SCREENING OF RETINOPATHY OF PREMATURITY USING INDIRECT OPHTHALMOSCOPE AND RETCAM : A PROSPECTIVE OBSERVATIONAL STUDY

Background:Aim And Objectives:To study the incidence of Retinopathy of Prematurity in Low birth weight Neonates and Preterm who are at high risk, by screening with Binocular Indirect Ophthalmoscope and Ret Cam 3 resulting in early diagnosis and further management of disease will prevent blindness and other complications in children due to ROP. Material And Methods:Prospective Observational study included 60 Newborns (25 female,35 male) with GA <34 weeks and/or birth weight <1750 grams, and GA 34-36 weeks and/or birth weight 1750-2000 grams with risk factor, screened with First Binocular Indirect Ophthalmoscope and then after 30 minutes with Ret Cam 3. Result:Both the techniques are equally effective in detection and staging of Retinopathy of Prematurityscreening.Conclusion:Both techniques give satisfactory results for screening of Retinopathy ofPrematurity and are comparable to each other, both having their own pros and cons.

Multiple myeloma - Presenting as acute kidney injury.

Background : Multiple myeloma (MM) is a commonly encountered hematological malignancy with significant renal involvement and often presents as renal failure. The aim of the present study is to analyze clinical spectrum of acute renal failure (ARF) in patients with MM. Material and methods. We analyzed 26(males 24; females 2) patients of multiple myeloma who were referred for evaluation of ARF between July 1994 - June 2007. The referral diagnosis did not include MM in majority 23(88%) of the patients. Multiple myeloma was diagnosed by at least two of the four features; (1) lytic bone lesions, (2) serum or urine monoclonal peak, (3) Bence Jones proteinuria and (4) more than 20%plama cells in marrow aspirate. Results: Multiple myeloma contributes 1.93 % of total ARF cases (26/1342) over a period of thirteen years. Mean age of patients was 59.3 ± 7.4 years. The clinical manifestations of myeloma included; anemia (100%), Bence Jones proteinuria (80%), "M" peak in serum electrophoresis (69%), lytic bone lesions (62%), "M" peak in urine electrophoresis (54%), body pain (58%), plasma cells more than 20% in bone marrow aspirate (38%). Oliguric ARF was seen in 73% patients. The precipitating factors of ARF identified were; hypercalcemia (31%); infection (23%); volume depletion (19%); and NSAIDs in (15%). Dialysis support was needed in 77% of the patients because of severe renal failure at presentation with mean serum creatinine of 9.05±2.84 mg%. Seventeen patients completed chemotherapy, seven last to follow up and two patients died. Ten (38.5%) patients had complete recovery of renal function; three patients had partial recovery and off dialysis and four patients remained dialysis dependent. Remission of myeloma was achieved in nine of seventeen patients treated with chemotherapy. Renal biopsy finding in nine patients revealed-cast nephropathy in (4), amyloidosis in (3), proliferative glomerulonephritis in (1) and cast nephropathy with chronic interstitial nephritis and plasma cell infiltration in one patient. Conclusion: Acute reversible renal failure is a common complication in MM, multiple myeloma should be considered as cause a cause of unexplained ARF in middle aged and elderly patients. ©

Study on clinico-epidemiological profile of HIV patients in eastern India.

In this study, 438 HIV positive patients attending the HIV clinic of Sir Sundar Lal Hospital, IMS, BHU were enrolled. Of these 354 were males (mean CD4 count 179 +/- 9.3 cells/microl) and 84 were females (mean CD4 count 323 +/- 28.26 cells/microl). The mean age of the study subjects at the time of diagnosis was 32.6 years. Heterosexual contact was the commonest mode of transmission in 352 (80.4%) patients followed by blood transfusion in 2.5%.History suggestive of a risk factor for HIV transmission could not be elicited in 62 (14.1%) patients. Among male patients, 71.5% were migrant workers. Fever (70.6%), weight loss (53.3%), chronic diarrhea (43.9%) and cough (40.3%) were the common presenting symptoms. Out of the 438 patients, 66.4% had opportunistic infections at the time of reporting to the hospital. The most common opportunistic infection was tuberculosis (38.8%) followed by oropharyngeal candidiasis (20.3%) and diarrhea (12.7%). CD4 counts of the patients were significantly inversely correlated with the number of symptoms and the number of opportunistic infections (correlation coefficient were -.289 and -.236 respectively).

Fracture of the entire posterior process of the talus.

A 25 year old, who had sustained a fracture of the entire posterior process of the talus, is presented. THe fracture was successfully managed conservatively.