Study Of The Surgical Outcome Of Sutureless Glueless Conjunctival Autograft In Pterygium Excision Surgery

Background: Pterygium is a hyperplastic elastoid wing shaped degenerative condition of the subconjunctival tissue which proliferates as vascularized granulation tissue infiltrating the cornea destroying the superficial layers of stroma and Bowman’s membrane causing corneal distortion and significant amount of astigmatism. Conjunctival autograft is a relatively new and effective surgical technique with good aesthetic results in the management of primary pterygium. Objective: To evaluate the surgical outcome in terms of recurrence and other complications of sutureless glueless conjunctival autograft in pterygium excision. Setting: Department of Ophthalmology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh. Methods: Prospective interventional non randomized hospital based case series was carried out in 50 eyes with primary pterygium. Pterygium excision with limbal conjunctival autograft without glue or suture was performed in all patients. The patients were followed post operatively on day 1, day 7, 1 month and 6 months. Recurrence and other complications were noted at each visit. Results: Mean age of the study population was 36.96_x0001_11.39 years, 64% were males with maximum patients (72%) presenting in the age group of 20-40 years. The overall complication rate was 10%. Graft retraction was seen in 4%, Conjunctival Cyst in 2% and 1 case showed Graft Rejection. Recurrence rate was noted to be 2% at the end of 6 months. Conclusion: Sutureless glueless conjunctival autograft following pterygium excision is a simple, safe and economical procedure for the treatment of pterygium having excellent outcome.

Role of Topical Nepafenac and Topical Dexamethasone in Postoperative Inflammation after Cataract Surgery: A Comparative Study.

Background: To study the role of nonsteroidal anti-inflammatory Nepafenac 0.1% topically in comparison to topical steroid for controlling postoperative inflammation after cataract surgery. Methods: Prospective randomized controlled trials were given and double blind study was done. In both groups, similar baseline parameters were taken into consideration. Postoperative inflammation, intraocular pressure and visual acuity following routine small incision cataract surgery were assessed in both groups in first 21 days. Parameters were graded according to severity. Results: There was not much difference statistically in two groups in the treatment of any of the signs, including ciliary congestion, aqueous cells, flare, descemet’s folds, visual acuity and intraocular pressure (p 0.001) however, there was apparent improvement with corticosteroids when aqueous flare was considered but with Nepafenac there was no side effect and was well tolerated. Conclusion: Nepafenac is equally effective as topical steroid and can safely be used in routine postoperative inflammation after uncomplicated cataract surgery.

Organophosphorus compound poisoning deaths in children: An autopsy survey from Manipal.

A 16-year retrospective autopsy-based study (1992–2008) was undertaken by the department of forensic medicine of Kasturba Medical College, Manipal to ascertain the profile of fatal organophosphorus compound poisoning in the paediatric age group. Out of 2532 autopsies performed during the period, twenty-four victims formed the material for the study. The age group of 13–18 years was most commonly affected, with a significant male preponderance. Many of the cases were suicidal in nature. Nearly half of the victims survived for a period of more than a day after consuming poison. A seasonal variation was noticed, with many cases being reported in the summer months.

Death due to benzodiazepine overdose: A case report.

Benzodiazepines are the most commonly prescribed antipsychotic drugs in modern medical practice. A case is reported where a young male was found dead in his room. No significant external injuries were present on the body, but intracranial haemorrhages were seen on internal examination during autopsy. Chemical analysis of relevant viscera and body fluids revealed the presence of alcohol and a benzodiazepine compound, although the exact nature and concentration of the latter could not be established. The cause of death was furnished as death due to benzodiazepine overdose.

A pilot study on observations on CD4 & CD8 counts in healthy HIV seronegative individuals.

BACKGROUND & OBJECTIVES: CD4 T lymphocyte count is used to measure the progression of HIV infection and is recommended as part of the standard care of HIV infected person. Information on reference CD4 counts and CD4:CD8 ratio in healthy individuals is lacking in India. Therefore the present study was undertaken to obtain base-line data on CD4 counts and CD4:CD8 ratio of healthy population from north India and to assess the feasibility of using the values as reference in an extended larger study. METHODS: In this pilot study 84 HIV negative healthy volunteers (56 males, 28 females) in the age group of 20-59 yr and who were willing to participate in the study were enrolled after proper counseling. Blood specimens were collected from each subject and processed for anti-HIV antibodies for exclusion of HIV. CD4 and CD8 counts of the samples were performed by fluorescence activated cell sorting (FACS). RESULTS: The mean +/- SD of the absolute numbers of CD4 and CD8 lymphocytes/microliter was 763.6 +/- 226 and 547.5 +/- 190 in males and 797.9 +/- 263 and 567.7 +/- 250 in females. The range of the CD4 and CD8 counts was 365-1328 and 264-991 in males and 415-1257 and 224-1126 in females respectively. The mean +/- SD of the CD4:CD8 ratio was 1.47 +/- 0.42 in males and 1.52 +/- 0.45 in females. INTERPRETATION & CONCLUSION: The results of this study showed that there is wide variability in CD4 count in our population, as is seen in studies reported from other parts of India. A large multicentric study could define the normal range for CD4 and CD8 counts and CD4:CD8 ratio in the Indian population.

Antitubercular treatment does not prevent constriction in chronic pericardial effusion of undetermined etiology: a randomized trial.

Patients of chronic exudative pericardial effusion are frequently treated with antitubercular treatment on presumptive grounds in developing countries, in a hope to prevent constrictive pericarditis. To assess the impact of antitubercular treatment on development of constrictive pericarditis in chronic large exudative pericarditis effusion of undetermined etiology, 25 patients above 12 years of age, with large pericarditis effusion beyond 12 weeks duration, were randomized in a prospective 2:1 fashion, to receive either 3-drug antitubercular treatment (group A) or placebo (group B) for six months. End points studied were, development of pericardial thickness as diagnosed by CT scan and constrictive pericarditis as diagnosed by cardiac catheterization. Twenty-one patients (14 in group A and 7 in group B) completed the study protocol. In all, five (23.8%) patients developed constrictive pericarditis/pericardial thickening. Histopathological examination of pericardiectomy specimens in over five patients were negative for tubercular pathology. Pericardial effusion resolved completely in another 10 (47.8%) patients. There was no significant difference in both the groups in development of constrictive pericarditis/pericardial thickening (group A: n = 3, 21.4% and group B: n = 2, 29.6%, p = NS). On multivariate analysis, development of constrictive pericarditis/pericardial thickening was associated with recurrent tamponade (p = 0.01), presence of tamponade at admission (p = 0.07) and haemorrhagic pericardial effusion (p = 0.08). Thus, antitubercular treatment does not prevent the development of constrictive pericarditis in patients of large chronic pericardial effusion of undetermined etiology.

Elective stenting for type B and C lesions: immediate results and follow-up angiographic restenosis.

From January to December 1995, 73 out of 174 patients with coronary artery disease underwent elective stenting for type B and C lesions. The age ranged from 35 to 73 years (mean +/- SD : 52.1 +/- 12.6) and the majority (91.7%) were males. Of the 74 vessels treated, the target vessel was LAD in 49 (66.4%), LCx in 13 (17.6%), RCA in 8 (10.8%) and SVG in 4 (5.2%). Based upon the ACC/AHA task force classification, 58 (79.5%) patients had type B1, 9 (12.3%) B2 and 6 (8.2%) had type C lesions. A total of 89 stents were deployed to treat 76 lesions with a range of 1 to 3 stents per lesion. A single stent was required for 67 lesions, 2 stents for 8 and 3 stents for 2 lesions. The stents used were Wiktor (29), Palmaz-Schatz (26), Gianturco-Roubin (24), Microstent (6) and Freedom (4), depending upon the anatomical and morphological characteristics with the lesion. Using high pressure strategy, the stents were deployed successfully in all (100%) with a reduction in luminal diameter stenosis from 92 +/- 5.4 to -5 +/- 6 percent. There was no subacute stent thrombosis despite nonusability of oral anticoagulation in 95.9 percent patients. None had any major complication in the form of acute myocardial infarction, need for emergency bypass graft surgery or death. Minor complications were encountered in 9 (12.3%) patients. At a mean follow-up of 26 +/- 14 weeks, 74 percent of the patients were asymptomatic. Out of 31 patients who had completed 6 months after the procedure, repeat angiography was performed in 29 (93.5%) at a mean duration of 29 +/- 6 weeks. The angiographic restenosis was found in 6 (20.7%) patients. In conclusion, type B and C lesions can be treated successfully using elective stenting with excellent immediate results and clinical outcome. Angiographic restenosis, which develops in about one-fifth of patients, appears to be much lower than reported after balloon angioplasty for these complex lesions.

Comparison of sodium valproate and phenytoin as single drug treatment in generalised and partial epilepsy.

Ninety four patients of generalised and partial epilepsy were randomly assigned to treatment with sodium valproate (49 cases) or phenytoin (45 cases). Serum levels were monitored. Cases were evaluated after 4, 12, 24 weeks of treatment. Both drugs were found to be equally effective in controlling generalised seizures. However, valproate is better in partial seizures. No correlation could be established. Side effects were minor with both the drugs.

Coagulation studies in patients with cirrhosis of liver: bleeders vs non-bleeders.

Haemostatic functions in 30 cases of cirrhosis liver (18 bleeders and 12 non-bleeders) irrespective of the type of cirrhosis were studied. All the cirrhotics were found to have normal bleeding and clotting time. Thrombocytopenia was observed in 10 cases (33.3 percent), reduced availability of PF3 in 8 cases (26.6 percent), multiple coagulation factor defects in 18 cases (60 percent), increased euglobulin lysis activity in 8 cases (26.6 percent) and low plasma fibrinogen in 12 cases (40 percent). The combination of these tests indicated consumption coagulopathy with secondary fibrinolysis as the major contributory factor in haemorrhagic diathesis in patients with cirrhosis of liver. These coagulation defects were found to be more severe in bleeders than non-bleeders.