Topographic distribution of retinal neovascularization in proliferative diabetic retinopathy using ultra-wide field angiography

Purpose: To analyze the topographic distribution of neovascularization (NV) and capillary nonperfusion (CNP) using ultra?wide field fluorescein angiography (UWFFA) in patients with proliferative diabetic retinopathy (PDR). Methods: This was a prospective, single?center, observational study in which all patients who presented between March 2019 and December 2020 and satisfied the inclusion criteria were recruited. In our study, patients with treatment?naïve PDR without any fibrovascular proliferation underwent UWFFA. The images were analyzed qualitatively for the topographic distribution of NV and the CNP area was quantified. The number of lesions picked by UWFFA was compared with 7 standard field (7SF) image using overlay of 7SF. The main outcome measure was characteristics of neovascularization, such as the number, location, and area of CNP, measured using UWFFA, which was considered with 95% confidence intervals (CI). Results: Two hundred and fifty?three eyes of 187 patients with a mean age of 56.03 ± 8 years were included. Mean neovascularization elsewhere (NVE) was 2.91 ± 3.43. Maximum NVEs were seen in the superotemporal (ST; 0.9 ± 1.13) quadrant, followed by the inferotemporal (IT; 0.7 ± 1.08), inferonasal (IN; 0.66 ± 1.02) and superonasal (SN; 0.66 ± 1.01) quadrants. Maximum CNP area was seen in the SN (13.75 ± 8.83 disc diameter square [DD2]) quadrant, followed by the IN (13.48 ± 8.59 DD2), IT (11.34 ± 8.37 DD2), and ST (11.3 ± 8.34 DD2) quadrants. Mean CNP area was maximum in patients with only neovascularization of disc (NVD; 64.99 ± 41.47 DD2), followed by both NVD and NVE (61.37 ± 35.61 DD2), and was minimum in patients with only NVE (36.44 ± 22.03 DD2). Eighty?one (32%) eyes out of 253 had NVE and 189 (75%) out of 253 had CNP area outside 7SF (overlay) of Early Treatment Diabetic Retinopathy Study (ETDRS). Conclusion: Diabetic NV lesions and CNP areas are distributed asymmetrically throughout the retina and are not restricted to the posterior pole. Compared to conventional 7SF imaging, UWFFA reveals significantly more retinal vascular pathology in patients with PDR.

TO DETERMINE FETOMATERNAL OUTCOME IN RH NEGATIVE PREGNANCY

Background: The present study was conducted to determine the fetomaternal outcome among Rh-negative pregnancies presenting to a secondary care hospital of North India. Methods: A prospective observational design was carried out among Rh negative mothers presenting to the Department of Obstetrics and Gynecology of Swaroop Rani Hospital, Prayagraj, from December 2021 to July 2022. On admission each mother was interviewed using a questionnaire. ABO/Rh grouping of the mothers as well as their husbands/partners were done. Rh antibody titers of the patients were done at first visit and repeated at 28 and 32 weeks respectively. The labor of each of the mothers was monitored carefully, with the mode of delivery and outcome of labor being recorded in the proforma. For the Rh typing of the neonate, cord blood was collected after delivery and sent for ABO/Rh grouping. Both the mother and the neonate were followed up till their discharge/death, and any adverse maternal or neonatal outcome in this period were noted. Results: During the study period, 46 mothers were assessed. The mean age was 23.9±1.4 years. Most of the mothers were multipara. 4.4% of them had a raised Rh antibody titer. Of the mothers, 13% delivered preterm and most required lower segment cesarean section (56.5%). 93.5% of the deliveries resulted in live births. The incidence of Rh incompatibility among the Rh-negative mothers was 83.7%. The mean birth weight was 2.8±0.4 kgs, with most of the babies being male (60.5%). The most common complications developing in the neonates was anemia (21%) and neonatal hyperbilirubinemia (9.3%). Only one (2.3%) of the neonates born to the mothers died due to post-birth complications. Conclusions: Rh incompatibility was observed to be high among the mothers assessed in the study, with 4.4% having raised anti-D titers. Anemia and neonatal hyperbilirubinemia were found to be the most common problems associated with such pregnancies.

Ileum neuroendocrine tumor: Case report and literature review

Ileal neuroendocrine tumors are rare primary epithelial neoplasm arising from enterochromaffin cells. A 65-year-old male presented with complaints of recurrent abdominal pain of 1 year duration. The pain was more aggravated in last 7 days associated with vomiting, loss of appetite and diarrhea. On radioimaging ultrasonography finding impression of small bowel mass lesion suggestive of ileac carcinoid tumor with ischemic bowel disease was given. Computerized tomograph abdomen pelvis showed a welldefined hypodense, round, hetergenous, enhancing mass measuring 2.6x1.6x1.2 cm., showing arterial enhancement in mesentery in close relation to ileum and metastatic lymph node mass- indicating likeness of neuroendocrine tumor. The surgical resection of ileum with mass and enlarged mesenteric nodes were done. On gross examination ileum specimen on cut open showed multiple, irregular mucosal thickenings with foci of ulceration. The submocosa showed single, circumscribed, round tumor measuring 3 x 2.5x1.5 cm. Cut section of tumor was yellowish, tan, well circumscribed and solid. The mesenteric lymph nodes were enlarged. The microscopic examination ileum showed a tumor composed of uniform, round cells having to oval nuclei with salt and pepper chromatin. Tumor cells were arranged in trabecular, nests, ribbons and in areas pseudo glandular pattern. Increased mitotic activity was noted (4/10 high power field). Mesenteric lymph nodes were involved by tumor. On histopathology reported as Well-differentiated neuroendocrine tumors (NET), G2, intermediate grade of ileum. The immunohistochemical stain were positive for synaptophysin, chromogranin A. The Ki-67 expression was <1%. Herewith we are presenting rare case of well-differentiated neuroendocrine tumor NET, G2, intermediate grade of ileum for its clinical, radio imaging ,pathological features and management.

A goat eye, wet lab model for training in Descemet membrane endothelial keratoplasty

Here we describe a new, non-human, ex-vivo model (goat eye model) for training surgeons in DMEK surgeons. In a wet lab setting, goat eyes were used to obtain a pseudo-DMEK graft of 8 mm from the goat lens capsule that was injected into another goat eye with the same maneuvers described for human DMEK. The DMEK pseudo-graft can be easily prepared, stained, loaded, injected, and unfolded into the goat eye model reproducing the similar maneuvers used for DMEK in a human eye, except for the descemetorhexis, which cannot be performed. The pseudo-DMEK graft behaves similar to human DMEK graft and useful for surgeons to experience and understand steps of DMEK early in learning curve. The concept of a non-human ex-vivo eye model is simple and reproducible and obviates the need for human tissue and the issues of poor visibility in stored corneal tissue.

Rectus muscle pseudo-adherence syndrome

Purpose: To describe a clinical entity called “rectus muscle pseudo?adherence syndrome” following buckling surgery. Methods: A retrospective data review was undertaken to analyze the clinical profile of strabismus patients who had developed it following buckling surgery. Between 2017 and 2021, a total of 14 patients were identified. The demography, surgical details, and intraoperative challenges were reviewed. Results: The average age of the 14 patients was 21.71 ± 5.23 years. The mean pre?op deviation was 42.35 ± 14.35 prism diopters (PD) of exotropia, and the mean post?op deviation was 8.25 ± 4.88 PD of residual exotropia at 26.16 ± 19.53 months follow?up. Intraoperatively, in the absence of a buckle, the thinned?out rectus adhered to the underlying sclera with much denser adhesions along its margins. When there was a buckle, the rectus muscle adhered to the outer surface of the buckle again, but less densely, with marginal union into the surrounding tenons. In both scenarios, due to the absence of protective muscle coverings, the rectus muscles were naturally adsorbed onto the immediately available surface in the presence of active healing by the tenons. Conclusion: While correcting ocular deviations following buckling surgery, a false sense of an absent, slipped, or thinned?out rectus muscle is very much possible. This is due to active healing of the muscle with the surrounding sclera or the buckle in a single layer of tenons. This is the rectus muscle pseudo?adherence syndrome, where the culprit is the healing process and not the muscle

Risk factors for clinically significant diffuse parenchymal lung abnormalities persisting after severe COVID-19 pneumonia

Background & objectives: The risk factors for clinically significant diffuse parenchymal lung abnormalities (CS-DPLA) persisting after severe coronavirus disease 2019 (COVID-19) pneumonia remain unclear. The present study was conducted to assess whether COVID-19 severity and other parameters are associated with CS-DPLA. Methods: The study participants included patients who recovered after acute severe COVID-19 and presented with CS-DPLA at two or six month follow up and control group (without CS-DPLA). Adults volunteers without any acute illness, chronic respiratory illness and without a history of severe COVID-19 were included as healthy controls for the biomarker study. The CS-DPLA was identified as a multidimensional entity involving clinical, radiological and physiological pulmonary abnormalities. The primary exposure was the neutrophil-lymphocyte ratio (NLR). Recorded confounders included age, sex, peak lactate dehydrogenase (LDH), advanced respiratory support (ARS), length of hospital stay (LOS) and others; associations were analyzed using logistic regression. The baseline serum levels of surfactant protein D, cancer antigen 15-3 and transforming growth factor-? (TGF-?) were also compared among cases, controls and healthy volunteers. Results: We identified 91/160 (56.9%) and 42/144 (29.2%) participants with CS-DPLA at two and six months, respectively. Univariate analyses revealed associations of NLR, peak LDH, ARS and LOS with CS-DPLA at two months and of NLR and LOS at six months. The NLR was not independently associated with CS-DPLA at either visit. Only LOS independently predicted CS-DPLA at two months [adjusted odds ratios (aOR) (95% confidence interval [CI]), 1.16 (1.07-1.25); P<0.001] and six months [aOR (95% CI) and 1.07 (1.01-1.12); P=0.01]. Participants with CS-DPLA at six months had higher baseline serum TGF-? levels than healthy volunteers. Interpretation and conclusions: Longer hospital stay was observed to be the only independent predictor of CS-DPLA six months after severe COVID-19. Serum TGF-? should be evaluated further as a biomarker.

Cognitive Function in Children With ?-Thalassemia Major

Objectives: To assess intelligence Quotient (IQ) in transfusion dependent ?-thalassemia major patients using Malin Intelligence Scale for Indian Children (MISIC) and to correlate verbal IQ (VIQ), performance IQ (PIQ) and full scale IQ (FSIQ) with serum ferritin levels and annual blood transfusion requirements. Methods: Cross-sectional study design, enrolling 100 patients of transfusion-dependent ?-thalassemia aged 6 years to 15 years 11 months. IQ was assessed using MISIC. Results: Mean (SD) full scale IQ was 95.96 (7.23). IQ was ‘average’ in most of the patients. There was a significant negative correlation of serum ferritin levels with object assembly (r=-0.215, P=0.034) component of PIQ; annual blood requirement with general comprehension component of VIQ (r=-0.275, P=0.006) and age at diagnosis with PIQ (r=-0.273, P=0.006). There was a significant linear correlation of PIQ (r=0.280, P=0.005) and FSIQ (r=0.274, P=0.006) with pre-transfusion hemoglobin. Conclusion: IQ correlates with age at diagnosis and average annual pre-transfusion hemoglobin. This highlights the importance of early diagnosis and maintenance of satisfactory hemoglobin levels

Preferred practice patterns and review on rosacea

Rosacea is a chronic, inflammatory facial dermatosis commonly found in fair skin tone population. Recent studies have shown the increasing prevalence in the dark skin tone population as well. Ocular involvement is very common and can occur without cutaneous features. Common ocular features are chronic blepharoconjunctivitis with eyelid margin inflammation and meibomian gland dysfunction. Corneal complications include corneal vascularization, ulceration, scarring, and rarely, perforation. Diagnosis is largely based on clinical signs, although it is often delayed in the absence of cutaneous changes, particularly in children. The management ranges from local therapy to systemic treatment, depending on the severity of the disease. There is a positive association between demodicosis and rosacea; however, causality is always argued. In this review, we describe the epidemiology, clinical features, and treatment of rosacea and ocular rosacea.

Detection and Comparision of Cytopathological Changes in Smokers and Non-Smokers: A Comparative Study

Background: Oral cancer is one of the sixth most common cancers in the world. Oral exfoliative cytology is one of the popular screening tool for oral cancer. Use of tobacco in any form are documented as the most common cause as initiators for dysplastic changes in oral mucosa. The purpose of the study was to detect the cytological changes in buccal mucosa, tongue and palate among non-smokers & smokers. Material & Methods: Smears sample were collected according to site (buccal mucosa, tongue & palate) from 100 subjects among smokers & non-smokers. Smears were then stained using Papanicolaou staining technique. Results: Among the smokers and non-smokers the results were statistically significant. Conclusion: Recent advances in the clinical visualization and detection of the oral mucosa have made the viability of cytological procedures more specific and sensitive. Contact endoscopy and use of autofluorescence devices are the forerunners in this group. The fluorescence characteristics of tissues depend upon their biochemical composition and histomorphological architecture, both of which undergo a change during malignant transformation. These changes are detectable as an alteration in the fluorescence spectral profile of the tissues21. Due to low feasibilities of such devices the benchmark of diagnosis will be microscopic tissue examination. Hence cytological smears will always be highly specific, sensitive, easy to use and reproducible procedures in routine screening of population for potentially and malignant conditions of the oral cavity.

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.

Study of Characteristics of COVID-19 Patients with Fatal Outcome during Wave-2 from a Tertiary Care Center in Western India

Background: A large surge of intensive care unit (ICU) admissions leading to mortal outcome was observed in wave-2 of coronavirus disease 2019 (COVID-19) due to the higher virulence of the Delta variant of the COVID-19 virus, which led to the scarcity of resources in hospitals. This study was done to observe the clinical characteristics of COVID-19 patients with fatal outcome. Materials and methods: We conducted a retrospective cross-sectional study in adults with COVID-19 pneumonia having fatal outcome during wave-2 of COVID-19, and their clinical characteristics were studied. Results: Out of 136 patients included in the study, the most common risk factors leading to adverse outcome were in the male gender, age (middle and elderly), with hypertension and diabetes mellitus (DM) as predominant comorbidities, early onset dyspnea, high C-reactive protein (CRP), high neutrophil to lymphocyte ratio (NLR), high D-dimer, bilateral lower zone involvement of lungs in chest X-ray (CXR), and development of acute kidney injury (AKI). Conclusion: The characteristics of the severely ill COVID-19 patients highlighted in the study could help clinicians in the early identification and management of high-risk patients. This study would help with resource planning and preparation for further COVID-19 waves and future pandemics.

LETS CONNECT WITH YOUTH (YOUTH PROBLEMS & SOLUTIONS)

The world is rapidly ageing but India is still young. India is having Demographic Dividend a window of opportunity, from the year 2020 till 2050. This means that we have the maximum young population (15-64) years of working. The median age of the Indian population is less than 29 years in year 2022 . India has about 67% of its population in the working age group of 15-64byears –the segment we call it as demographic dividend. This window of opportunity is further more advantageous as other nations like USA & Japan have aging population. The need of the hour is tapping the talent powerhouse of our youth. But do we know youth. Do we understand young people. One in seven young person is depressed in India as per UNICEF report 2021. 80% percent of India's workforce reported mental health issued but only half took steps to seek mental help. These ?gures are alarming enough for industry, educational institutes & government to frame policies, take steps to bring back our youth into mainstream with full vigour, con?dence & optimum productivity level. Unless the preparatory work of skilling, reskilling and job creation happens, India stands to lose the opportunity of demographic dividend . To harness the youth potential we ?rst need to understand the problems of youth and then frame polices that are executed to employ youth productively and at the same time their mental and physical health is well taken care of. The session deliberates on problems of youth and suggests practical solutions to these.

A Cross-Sectional Study to Assess the Knowledge Regarding Rights and Responsibilities of Nurses at a Selected Tertiary Care Hospital

.Health care system could not function efficiently, if nurses were not present to perform their part. Nurses do their work responsibly and passionately to serve the mankind and the needy ones. Sense of responsibility makes a person more accountable to their duty, while the knowledge of the rights gives personal security and confidence. It is essential for the nurses to be well aware of their rights and responsibilities to provide comprehensive care to the patients. A cross-sectional survey was carried out at AIIMS, New Delhi, to assess nurses'#39; knowledge regarding rights and responsibilities. Convenient sampling was used to select 210 samples from ICU, ward, OPD, OT and emergency department. Structured knowledge questionnaire was used to collect the data. The study found that nurses had good knowledge regarding nurse'#39;s rights (mean score 27'plusmn;3.7). Similarly the nurses were well aware of their responsibilities with mean knowledge score of 15'plusmn;1.29. Knowledge regarding the rights of the nurses was significantly associated with age (p=0.034), educational qualification (p=0.018) and years of experience (p=0.003) whereas knowl- edge regarding the responsibility of the nurses was independent of socio-demographic variables; 65.7 percent of subjects had attended empowerment programmes. To conclude, nurses were well aware about their rights and responsibilities. Formal educational and empowerment programme are proved to be helpful in enhancing their knowledge. Therefore, the employers should plan an ongoing, appropriate empowerment programme for the nurses to keep them updated.

Association of Metformin with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis

Studies have demonstrated high prevalence of mortality in coronavirus disease (COVID-19) patients with type 2 diabetes mellitus; however, the effects of antidiabetic pharmacotherapy on COVID-19 complications need further exploration. The aim of the study was to explore the association of metformin use and mortality in COVID-19 patients. A literature search was conducted using the databases Medline (via PubMed) and Cochrane Central Register of Controlled Trials until February 09, 2021. Nine studies were included in the meta-analysis, including 12,684 COVID-19 patients. The meta-analysis suggested 37% lower risk of mortality in patients receiving metformin (risk ratio: 0.63; 95% confidence interval: 0.50–0.78; p?<?0.001). However, no significant difference in hospitalization days between the two groups (p?=?0.197) was observed. The analysis revealed significantly lower risk of having obesity (p?<?0.001), hypertension (p?<?0.001), heart failure (p?<?0.001), and cerebrovascular disease (p?=?0.015) in the group receiving metformin. The analysis also demonstrated significantly lower risk of using anticoagulants (p?=?0.015), diuretics (p?<?0.001), and antiplatelets (p?=?0.010) in patients receiving metformin. Our findings suggest that metformin use decreases mortality in COVID-19 patients. However, randomized studies demonstrating the consequences of metformin use are needed to understand the magnitude of the beneficial effects of metformin

Variability in the Epithelial Expression of Ki67 and Polarization Characteristics of Collagen in Odontogenic Cysts and Tumours

ABSTRACT Objective: To assess the proliferation of epithelium (using the Ki67 index) and the polarization pattern of collagen in selected odontogenic cysts and tumours. In addition, an exploratory analysis of the effect of inflammation on the proliferation rate was done. Material and Methods: Following immunohistochemical staining, the labelling/proliferation index of Ki67 was calculated. The thickness and corresponding polarization colour of 100 juxta-epithelial picrosirius red-stained collagen fibers were assessed using linear micrometry with an eyepiece reticule under × 1000 magnification. Inflammation was graded subjectively as mild, moderate, and severe. Results: Overall Ki-67 expression was higher in the radicular cyst, Odontogenic Keratocyst, Ameloblastoma, while suprabasal Ki-67 positivity was maximum in Odontogenic Keratocyst. The stromal collagen fibers in Ameloblastoma showed predominantly green birefringence, whereas Odontogenic Keratocyst had orange birefringence. There was no significant association of inflammation with Ki-67 expression or birefringence patterns. Conclusion: The highest Ki67 expression in the radicular cyst, followed by Odontogenic Keratocyst and Ameloblastoma. Differences in the collagen maturation pattern were noted innately in five lesions studied and were further influenced by inflammatory changes. Epithelial proliferation and concomitant expression of thickness and maturity of the stromal collagen are innate features of the lesion further influenced by inflammation in various odontogenic cysts and tumours and may, in turn, guide the clinical behavior.

Comparison of Intraoperative Low-Dose Ketodex and Fentanyl Infusion for Postoperative Analgesia In Spine Surgery: A Prospective Randomized Double-Blind Study

Methods@#The study included 60 patients graded American Society of Anesthesiologists I and II and scheduled for thoracolumbar spine surgery involving >3 vertebral levels. The patients were divided into two groups: group KD (ketodex) and group F (fentanyl). The primary objective was to compare the postoperative analgesic requirements among the groups. The secondary objectives included a comparison of the intraoperative anesthetic requirements, postoperative pain scores, hemodynamic parameters, side effects of the study drugs, and the duration of post-anesthesia care unit stay of both the groups. @*Results@#Ketodex use prolonged the mean time to first rescue analgesia (22.00±2.30 hours vs. 11.69±3.02 hours, p 0.05). The postoperative pain scores were significantly lower in the group KD than in group F at most timepoints (p 3 vertebral levels to achieve prolonged analgesia without any opioidrelated side effects.

MANAGEMENT OF A HUGE PARAPHARYNGEAL MASS : A SURGICAL NOVELTY

Parapharyngeal space(PPS) tumors are very uncommon. Though majority of these tumors are of benign origin, the most common among them is a pleomorphic adenoma. Surgical removal is mainstay for the treatment of these tumors for which a strategic preoperative evaluation of each patient and knowledge of different surgical approaches to PPS are essential. Here we report a rare but typical case of a 35 years old female presented to OPD with a mass in right the parapharyngeal space. The mass was excised successfully using mandibular swing approach and the post operative histopathology report suggested it to be “pleomorphic adenoma”

Dengue and Chikungunya viruses Co infection: A serological based study from tertiary care center, Ahmadabad, India

Introduction: Dengue and Chikungunya (CHIK) infections appear to be increasing in all parts of India. Aedes aegypti mosquitoes are common vectors for dengue virus (DENV) and CHIK virus (CHIKV - Chikungunya Virus). In areas where both viruses co circulate, they can be transmitted together. Aim: The present study was undertaken to study the prevalence of dengue–CHIK co infection and compare with monoinfection. Methods: IgM antibody capture ELISA (Enzyme linked immunosorbent assay) for dengue IgM and CHIK IgM and ELISA for dengue non structural protein 1 antigen was performed on serum samples obtained from suspected patients. Results: Out of total 1071 samples from suspected patients for dengue & chikungunya infection, 212 (19.7%) samples were positive for DENV while CHIK IgM antibodies were positive in 145 (13.53%) patients. Total 44 sera were positive (4.10%) for co-infection of dengue and CHIK. Conclusion: Increase in the number of Dengue and Chikungunya infections and their cocirculation is an important public health concern which warrants the implementation of strict control measures