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Myopia is a major public health problem worldwide, including India, with the global prevalence of myopia increasing rapidly over decades. The clinical and socioeconomic impact of myopia is also expected to rise with rising prevalence. Therefore, the focus has now been shifted to prevent the incidence and progression of myopia. However, there is lack of any standardized guidelines for myopia management. This document aims to generate a national-level expert consensus statement on the management of childhood myopia in the Indian scenario. The expert panel of pediatric ophthalmologists consisted of 63 members who met in a hybrid meeting. A list of topics deliberating discussion in the meeting was provided to the experts in advance and they were instructed to provide their opinions on the matter during the meet. The panel of experts then gave their views on each of the items presented, deliberated on different aspects of childhood myopia, and reached a consensus regarding the practice patterns in the Indian scenario. In case of opposing views or lack of a clear consensus, we undertook further discussion and evaluated literature to help arrive at a consensus. A written document is prepared based on recommendations explaining definition of myopia, refraction techniques, components and methods of workup, initiation of anti-myopia treatment, type and timing of interventions, follow-up schedule, and indications for revised or combination treatment. This article formulates evidence-based guidelines for progressing myopes and pre-myopes and also establishes uniformity in the management of childhood myopia in the country.
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Purpose: To study the long?term microvasculature changes at the macula and the optic disk in eyes with nonarteritic anterior ischemic optic neuropathy (NAION). Methods: Patients with acute NAION of less than 6 weeks duration were included. Optical coherence tomography angiography (OCTA) of the macula and the optic disk was performed at baseline, 3 and 6 months and compared with the controls. Results: The mean age of 15 patients was 52.25 (±9.06) years. The whole image superficial peripapillary density (42.49 ± 5.28) was significantly low when compared to that of control eyes (46.36 ± 2.09); similarly, radial peripapillary capillary density (49.35 ± 5.64) was also significantly reduced when compared to controls (53.45 ± 1.96, P < 0.05). These parameters showed significant progressive decrease at 3 and 6 months (P < 0.05). At the macula, both superficial (41.83 ± 3.64) and deep macular vasculature densities (47.30 ± 2.04) were significantly reduced when compared to control eyes (52.15 ± 4.84 and 55.13 ± 1.81, respectively). The vascular density at the macula remained stable at 3? and 6?months period. Conclusion: The study shows that the microvasculature in case of NAION is significantly reduced both in peripapillary area and in macular area.
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Purpose: To observe the photoreceptor anomalies in cases of ametropic amblyopia. Methods: A prospective study with 25 isoametropic amblyopic children in the age group of 5–14 years and 25 age?matched controls was done. Examination included refraction, best?corrected visual acuity (BCVA), and color vision. Adaptive optics (AO) and multifocal electroretinogram (mf?ERG) were done to assess the anatomy and function of photoreceptors. The subgroup analysis of the improved and non?improved groups was done. Results: The mean cone density in cases and control in the superior, temporal, and nasal quadrants was respectively as follows (21640 ± 5713, 24040 ± 3386, P = 0.01) (19755 ± 6282, 21832 ± 2911, P = 0.03) (19897 ± 5418, 22171 ± 3660, P = 0.01) (20768 ± 4799, 22819 ± 3241, P = 0.01). The amplitude of N1 wave and P1 wave in cases was significantly low compared to the controls. Cases with subnormal color vision had reduced BCVA (0.55 ± 0.018) in comparison to the children with normal response (0.350 ± 0.014). Cone density was also significantly reduced in children with subnormal color vision. Sixteen out of 25 cases showed BCVA improvement with spectacles. Baseline cone density was found to be significantly higher in the improved group. There was no correlation between BCVA and AO parameters. Conclusion: Patients with ametropic amblyopia show subnormal photoreceptor properties than controls. Low cone density may be associated with defective color vision and poor prognosis in these cases
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Childhood nystagmus creates a visual storm both for the affected child and the treating doctor. This problem occurring in the development phase of the child affects not only the vision but also the general development, if not diagnosed and managed in time. Moreover, some forms may even harbor a neurological tumor needing timely management. First, a brief introduction of nystagmus classification, a simplified approach to diagnose the common childhood nystagmus, and the value of electrophysiology will be presented. Next, the approach to treatment, using a thorough clinical examination, illustrated by patient examples of different types of nystagmus will be presented. The different forms of childhood nystagmus are described: idiopathic infantile nystagmus syndrome (IINS), sensory nystagmus (SN), fusion maldevelopment nystagmus (FMDN), spasmus nutans syndrome (SNS), nystagmus blockage syndrome, periodic alternating nystagmus, and others as well as their specific management. The role of electronystagmography and that of neuroimaging in specific conditions is life saving and is described. The role of auditory biofeedback, acupuncture, medical treatment, and surgical procedures like Augmented Anderson procedure, Hertle-Dell'Osso procedure, supra maximal retro-equatorial recession, and posterior fixation have been elucidated. Newer techniques have simplified the management options and improved the functional outcomes in childhood nystagmus. To conclude, children with nystagmus of types IINS, FMDN, SNS, or SN need to be managed differently. It is thus possible to timely manage these children, not only to save their life and improve their vision but also to improve their living quotient.
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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.
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Purpose: To evaluate the surgical efficacy of reinforced plication of the medial rectus muscle to resection as an effective muscle strengthening procedure in exotropia. Methods: This is a prospective randomized trial in patients with exotropia who underwent complete orthoptic evaluation followed by random assignment into two groups by using a computer?drawn random number table. Group 1 patients underwent standard resection with recession procedure, and group 2 patients underwent reinforced plication with recession procedure. Follow?up was performed at day 1, 1 week, 1 month, 3 months, and 6 months to assess the surgical efficacy. Results: A total of 80 patients were included in the study of which 39 were in group 1 and 41 in group 2. The mean age in group 1 was 23.48 ± 11.94 years and 23.29 ± 10.02 years in group 2. The mean preoperative deviation in group 1 for distance was 50.13 ± 11.95 PD and 50.12 ± 9.79 PD in group 2 (P = 0.499). In group 1 with a mean surgical dose of 5.27 mm medial rectus resection and 8.04 mm lateral rectus recession, a 7.11 ± 3.95 PD deviation was noted at the end of 6 months. Similarly, in group 2 with a mean surgical dose of 5.16 mm medial rectus plication and 8.16 mm lateral rectus recession, a 6.00 ± 2.46 PD deviation was noted at the end of 6 months. Between groups, ocular surface changes, inter?surgeon comparison, and exotropia subtypes did not reveal any significant differences. Conclusion: In our observation, the reinforced medial rectus muscle plication showed clinically comparable results as compared to the standard resection procedure at the end of 6 months. Therefore, this innovative modification can be considered as an alternative to standard resection
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Background: Percutaneous nephrolithotomy (PCNL) has become a well-established procedure for the management of pediatric renal calculi. Paediatric PCNL has been performed using both adult and paediatric instruments. Objectives: To evaluate the safety, efficacy and complications using the Modified Clavien scoring system (MCSS) in children undergoing PCNL using adult sized instruments.Methods: All patients less than 16 years old were analyzed retrospectively in Western Rajasthan undergoing PCNL procedure at Dr. SN Medical College and Hospital from April 2016 to March 2019. All PCNL procedures were performed in prone position under general anaesthesia with fluoroscopic guidance and using adult size instruments. All the demographics, surgical data and perioperative information were collected.Results: Total 112 patients with 120 renal units (8 patients with bilateral stones), (66 boys and 46 girls), with a mean (range) age was 10.01±4.02 (2-16) years. The mean (range) stone size in our study was 28.94±1.10 (20-50 mm). Overall, stone-free rate after PCNL was 95%. Twenty five (25) children (20.8%) had operative complications; 23/25 (92%) had, Clavien grade I in 15 (60%), grade II in 8(32%) and all managed conservatively. 2 patients had hydropneumothorax, managed with ICD tube. Stone size, operative duration and haemoglobin drop were significantly associated with complications on Univariate analysis (p<0.05).Conclusions: In paedriatric age group PCNL is considered safe with MCSS showing grade I and grade II complications in majority (92%) of patients.
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INTRODUCTION: - The clinical signs and symptoms of PCOS also vary among ethnic groups. The reason could be due to differences in lifestyle, dietary factors, genetic and biochemical composition. As the etiopathogenesis of this syndrome still seems to be unclear, a common definition and proper treatment plan for PCOS does not exist. METHODOLOGY: - 100 total number of cases were included in this study. This study was carried in the department of Obstetrics and Gynecology in Adesh Institute of Medical Sciences and Research, Bathinda, Punjab RESULT:- In the present study showed highly significant Pearson correlation between LH/FSH & FT3, LH/FSH & TSH, Serum prolactin & TSH. CONCLUSION:-This study was suggested that, TVS is the most the important diagnostic tool and serum LH/FSH ratio was secondary tool.
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Background: The endogenous micro flora contains a variety of bacteria. These are aerobic, facultative and obligate anaerobic bacteria like many important pathogens such as Klebsiella, Pseudomonas, Escherichia coli, Staphylococcus, Streptococcus species and besides the normal lactobacilli. These organisms exist in a commensal, synergistic or antagonistic relationship. Methods: This study was conducted in Department of Gynecology in Adesh Institute of Medical Sciences and Research, Bathinda, Punjab. Study Population: -50 post-partum cases were subjected in this study. Results: In this study 50 total numbers of cases were included, out of which 60% were belongs to 25-29 age group followed by 20-24 (32%), 30-34 (6%) & 35-40 (2%) age group. 16% infection occur in the post -partum study out of fifty cases caused by different types of organism. Conclusion: This study reveals that in post-partum period, addition of lactobacilli iatrogenically may prove to be useful in prevention of infection.
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Iron deficiency anemia (IDA) is one of the most common nutritional disorders worldwide, affecting people of all ages in developed and developing countries. causes dimunition of various antioxidant enzymes like superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase. The objective of the study was to detect impact of iron supplementation in anaemic & non- anaemic pregnant subjects on oxidative stress. Patients are divided into two groups, Control groups (60 non-anemic pregnant women) & Study groups (60 anemic pregnant women). The blood sample (5 ml) was collected from different groups of subjects. In controls groups, a fall in catalase, superoxide dismutase, glutathione peroxidase and glutathione reductase were seen while lipid peroxidase was found to have increased significantly after iron therapy. In study group, and increment in all markers except lipid peroxidase was seen and the level of lipid peroxidase was decreased following iron supplementation which was statistically significant (p<0.001). it may be concluded that iron deficiency anaemia is associated with free radical generation and peroxidation of vital body molecules which implies increased risk for pregnant women.
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Damage to the inferior alveolar nerve (IAN) while extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth. The aim of this study was to compare the sequelae of coronectomy with odontectomy in impacted mandibular third molars. Patients and Methods: This study included thirty patients which were divided into two groups, Group-I (test group) including 15 patients undergoing coronectomy and Group-2 (control group) of 15 patients undergoing odontectomy. Investigations included digital orthopantomogram. The parameters for this study included pain, swelling, nerve paresthesia, trismus, postoperative infection, postoperative wound dehiscence, postoperative pocket depth, and migration. Results: In Group-1 (coronectomy group), the patients underwent follow-up for 6 months to evaluate migration of the retained mandibular third molar root which was in proximity with the IAN. There was a mean increase in migration when the distance from the inferior border of IAN until the apex of the retained mandibular third molar root was measured which was by 3.43 mm after 6 months of follow up. Conclusion: On statistical analysis, the result in this study showed no statistical difference in both the groups in all the parameters that were taken.
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Objective To assess the efficacy and safety of a "mini-perc" technique of percutaneous nephrolithotomy for the removal of pyelocaliceal stones and upper ureteric calculi. Materials and Methods Data of 94 patients who underwent mini-perc, were reviewed with relation to clinical presentation, stone characteristics, operative time, need for transfusion, stenting, nephrostomy placement, stone free rate, complications and hospital stay. The effect of stone diameter, stone burden, relation of primary vs secondary tract and placement of dj stent with respect to analgesic requirement and hospital stay were analysed. Also relationship of operative time with stone burden, placement of dj stent and presence of secondary tract were studied. ResultsThe immediate and at 1 month stone free rate was 100%, in all stone locations which was not influenced by stone diameter or stone burden. The mean hospital stay after the procedure was 2.09±0.39 days. Conclusion In experienced hands miniperc provides a very good option for treatment of renal stones in all locations and upper ureteric calculi with low complication rates.
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BACKGROUND: The purpose of this study is to assess the utility of ocular ultrasound B scan in the emergency at the first point of care for detecting posterior segment and orbital pathologies in cases of paediatric ocular emergencies. METHODS: A prospective observational study involving 122 paediatric patients presenting to eye emergency over a period of ninety days were assessed with ultrasonography for the posterior segment as well as orbital pathology whenever indicated. The ocular ultrasound was performed gently over closed eyelids. RESULTS: Posttraumatic globe injuries were the most common indication for posterior segment evaluation, which constituted 80 (65.57％) eyes. Among these 52 patients had an anechoic posterior segment and 28 patients had variable findings such as vitreous haemorrhage (8.19％), retinal detachment (6.55％), choroidal detachment (4.91％), posteriorly dislocated clear lens (0.81％) and retained intraocular foreign body (5.73％). Non-traumatic cases constituted around 42 (34.42％) eyes, which included corneal ulcer (7.37％), retinoblastoma (6.55％), endophthalmitis (4.91％), extraocular muscle cysticercosis (4.91％), orbital cellulitis (4.09％), periocular haemorrhage (2.45％), proptosis(1.63％), paediatric cataract (1.63％) and cryptophthalmos (0.81％). No adverse events of performing the ultrasound was noted. CONCLUSION: First point ultrasonography in paediatric ocular emergencies is a cheap, portable and an effective tool in the assertion of significant posterior segment and orbital diseases.
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Background: To study maternal outcome in eclampsia in relation to respiratory complications, fever, DIC, renal system affection and electrolyte imbalance. (2) To study the fetal outcome in eclampsia in relation to small for gestational age, intrauterine death, neonatal mortality, perinatal mortality and need for NICU admission. Methods: It was a cross-sectional prospective study conducted at Department of Obstetrics and Gynaecology at Department of Gynaecology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India. All patients admitted with eclampsia was enrolled for the study as per the criteria given. It was a a cross-sectional prospective study conducted on women admitted with eclampsia after the gestational age of 20 weeks and presented with convulsions. The outcome in relation to maternal and neonatal morbidity and mortality was studied on the basis of various complications and defined parameters. Results: A total of 50 patients were enrolled in the study. The most common age group of patients who had eclampsia after 20 weeks of gestation belonged to age group of 31-35 years followed by 26-30 years and the least common age group was between 41- 45 years of age. The mean age was found to be 28.23 years. The most common indication of LSCS in patients with eclampsia was fetal distress followed by Unfavourable cervix, failure of induction and contracted pelvis. The most common complications seen in patients with eclampsia included Respiratory complications like aspiration pneumonia, pleural effusion and pulmonary edema. Conclusions: Less ANC visits were associated with more threat and complications. Eclampsia was found to be associated with preterm delivery. Increase in convulsion to delivery interval lead to increase severity of complications.
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The present work introduces the clinical case report of a 32-year-old male patient who sought the Department of Conservative Dentistry and Endodontics in Bangalore Institute of Dental Sciences, Bangalore with complaint of pain in the second upper left premolar. At the clinical examination, the tooth presented caries in the distal region, sensitivity to cold water and slight symptomatology to percussion. Radiographically the tooth presented a deep carious with pulp envelopment and thickening of the periodontal ligament in the apical region. During the opening of endodontic access a perforation occurred in the mesial region due to the incorrect direction of the drill. The perforation site was gently dried with hemostatic agent and then GIC was placed condensing along the perforation walls. Once this was done, root canal treatment was continued and the root canal was obturated to assess the attitude and practice of dental professionals towards using of advance radiographic technique.
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Traumatic optic neuropathy due to missile injury typically results in unilateral visual loss.[1] We discuss an uncommon case, in which injury from retroocular passage of a single bullet resulted in bilateral orbital perforations, frozen globes, and complete blindness. A 20‑year‑old female presented with bilateral absent light perception detected immediately, following alleged accidental bullet injury. There were no cranial manifestations and sutured skin wounds were visible on the temporal aspects of both the orbits. Bilateral ocular coats were intact with normal intraocular pressure and anterior segments. However, there was bilateral complete afferent pupillary defect and vitreous hemorrhage. Noncontrast computerized tomography (NCCT) imaging revealed multiple orbital and nasal fractures, a bony fragment abutting the right globe [Fig. 1a], and bilateral temporal orbital perforations on reconstructed images [Fig. 1b and c]. The entry wound was left‑sided and slightly lower than the right‑sided exit wound [Fig. 1b and c]. Sonography revealed attached bilateral retinas. The combination of complete afferent and efferent neural dysfunction was attributed to injury of bilateral posterior orbits near the apical region. No ocular intervention was planned due to poor prognoses and absence of any foreign body.
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Zingiber officinale Roscoe, commonly known as ginger, is a traditional herb used to treat various disorders. In this study, we evaluated potential pharmacological effects of ethanolic extracts of Z.Officinale with respect to central nervous system (CNS) activity in mice. Role of ethanolic extract of ginger on CNS activity in mice was studied using models of elevated plus maze test, barbiturate-induced sleeping time, tail suspension test, hot-plate and tail-flick test. Ginger extract was administered to mice at single doses of 50 and 200 mg/kg, perorally while diazepam (1 mg/kg), morphine (5 mg/kg) and imipramine (30 mg/kg) intraperitoneally were used as standard drugs. The results showed that the ginger extract at all dose levels significantly exhibited anxiolytic activity increased the sleeping latency but reduced the sleeping time. Tail suspension test showed that the extract at both the doses was able to induce a significant decrease in the immobility time, similar to imipramine, a recognized antidepressant drug. Tail-flick and hot-plate tests demonstrated antinociceptive property of ginger extract, similar to morphine, a recognized antinociceptive agent. Higher dose level (200 mg/kg) showed better protective effects. Phytochemical screening of ethanolic extract revealed the presence of various phytoconstituents such as phenolic compounds, flavonoids, tannins, anthocyanins, carbohydrates, glycosides, proteins, resins and volatile oils. The possible mechanism by which ginger exhibited the significant beneficial effects on various CNS models in mice could be attributed to its antioxidant potential.
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Introduction: Free radicals and the oxidative stress have been implicated in a large number of chronic disorders such as Diabetes mellitus and its late complications, Cardio vascular disease, Arthritis also in some acute conditions such as the hemolytic disease in Glucose 6 Phosphate Dehydrogenase (G 6 PD) deficiency, where free radicals play a direct cytotoxic role causing cellular damage. Various exogenous substances have been found to be of great use for the purpose of scavenging free radicals. These includes micro nutrients such as vitamins eg. Vit C, Vit A etc or other dietary agents polyphenols, flavenols, tannins etc. In traditional medicine certain food items and their extracts are considered useful in combating conditions such as diabetes mellitus, Cardio vascular diseases etc and their long term complications that are caused by oxidative stress. Nigella Sativa seeds are one such condiment used in food in south east, central Asia and middle east and also used in ancient Indian (Ayurveda) and Greeko-arabic (Unani) systems of medicine. Material and Method: The objective of this study is to quantify the free radical scavenging and Cytoprotective effects of ethanolic extract of Nigella Sativa seeds. To measure the free radical scavenging activity DPPH free radical scavenging assay was used. To measure cyto-protective effects of Nigella Sativa seed extract, an AAPH assay was used with the Cyto-protective effect being measured on RBCs (Red blood cells) suspended in PBS buffer. Results: In the DPPH assay the ethanolic extract of Nigella Sativa seeds showed significant free radical scavenging activity. The activity was concentration dependent. Conclusion: In AAPH RBC lysis assay the ethanolic extract of Nigella Sativa seeds did show considerable protective effect against AAPH induced RBC lysis. Once again the activity was concentration dependent.