RETINA ON CORNEA IN CASE OF MECHANICAL OCULAR INJURY: A CASE REPORT

Ocular injuries are one of the major factors for mono-ocular blindness in adult population. Majority of mechanical ocular injuries occurs in factories. Our patient had injury with grinder blade. On examination, vision was no perception of light in right eye, corneoscleral tear along with lens and vitreous in the wound. Ocular trauma score was 1 with chances of visual recovery nil. After primary treatment, when we had taken patient under general anaesthesia, we found whole retina lying over cornea which was a rare event. We excised that tissue and tear repair was done. None of the factors which can lead to expulsive haemorrhage was observed in patient. We have seen many patients with extensive corneoscleral tear but never seen retina coming out of the wound. We recommend to use all protective equipments for workers to prevent industrial ocular injuries.

Warm Autoimmune Haemolytic Anaemia due to IgA and IgG � A Rare Clinical Scenario

Autoimmune Haemolytic Anaemia (AIHA) is a decompensated acquired haemolysis caused by the host immune system producing autoantibodies that bind to the antigens on the surface of circulating erythrocytes, leading to haemolysis and decreased red cell survival. It requires efficient and advanced immunohaematological and transfusion support. Despite advances in medical field, simple test like Direct Antiglobulin Test (DAT) still remains the diagnostic hallmark. The sensitive column gel technology further helps to characterise these antibodies according to class, subclass and titre of antibodies. It is very important to characterize these autoantibodies as there is a relation between strength of DAT and in vivo haemolysis. Serologically, cases are divided into warm (mainly due to IgG), cold (mainly due to IgM) or mixed depending upon the thermal amplitude of the antibody. IgA and IgG antibodies causing warm type of AIHA are rare as monospecific gel cards are not available in all centres. We here report rare case series of warm AIHA caused by dual antibodies IgA and IgG.

PARTIAL LONGITUDINAL VAGINAL SEPTUM WITH A PELVIC MASS IN LABOUR: A CASE REPORT AND A SHORT REVIEW OF LITERATURE

Introduction Mullerian anomalies arise because of aberrant embryogenesis and a longitudinal vaginal septum (LVS) is a failure of resorption of the distal Mullerian canal. A 26-year-old Material and methods pregnant lady with full-term gestation presented to our rural hospital in labour. Her physical examination was normal except for a partial longitudinal vaginal septum that she had in the proximal vagina distinct from the cervix extending from the 12 O clock position of the anterior vaginal wall to 6 O clock of the posterior vaginal wall along with a bulge felt in the posterior fornix. An emergency lower segment caesarean section was performed for possible fetal distress and a right ovarian mass was encountered which was removed along with the resection of the partial longitudinal vaginal septum. Her postoperative period was uneventful and the histopathology report of the ovarian mass turned out as a mature cystic teratoma. A partial Conclusion longitudinal vaginal septum can be easily resected during labour if it hasn't been diagnosed before. This is one of the ?rst cases reported where a partial LVS along with an ovarian mass was reported and managed successfully by resection

A Comparative study of insight in patients of depressive spectrum disorders attending outpatient department of tertiary care centre.

Introduction: Poor insight is a common feature of bipolar depression and unipolar depression with and without psychotic symptoms (PS) which may lead to poor clinical outcome. Studies on insight in these populations are relatively limited and the majority of studies were published over the previous decade. Methods: This was a cross-sectional, observation study conducted in Psychiatry O.P.D. of tertiary care hospital. The sample consisted cohort of 20 outpatients each with unipolar depression, unipolar depression with psychotic symptoms and bipolar disorder current episode depression with psychotic symptoms. The depression was assessed by HAM-D and insight by Item G12 of the General Psychopathology section of PANSS. Results: Significant difference in insight is seen in all three groups. Bipolar patients with PS had the poorest insight, patients with unipolar depression had best. Statistically significant correlation is present with older age and lack of insight among patients of unipolar depression with PS (rho =.599, P =.005) and bipolar depression with PS (rho =.686 P=.001). Conclusion: Insight in depressive illness is affected by multiple factors; this study shows that age, bipolarity and presence of psychotic symptoms are associated with poor insight. Management of the patients of depressive spectrum should incorporate strategies to improve insight

Percutaneous Coronary Intervention in Anomalously arising Coronary Arteries

Objective: Anomalous origin of coronary arteries (ACA) is rare. The objective of this communication is to describe the difficulties in angiographic recognition and challenges in percutaneous management. Methods: The material for this retrospective study was provided by contributing interventional cardiologists practicing in tertiary care centers. Results: From 2010 to 2019, 27 patients underwent percutaneous coronary intervention (PCI) for ACA. Four groups were encountered including anomalous origin from opposite sinus [left anomalous coronary artery from opposite sinus (L-ACAOS, n = 5), right anomalous coronary artery from opposite sinus (R-ACAOS n = 4)], origin of left circumflex from right sinus (n = 12), and origin of right coronary artery from posterior sinus (n = 6). The selection of a guiding catheter is the crucial step and a wide range of accessories was required to achieve an excellent outcome. Radial access may have an advantage in R-ACAOS, although the majority had a successful procedure from the femoral approach. Conclusion: Percutaneous management of patients with anomalous coronary arteries is challenging but can be accomplished with an excellent immediate outcome.

Regurgitation on pressure over the lacrimal sac versus lacrimal irrigation in determining lacrimal obstruction prior to intraocular surgeries

Purpose: To determine the diagnostic accuracy of manual regurgitation on pressure over the lacrimal sac (ROPLAS) versus lacrimal irrigation for screening nasolacrimal duct obstruction (NLDO) in adults prior to intraocular surgeries. Methods: This cross-sectional study took place in a tertiary eye care hospital in South Tamil Nadu, India. From January to December 2017 and included consecutive patients who presented for routine cataract surgery. Prospective data collection occurred in 8369 eyes of patients who underwent cataract surgery. All patients underwent ROPLAS testing by an ophthalmologist followed by lacrimal irrigation by trained ophthalmic assistants, rechecked or confirmed in equivocal cases by ophthalmologists who were masked to the ROPLAS status. The primary outcome, the sensitivity, specificity, positive, and negative predictive values to detect lacrimal occlusion by ROPLAS compared with lacrimal irrigation with 95% confidence intervals was estimated. Results: A total of 8369 eyes underwent cataract surgery during the time periods of the study. ROPLAS and lacrimal irrigation were performed in all eyes. The sensitivity of ROPLAS to diagnose NLDO correctly was 54.5% (95% CI, 44.8%�.9%) and its specificity was 100% (95% CI, 100%�0%). The positive and negative predictive values were 75.3% (95% CI, 65.6%-83.0%) and 99.4% (95% CI, 99.2%�.5%), respectively. Conclusion: We found that ROPLAS when used alone had very low sensitivity and low positive predictive value in detecting NLDO prior to cataract surgery as compared with lacrimal irrigation. Hence, we recommend performing ROPLAS and lacrimal irrigation in every patient as part of the routine preoperative workup prior to cataract surgery

A Clinical Study on Efficacy of Jivaniya Ghritapana in Shushkakshipaka (Dry Eye Syndrome)

Dry eye syndrome is a disease commonly seen in all age groups with a greater ration in elderly population. Large scale studies have determined that increasing age, female sex, and Asian race are all associated with higher DED prevalence. Their occurs tear deficiency and ocular surface disorders, which produces symptoms like discomfort, visual disturbance and tear film instability. Clinically and etymologically, similar entity to Dry eye syndrome is Shushkakshipaka. In modern ophthalmology, conventional approach for Dry eye syndrome is lubricating eye drops which are not satisfactory. Ayurveda has a holistic approach to deal with this problem. This clinical study was done to evaluate the effect of Jivaniya Ghritapana in Shushkakshipaka (dry eye syndrome). An open clinical trial for 10 patients was planned. They were presenting with clinical features of Shushkakshipaka (Dry Eye Syndrome). Snehapana was done in all patients with Jivaniya Ghrita. Results: On assessing the selected criteria, significant results were found in subjective parameters like Rukshta (feeling of dryness), Gharshana (gritty sensation), Daruna vartmakshi (hardness of eyelids), Karachaunmilana (difficulty in opening and closing of eyes), Daha (burning sensation) & intolerance to light. Significant result was found in all objective parameters. Conclusion: Thus we can conclude that, for successful treatment Shushkakshipaka (Dry Eye Syndrome), Snehapana can be advised in such patients.

Safety, efficacy, and patient selection of ripasudil in patients with uncontrolled glaucoma with maximum conventional medical therapy

Purpose: Ripasudil hydrochloride hydrate (0.4%) is the first Rho?associated protein kinase (ROCK) inhibitor eye drop that lowers intraocular pressure (IOP) by increasing conventional aqueous outflow through the trabecular meshwork and Schlemm’s canal. We aimed to evaluate the safety and efficacy of ripasudil in patients using the maximum topical anti?glaucoma medications and with uncontrolled IOP. Methods: In our prospective interventional study, we enrolled 27 eligible and consenting patients (46 eyes) who presented to us between January 2021 and June 2021. Ripasudil 0.4% was added as adjunctive therapy to the ongoing glaucoma treatment. On follow?up visits at 7 days, 15 days, 1 month, 2 months, and 3 months, the visual acuity, IOP with applanation tonometer, anterior segment, and fundus were evaluated. The IOP before and after the use of ripasudil eye drops was compared by paired t?test. Results: Among the 27 patients, 18 were males and 9 were females. A statistically significant reduction in IOP was noted at all time durations (P < 0.00001) with the maximum reduction at 3 months with all patients achieving their target IOP. No patient developed any side effects necessitating the omission of ripasudil. The most common adverse event noted was conjunctival hyperemia (22 patients), which was mild and transient. Conclusion: Ripasudil showed additional IOP?lowering effect with other antiglaucoma medications and exhibited no significant side effects.

Characterizing the third wave of COVID-19: An analysis from the National Clinical Registry of COVID-19

Background & objectives: Data from the National Clinical Registry for COVID-19 (NCRC) were analyzed with an aim to describe the clinical characteristics, course and outcomes of patients hospitalized with COVID-19 in the third wave of the pandemic and compare them with patients admitted earlier. Methods: The NCRC, launched in September 2020, is a multicentre observational initiative, which provided the platform for the current investigation. Demographic, clinical, treatment and outcome data of hospitalized COVID-19 patients were captured in an electronic data portal from 38 hospitals across India. Patients enrolled during December 16, 2021 to January 17, 2022 were considered representative of the third wave of COVID-19 and compared with those registered during November 15 to December 15, 2021, representative of the tail end of the second wave. Results: Between November 15, 2021 and January 17, 2022, 3230 patients were recruited in NCRC. Patients admitted in the third wave were significantly younger than those admitted earlier (46.7±20.5 vs. 54.6±18 yr). The patients admitted in the third wave had a lower requirement of drugs including steroids, interleukin (IL)-6 inhibitors and remdesivir as well as lower oxygen supplementation and mechanical ventilation. They had improved hospital outcomes with significantly lower in-hospital mortality (11.2 vs. 15.1%). The outcomes were better among the fully vaccinated when compared to the unvaccinated or partially vaccinated.Interpretation & conclusions: The pattern of illness and outcomes were observed to be different in the third wave compared to the last wave. Hospitalized patients were younger with fewer comorbidities, decreased symptoms and improved outcomes, with fully vaccinated patients faring better than the unvaccinated and partially vaccinated ones.

Improving and enhancing the level of Employee Engagement in Modern era

Engaged employees are the true assets and retaining them depends on their adaptation of existing and challenging culture of the organization. The employees have different attitudes and approach in their workplace environment and they continuously strive in the positive manner to achieve those pre-defined goals once they enter the organization of their choice. The role played by engagement on employees is such that the behaviour, values and the expectations of employees is directed towards the fulfilment of overall organizational goals and individual goals. The literature survey of employee engagement showed a strong relationship with the employee's performance and to enhance this association the workplace environment of an organization shall always work towards learning new things and developing the ideas that help the employees to keep themselves engaged in a long term. The findings and measures of past studies has been thoroughly studied and analysed for their relevancy in enhancing the employee's engagement level that can be applied in any organization striving for excellence.

Optical coherence tomography features and correlation of functional and structural parameters in patients of idiopathic intracranial hypertension

Purpose: To determine the correlation between functional parameters and optical coherence tomography (OCT) features in patients of idiopathic intracranial hypertension (IIH). Methods: A prospective observational study in early and established cases of papilledema in IIH presenting from December 2017 to February 2019. Functional parameters (visual acuity, contrast sensitivity, mean deviation, VER, and MfERG) and structural parameters (RNFL, GCL?IPL, and optic disc height) were measured at baseline and every 6 weeks for 6 months. Results: At baseline, average RNFL had a moderate negative correlation with mean deviation (r = ?0.45; P = 0.0007) and a positive correlation with logMAR visual acuity (r = 0.18; P = 0.17). On the contrary, baseline GCL and logMAR visual acuity had a negative correlation (r = ?0.4, P = 0.02). Optic disc height (ODH) had a negative correlation with visual field mean deviation (r = ?0.046; P = 0.0005). At 6 months, ODH and GCL?IPL complex had a statistically significant correlation with functional parameters. However, RNFL values did not show any significant correlation with any of the functional parameters. Baseline GCL?IPL and optic disc height values had a moderate and significant correlation with final functional parameters. However, RNFL did not show any correlation with final functional parameters. Correlation between GCL?IPL thickness at 6 weeks and final functional parameters were stronger than that with baseline GCL values. Conclusion: In the setting of severe papilledema, RNFL can misguide the prognosis. GCL?IPL can be a valuable tool for an objective evaluation of the integrity of the optic nerve in IIH and ODH may be used as an alternative or in combination with GCL?IPL in these cases.

Determining PD?L1 expression in head and neck squamous cell carcinoma using immunohistochemistry

Background: Advanced head and neck squamous cell carcinoma (HNSCC) has limited treatment options. Programmed death-ligand1 (PD-L1) expressed by tumor cells interacts with PD-1 receptor on T lymphocytes leading to immune evasive response and survival advantage. Therapy with immune check-point inhibitors target PD-1/PD-L1 blockade inducing tumor regression. Immunohistochemistry (IHC) for PD-L1 expression enables patient selection for immunotherapy and may be considered a potential predictor of clinical response. Methods: A retrospective analysis of IHC for PD-L1 expression using manual laboratory developed technique (LDT) with antibody clone 22C3 (Dako) in 93 cases of HNSCC. PD-L1 expression was correlated with age, gender, tumor site, grade and stage. Results: PD-L1 IHC was performed in 93 cases and immunopositivity was noted in 59 (63.4%) cases. High expression with combined proportion score (CPS) ?50 was seen in 15 (16.1%) cases and low expression with CPS ?1 expression was seen in 44 (47.3%) cases. An almost-perfect interobserver agreement was noted by two pathologists for PD-L1 IHC expression (Cohen’s kappa coefficient = 0.910). No statistically significant correlation was noted between PD-L1 score and patient demographics, tumor site, grade or stage. Conclusion: Detection of PD-L1 status by IHC enables identification of HNSCC patients eligible for future targeted immunotherapy.

Substance use and oral health sensations among substance users residing in rehabilitation centres in an Indian City

Background: The term substance is usually used to address psychoactive/psychotropic drugs which include both licit and illicit drugs. These substances have varied consequences, including long?term and short?term effects, which include sensations post?consumption. Aim: To determine patterns of substance use and short?term oral health effects among substance users. Materials and Methods: A self?administered questionnaire?based study was conducted on the inmates of drug deaddiction and rehabilitation centres in Bhubaneswar city. Results: All the subjects were males and majority (60.6%) were polydrug users. Alcohol (87.3%) was the most commonly used substance, followed by ganja (57%), bhang (35.3%) and brown sugar (33%). A wide range of oral health sensations like dryness of mouth, taste change, numbness in mouth, feeling like chewing something, loose teeth and stammering/difficulty in speaking were found to be significantly associated with substance use. The age of start of substance use (P < 0.0001), socioeconomic status (P = 0.026) and marital status (P < 0.0001) were significantly associated with the pattern of substance use. About 37.6% of inmates felt that they had very good oral health before starting drug use, while only 15.4% described their oral health as very good at present. Having no oral health problem was the most common reason for not visiting a dentist, followed by ignorant attitude towards oral health. Conclusion: A wide range of oral health sensations were found to be caused due to substance use. Understanding of oral health sensations can aid practitioners detect and report cases of substance use in its early phase.

Isolation and Characterization of Alkaline Pectinase Productive Bacillus tropicus from Fruit and Vegetable Waste Dump Soil

Abstract Alkaline pectinase is the utmost significant industrial enzyme of the bioscouring process. By considering bio scouring of cotton, 30 microbial isolates from fruit and vegetable waste rich dump soil of Solang Valley and Vasishta (Manali, Himachal Pradesh, India) were isolated and screened for the alkaline pectinase production in the current research work. Only four isolates P3, P16, P21, and P27 were capable to produce extracellular alkaline pectinase at pH 9. Further by applying submerged fermentation, the alkaline pectinase production was quantitatively screened. The most efficient isolate was P3 identified as Bacillus tropicus, based on morphological, biochemical, and molecular characterization. Molecular characteristics confirmed by 16S rDNA sequence analysis. The nucleotide sequence of the isolate was novel with a 97% similarity index and submitted to the GenBank with accession number MK332379. The Bacillus strain selected was active at broad pH range from 8-10.5 and a temperature range from 25-50 oC. Optimum pH and temperature observed were 9 and 37 oC respectively and can be suitably used for the bio scouring process for the pretreatment of the fabrics.

Effectiveness of Transcutaneous Electrical Nerve Stimulation Therapy on whole Salivary Flow in Patients with Xerostomia and Healthy Adults

ABSTRACT Objective: To evaluate and compare the effectiveness of transcutaneous electrical nerve stimulation (TENS) therapy on whole salivary flow in patients with xerostomia and healthy adults. Material and Methods: Thirty subjects with a history of xerostomia and subjects withunstimulated salivary flow equal to or less than 0.5 ml in 5 min were included in the study group, and 30 healthy subjects were included in the control group. Low forced spitting unstimulated saliva was collected for five minutes in a test tube fitted with a funnel. Then electrode pads of the TENS unit were applied bilaterally on skin overlying the parotid glands and at optimal intensity, stimulated saliva was collected for 5 minutes with the same method in a separate graduated test tube. The salivary flow rate (per minute) was calculated by dividing the amount of collected saliva (volume in mL) by the duration of collection period (5 minutes) and the salivary flow rates prior and after electrostimulation were compared for both groups. The Student's t-test (unpaired and paired) was performed for group-wise comparisons. Results: In study group, the mean unstimulated salivary flow rate was 0.07 ± 0.01 mL/min. There was an 85.71% increase in salivary flow (0.13 ± 0.03 mL/min) during the TENS application and the difference was highly significant (p<0.001). In control group, the mean unstimulated salivary flow rate was 0.37 ± 0.07 mL/min. There was a 21.62% increase in salivary flow (0.45 ± 0.07 mL/min) during the TENS application and the difference was highly significant (p<0.001). An increase in mean salivary flow rate both in males and females after TENS application in both groups (p<0.001) was noted. The difference between unstimulated, stimulated and mean difference in salivary flow rate between males and females was notstatistically significant in both groups (p<0.05). Conclusion: TENS can be an effective therapy in increasing whole salivary flow rates in patients with xerostomia.

Effect of climato-environmental parameters on chlorophyll a concentration in the lower Ganga basin, India / Efecto de los parámetros climáticos ambientales sobre la concentración de clorofila a en la cuenca baja del Ganges, India

Introduction: Chlorophyll a concentration proxies the phytoplankton biomass which directly involves in signifying the production functions of aquatic ecosystem. Thus, it is imperative to understand their spatio-temporal kinetics in lotic environment with reference to regional climatic variabilities in the tropical inland waters. Objective: In-situ studies were conducted to examine the changes in phytoplankton biomass in lower Ganga basin as influenced by various environmental parameters under regional climatic variability during 2014-2016. Methods: Firstly, the most key influential environmental parameters on riverine Chl-a concentration were determined. Then the direct cascading effect of changing climatic variables on key environmental parameters were derived through modeling and quantified probable changes in mean Chl-a concentration in the lower stretch of river. Results: Only five environmental parameters namely water temperature, total dissolved solid, salinity, total alkalinity and pH were key factors influencing Chl-a (Multiple R2: 0.638, P < 0.05). Present estimates indicate that if the present rate of regional climatic variability over the last 3 decades (mean air temperature + 0.24 °C, total annual rainfall -196.3 mm) remain consistent over the next three decades (2015-2045), an increase in mean Chl-a by + 170 µgL-1 may likely be expected grossly reaching about 475.94 µg L-1 by the year 2045 or more. Conclusions: The present study is first such comprehending a gross hint towards the probable ecosystem response with an alternative model based methodology in data-deficient situations. Subsequently, the output would also be of great benefit for increase water governance and developing strategy protocol for sustainable water management for greater ecosystem services.

Introducción: La concentración de clorofila a representa la biomasa de fitoplancton la cual influye directamente en las funciones de producción de los ecosistemas acuáticos. Por lo tanto, es imperativo comprender su cinética espacio-temporal en el ambiente lótico con respecto a las variabilidades climáticas regionales en las aguas continentales tropicales. Objetivo: Se realizaron estudios in situ para examinar la influencia de varios parámetros ambientales en la biomasa del fitoplancton en la cuenca baja del Ganges durante 2014-2016. Métodos: En primer lugar, se determinaron los parámetros ambientales más influyentes en la concentración de Chl-a fluvial. Luego, el efecto directo en cascada de las variables climáticas sobre los parámetros ambientales clave, mediante el modelado y los cambios en la concentración media de Chl-a en el tramo inferior del río. Resultados: Solo cinco parámetros ambientales, entre ellos, temperatura del agua, sólidos disueltos totales, salinidad, alcalinidad total y pH, fueron factores clave que influyeron en la Chl-a (R2 múltiple: 0.638, P < 0.05). Las estimaciones actuales indican que si la tasa actual de variabilidad climática regional durante las últimas 3 décadas (temperatura media del aire + 0.24 °C, precipitación total anual -196.3 mm) permanece constante durante las próximas tres décadas (2015-2045), se presente un aumento en el promedio de la Chl-a en +170 µgL-1 y alcance aproximadamente 475.94 µgL-1 para el 2045 o más. Conclusiones: Este estudio presenta una metodología basada en modelos alternativos en situaciones de escasez de datos, la información generada también podría contribuir a mejorar la gobernanza del agua y a desarrollar un protocolo para la gestión sostenible del agua y de esta manera mejorar los servicios ecosistémicos.

Aetiological and Clinical Profile of Hypertension in Children

We wanted to study the clinical and aetiological profile of hypertension in children and compare the results with previous studies done in paediatric hypertension among children between 3 and 15 years of age. METHODSAll children between 3 and 15 years of age who visited the Outpatient & Inpatient Department of Paediatrics, SAIMS were screened for the presence of hypertension. Systematic investigations were done to find out the aetiology of hypertension. RESULTSMaximum number of patients were in the age group of 3 to 9 years, followed by 12 to 15 years and 9 to 12 years age groups. Males were affected more. Nephrotic syndrome was the commonest cause of hypertension in children. CONCLUSIONSIn this study, it has been observed that minimum number of patients were in age group 9 - 12 years patients (19.3 %) and maximum number of patients were in the age group 3 - 9 years (51.6 %) with a M : F ratio of 1 : 0.93. and the main aetiology of hypertension was found to be nephrotic syndrome.

Lapatinib-loaded nanocolloidal polymeric micelles for the efficient treatment of breast cancer

This study aims at preparing and evaluating lapatinib-loaded polymeric micelles for the better treatment of breastcancer (BC). LP-loaded polymeric micelles (LP-PMs) were prepared as per our previous studies by using Soluplus®as the polymer. Therefore, we employed the lyophilization technique using mannitol as a cryoprotectant and furtherconducted in vitro and in vivo anticancer efficacy studies, in addition to our previously reported works. We found thatthe lyophilized LP-PMs were sufficiently stable and retained encapsulated drugs. Furthermore, their smooth surfacewas visualized on the atomic force microscopy. The X-ray powder diffractogram of LP-PMs showed successfulencapsulation of Lapatinib; however, the presence of few drug molecules on the surface was evidenced by energydispersive X-ray analysis. Furthermore, LP-PMs showed sustained release of drugs, with selective drug release in anacidic environment, resembling that of a tumor. The LP-PMs exhibited higher cytotoxicity against SKBr3 BC cellsand also induced effective inhibition of the growth of the tumor in vivo when compared to that of lapatinib solutionand marketed formulation. The results of this study indicate the greater potential of LP-PMs for the efficient treatmentfor BC

Effectiveness of bundled interventions in reducing surgical site infections in elective caesarean sections and caesarean hysterectomies in a tertiary care centre

Background: Surgical site infections are the most common and easily preventable infections complicating surgeries. CDC recommends certain bundle interventions for the prevention of SSIs. Hence the present study was undertaken to see the effectiveness and feasibility of the bundle interventions in the elective caesarean sections and caesarean hysterectomies.Methods: A total of 600 patients were taken. Bundled interventions were applied in 278 caesarean sections and 26 caesarean hysterectomies. Routine care was implemented in 262 caesarean sections and 34 caesarean hysterectomies. Rate of SSI, risk factors associated and treatment outcomes were studied.Results: 8 out of 304 cases of the bundled intervention group developed SSI, giving a rate of 2.6%. 52 cases out of 296 in the routine care group developed SSI, the SSI rate being 17.5%. Anemia and diabetes were the most common risk factors.Conclusions: Adherence to bundled interventions can significantly and easily reduce the incidence of SSI.

Esophageal varices presenting as lower GI bleed in an infant: a rare presentation

GI Bleeding is a common problem encountered in the emergency department and in the primary care settings. Lower GI Bleeding is relatively rare as compared to upper GI bleeding. Common causes of lower GI Bleeding are Polyp (32.5%), chronic nonspecific colitis (20.7%), lymphoid nodular hyperplasia (20%), Proctitis (18.2%), Solitary rectal ulcer (10%), Inflammatory bowel disease (6.5%).Among the various causes of lower GI Bleeding, esophageal varices is a rare cause. One such case presented to us with lower GI bleeding, on further evaluation was found to having esophageal varices due to portal hypertension. Child improved after conservative and definitive management.