) and Ibuprofen gel phonophoresis (IGP) have innumerable benefits for patients with knee osteoarthritis (KOA). However, it is still unclear which treatment is effective among them in rehabilitating patients with KOA. OBJECTIVE: To verify whether 8-week HILT is no worse than the IGP in treating patients with knee osteoarthritis living in hilly terrain. MATERIALS AND METHODS: A total of 108 individuals with KOA will be recruited by simple random sampling to participate in a randomized, double-blind, controlled study. Recruited individuals with KOA will be randomly divided into two groups, the HILT group (experimental group) and the IGP group (active control group). The treatment duration of HILT and IGP will be 8 minutes in one session/knee joint for each day for 3 days/week up to 8 weeks in addition to their conventional exercises for 30 minutes. The Western Ontario and McMaster Universities Osteoarthritis Index, Digitalized pain pressure algometer, and 36-Item Short-Form Health Survey questionnaire are the outcome measures that will be recorded at baseline, end of the 8-week post-intervention period. PERSPECTIVES: The results from this trial will contribute to evidencebased recommendations for the clinical implication of whether HILT is no worse than IGP, along with exercise intervention for treating individuals with KOA living in hilly terrain.
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Osteoarthritis , Ibuprofen , Laser TherapyABSTRACT
Enterococci are important human pathogens that cause many infections including nosocomial infections. Some important clinical infections caused by Enterococcus species are urinary tract infections, bacterial endocarditis, genital tract infections, surgical wound infections, bacteraemia and meningitis.Around, 80 - 90% of infections are commonly caused by E. faecalis followed by E. faecium with a contribution of about 10 - 15% along with emergence of multi-drug resistance (MDR) including to vancomycin. Enterococci have developed both intrinsic and acquired resistance towards many antibiotics including to high level aminoglycosides. This short term project was undertaken to study the prevalence and antibiotic susceptibility (AST) pattern of Enterococcus species isolated from clinical specimen with special reference to high level aminoglycoside resistance (HLAR) in a rural tertiary care hospital. Methods100 Enterococci isolated from clinically relevant samples were identified according to standard procedures and AST was carried out according to CLSI guidelines. ResultsOut of 100 enterococci, 70 E. faecalis, 21 E. faecium and 09 other Enterococcus species were isolated. The results showed that majority of enterococci was isolated from >60 age group (37%), from male patients (59%), from urine samples (59%) and from medicine department (36%). AST showed overall high resistance to Penicillin (98%) Ampicillin (86%), Gentamicin (85%), Ciprofloxacin (60%), Vancomycin (12%) (VRE), high level gentamicin (42%) (HLGR) and high level streptomycin (34%) (HLSR) and 15% isolates showed resistance to HLGR + HLSR. Multi drug resistance was seen in 40 (57.1%) E. faecalis isolates and 11 (52.3%) E. faecium isolates. Minimum resistance was observed with Linezolid (3%). ConclusionsThe present study showed high prevalence of antibiotic resistance in Enterococci. Hence, Enterococcus species isolated from samples should be routinely screened for HLAR, MDR and VRE so as to prevent the spread of multi drug resistant Enterococci and for proper selection of antibiotics.
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Introduction: Gastric carcinoma is an aggressive malignancy with non-specific early symptoms. It is the second most commoncause of cancer-related deaths in the world.Materials and Methods: All cases of gastric carcinomas aged <40 years presented at Sri Ramachandra Institute of HigherEducation and Research from January 2016 to December 2019 were included in this study. The presenting symptoms andoutcome were collected from medical records. Pathology reports of the included cases were retrieved and associated factorswere analyzed.Results: Out of the 177 known cases of gastric carcinoma, 17 were under the age of 40 (9.6%), out of which, 10 (58.8%)were female and 7 (41.7%) were male. The number of males was higher in the patients >40 years. Fourteen cases (82.3%)were between 30 and 40 years. Three cases (17.6%) were between 20 and 30 years of age. Helicobacter pylori associatedgastritis was seen in 6 cases (35.2%). Out of the 17 cases (41.1%), 7 were poorly differentiated. The distal stomach was thesite of the tumor in 15 cases (88.2%), 2 cases were present in the gastroesophageal junction. The most common presentingcomplaints of these patients were abdominal pain, abdominal distension, vomiting associated with food intake, and constipation,with the duration of these symptoms being 1–6 months. Two patients (11.7%) had a positive family history. Three patients(17.6%) had a positive history of substance abuse. Five patients reported a history of loss of weight and appetite. One patienthad metastasis to the liver, one to the liver, bone, and lungs, and one to the liver and esophagus. Ten patients (58.8%) weretreated with gastrectomy (subtotal/distal/partial) and two patients with esophageal gastrectomy. Most of the patients were givenchemotherapy and one was given palliative chemotherapy and radiotherapy.Conclusion: Tumors rarely occur in the young, hence malignancy is not suspected and diagnosis is delayed. This leads to ahigher mortality rate as patients present with advanced stage of the disease. This study highlighted the “shift in trend” of incidenceof gastric carcinomas in younger age group. Screening and early diagnosis and treatment are essential for young patients.
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Background: Uterine fibroids constitute a substantial bulk of patients presenting to Gynaecology department. Many newer imaging modalities have evolved for their correct evaluation, but in a developing country like India, ultrasound is still being used as a screening as well as diagnostic modality. So, this study was done to compare ultrasound and magnetic resonance imaging for evaluation of uterine fibroids in terms of their sensitivity, specificity Trans vaginal and positive predictive value using Histopathology as a gold standard so as to improvise on current clinical practices in this country.Methods: An ethically approved prospective study was done upon 50 patients with suspected uterine masses at SMS Hospital Jaipur. All included patients underwent Trans vaginal Ultrasound (TVS) and Magnetic resonance imaging (MRI) and were accordingly treated surgically. Histopathology report was traced postoperatively. Data was collected and subjected to various statistical tests including Cohen’s kappa.Results: Most of the patients were <50 years and presented with complains of pain abdomen. Among total 50 cases, the sensitivity of TVS and MRI was 44% and 92%, specificity was 96% and 88%, PPV was 91.67% and 88.46%, NPV was 63.16% and 91.67% respectively, kappa was 0.40 and 0.80 i.e. agreement between TVS and MRI v/s HPE was 40% and 80% respectively. The diagonal agreement between transvaginal USG and MRI, was 63%.Conclusions: TVS is a good screening modality but MRI is definitely better for proper characterization and localization of fibroids enabling clinicians to select the most appropriate management in everyday clinical practice.
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Introduction: Cholelithiasis is one of the most commonsurgical diseases. Laparoscopic cholecystectomy has beenuniversally accepted as gold standard for treatment ofcholelithiasis. Although many studies have shown postoperative changes in liver function tests after high pressurepneumoperitoneum during laparoscopic cholecystectomy,but very few studies have investigated the effects of lowpressure pneumoperitoneum on hepatic functions.The presentstudy was designed to compare post-operative changes inliver function tests among patients randomized to either lowpressure laparoscopic cholecystectomy(LPLC) (i.e.8 mmHg)or high pressure laparoscopic cholecystectomy(HPLC) (i.e.14mmHg).Material and methods: After taking a well informed writtenconsent,150 cases undergoing laparoscopic cholecystectomywere enrolled in the study and randomised preoperatively intotwo groups (LPLC and HPLC). Liver function tests (LFTs)including Total Bilirubin, Conjugated Bilirubin, AspartateTransaminase (AST), Alkaline Phosphatase(ALP), AlanineTransaminase (ALT), Gamma-glutamyl Transferase (GGT),Total Serum Protein, Total Serum Albumin) were done onpost-operative day (POD) 1 and day 7 and compared withpreoperative LFTs in both groups.Results: The study demonstrated significant increase inConjugated bilirubin on POD 1(p < .001), AST on POD1 (p: .005), ALT on POD 1 (p <.001), ALP on POD 1(p < .001) in HPLC as compared to LPLC patients. LFTsin both groups were found to be normal on POD 7 withoutsignificant difference between the two groups.Conclusion: Low pressure laparoscopic cholecystectomy hasless adverse effects on liver functions as compared to the highpressure laparoscopic cholecystectomy