Need of optical aids for schools for blind students in Pune and Nasik districts and compliance of their use

Purpose: To assess the need for spectacles and low?vision aids (LVA) in students attending schools for the blind and study their compliance with use. Methods: Comprehensive ocular evaluation was performed using a hand?held slit lamp and ophthalmoscope. Vision acuity was measured using a logarithm of the minimum angle of resolution (logMAR) chart for distance, as well as for near. Spectacles and LVAs were dispensed after refraction and LVA trial. Follow?up was performed to assess the vision using the LV Prasad Functional Vision Questionnaire (LVP?FVQ) along with compliance with use after 6 months. Results: Of the 456 students examined from six schools, 188 (41.2%) were female; 147 (32.2%) were <10 years of age. In all, 362 (79.4%) were blind since birth. The students dispensed only LVAs were 25 (5.5%), only spectacles were 55 (12.1%), and both spectacle and LVAs were 10 (2.2%). The vision improved using LVAs in 26 (5.7%) and using spectacles in 64 (9.6%). There was a significant improvement in LVP?FVQ scores (P < 0.001). Also, 68/90 students were available for follow?up, of whom 43 (63.2%) were compliant to use. Causes of not wearing spectacles or LVA in 25 were left somewhere or lost 13 (52%), broken 3 (12%), uncomfortable to use 6 (24%), not interested to use 2 (8%), and got operated 1 (4%). Conclusion: Although the dispensing of LVA and spectacles improved the visual acuity and vision function of 90/456 (19.7%) students, nearly a third were not using them after 6 months. Efforts need to be taken to improve the compliance of use

Admission test cardiotocography in labour as a predictor of foetal outcome in high risk pregnancies

Background: Continuous fetal heart monitoring in all pregnant women in labour has gained prominence in obstetric practice in the recent years. The aim of this study was to emphasize on the role of admission cardiotocography (CTG) in labour as a predictor of foetal outcome in high risk pregnancies.Methods: This was a prospective observational study done on 340 high risk patients admitted in labour with a period of gestation of ≥37 weeks. An admission CTG which consists of a 20-minute recording of FHR and uterine contractions was taken and the foetal outcome was correlated with it. The non-parametric Chi-square test was used for statistical calculations and a p valve of <0.05 was considered to designate statistical significance.Results: The admission CTG was reactive in 69.4% of all patients, equivocal in 22.2% and pathological in 8.4% of the 340 recruited patients. A total of 37.5% of the patients were post-dated followed by 20.6% of pregnancy incuded hypertensive patients. The neonatal outcomes in terms of fetal distress, meconium stained liquor, NICU admission were considerably higher in pathological test. The specificity of the test was 53.3%, and the negative predictive was    86.49%.Conclusions: Admission CTG is a simple, useful screening test and serves as a non-invasive tool in forecasting the adverse foetal outcomes in high risk pregnancies.

Camptodactyly: An unsolved area of plastic surgery

BACKGROUND: Camptodactyly refers to permanent flexion contracture at the proximal interphalangeal joint. Most cases are limited to fifth-finger involvement. Although common, the treatment of camptodactyly is controversial. Many published studies have emphasized conservative treatment, while others have described surgical procedures. The problem with this deformity is that it presents in several forms, which means that there is no single model for effective treatment. The aim of this paper is to present the difficulties encountered with this condition and the management thereof on an individual basis. METHODS: This is a case series of 14 patients (nine males, five females) who underwent surgical treatment. The results were classified using the method from Mayo Clinic as excellent, good, fair, and poor. RESULTS: Fourteen patients with 15 fingers underwent surgery, and the results achieved were as follows: excellent, 0; good, 1; fair, 6; poor, 8. The treatment of camptodactyly still remains controversial, and hence proper planning individualized to each patient is needed to achieve the maximal improvement with realistic goals. CONCLUSIONS: Although we performed individualised surgery, our careful follow-up was not able to identify any method as superior over another with respect to gain in extension and loss of flexion. We therefore propose that the extensor mechanism should not be disturbed during surgery to treat camptodactyly cases.

Left internal mammary artery to pulmonary vasculature fistulae closed with particle embolizaton: new form of percutaneous intervention.

The left internal mammary artery is frequently employed as a conduit in coronary bypass surgery. We report a 42-year-old male post-coronary artery bypass grafting patient with, angina on exertion who was found to have multiple atrioventricular fistulae arising from left internal mammary artery to pulmonary vasculature leading to coronary steal and positive stress thallium in left anterior descending territory. These fistulae were selectively embolized with polymer particles leading to improved flow in distal left anterior descending artery. Postintervention, the patient has been asymptomatic for more than 8 months.

Mitral valve replacement on a beating heart.

We report the case of a patient who needed mitral valve replacement but was at a high risk of myocardial injury with the conventional technique (cardioplegic arrest on cardiopulmonary bypass). Valve replacement was carried out on a beating heart on cardiopulmonary bypass by perfusing the heart continuously with oxygenated noncardioplegic normothermic blood via the coronary sinus.

unusual presentation of endobronchial tuberculosis

To show unusual presentation of Endobronchial tuberculosis mimicking foreign body. Design: Emergency Bronchoscopy in cases with presentation like foreign body aspiration. Setting: Medical College Hospital Kota, Rajasthan, India. Young girl of 6 years age admitted in the hospital with breathlessness and signs of diminished air entry in Rt. Lung. Main outcome measures: Presentation of collapse and consolidation in endobronchial tuberculosis. Air entry restored after removal of mass from Rt. main bronchus through bronchoscopy and complete response took place after completing antitubercular treatment. We conclude that the bronchoscopist while dealing with foreign bodies in children should keep possibility of tuberculosis in mind

Comparative efficacy of exogenous acetylcholinesterase administration on soman and dichlorvos toxicity in rats.

Cholinesterase (ChE) activity in the blood serum of rats was elevated to 15, 25, and 45 times by the sc administration of 1000, 2000 and 3000 electric eel acetylcholinesterase (AChE) units respectively. Apparently no ill-effect to animals was observed. The maximal activity of the enzyme occurred in 90 min after its administration and was directly proportional to the administered dose. The increase activity of ChE in the serum on the exogenous administration of AChE persisted for 18 hr. The exogenously raised serum ChE, protected rats against lethal dose of dichlorvos, but not against lethal dose of soman. The possible mechanism of differential response in discussed.

Effect of soman administration on beta-esterases in blood, liver microsomes and brain regions of rats.

Activities of enzymes cholinesterase (ChE) and carboxylesterase (CaE) were assayed in serum, liver microsomes and three regions of brain, viz; cerebrum, cerebellum and brain stem (with mid brain) in male albino rats at 0.5 and 2 h periods after administration of 1/2 LD 50 dose of soman (0.22 mg/kg) intraperitoneally in olive oil as vehicle. At 0.5 h, in serum, ChE activity declined to 33% of its initial level whereas CaE activity was almost completely inhibited. However, in the liver microsomes at this period, ChE activity was greatly inhibited (18% of initial level) whereas CaE activity was nearly unaffected. At 2 h period, both the enzymes in the serum were almost completely inhibited. In the brain regions (excepting in cerebellum), both the enzymes were nearly similarly inhibited (by 55% to 65% of the initial level) at both the periods. The time related differential response of these two beta-esterases in acute soman intoxication probably occurred in the peripheral tissues like blood and liver but not in the CNS.