Antibiotic prophylaxis for cataract surgery - Practice patterns amongst Indian Ophthalmologists

Purpose: To assess the current trends in use of perioperative antibiotic prophylaxis, especially intracameral antibiotics (ICAB), for cataract surgery in India. Methods: This was an E?survey using a previously validated questionnaire carried out by the All India Ophthalmological Society (AIOS) in August 2022. An E?mail invitation to complete an online 40?point survey was sent to all members of the AIOS using a digital E?mail service (Survey Monkey) and social media platforms. Results: Out of 1804 total respondents, 58% (n = 1022) reported using routine ICAB prophylaxis. Of those using ICAB, 89% (n = 909) reported using it for all cases, whereas the rest used it for specific indications such as post?PC rent (n = 43), one eyed patient (n = 19), and high?risk cases (n = 50). Commercially available moxifloxacin was by far the commonest agent used for ICAB (n = 686, 67%). Eighty respondents (8%) reported noticing occasional toxic reactions and nontoxic corneal edema (n = 64, 6%) with ICAB. Surgeons with >10 years� experience especially practicing in medical colleges used fewer ICAB (OR = 0.52, 95%CI = 0.38 � 0.72, P < 0,001) compared to younger surgeons (<5?year experience) in solo clinics. The commonest reason for nonadoption of IC antibiotics was 搖nconvinced of the need to use it in my setting� (n = 296, 52% of those who answered this question). Conclusion: IC antibiotic prophylaxis for cataract surgery has significantly increased in India from 40% in 2017 to 58% in 2022. Commercially available moxifloxacin was preferred by the majority users. Intraocular inflammation may occur occasionally and needs safer formulations to avoid this

VARIATIONS IN INVOLVEMENT OF STRUCTURES IN PATIENTS WITH COVID-19 ASSOCIATED RHINO-ORBITO-CEREBRAL MUCOR MYCOSIS

Mucormycosis or black fungus previously called as zygomycosis is not a common fungal disease. It occurs in the patients with low neutrophil counts, severe malnutrition and hematological malignancies. Mucor mycosis also common in patients with tuberculosis, diabetes mellitus, COVID-19 and steroid therapy since all these conditions lead to low immunity. Mucormycosis involves different body organs like nose, orbit, brain, skin, gastrointestinal tract, lung, blood and is classied accordingly. Infection mainly enters in the body through nose and mouth or through cuts present over the skin. In case of rhino-orbito-cerebral type of mucormycosis the clinical feature might be from nasal blockage and crusting to life threatening complication like brain abscess and meningitis. The treatment for mucor mycosis might be antifungal drugs alone or combined with surgical debridement depending upon involvement of vital structure and complications. After covid-19 infection, incidence of rhino-orbito-cerebral mucor mycosis increased. The rare disease is to be common due to multiple factors in covid-19 infected patients. Diabetes was a major etiological factor because high blood glucose level and acidosis is responsible for virulence and survival of the fungi. Most common clinical feature was nasal blockage and crusting of nasal cavity mucosa and most common involved sinus was maxillary sinus while involvement of maxillary sinus with ethmoid sinus was highest.

STUDY OF BIOMEDICAL WASTE MANAGEMENT IN DIFFERENT TYPES OF MEDICAL FACILITIES

OBJECTIVE- To study disposal of different types of biomedical waste and to studythe status of BMW management in different level of hospitalsMETHOD-Medical facilities were divided into 4 groups. 10 facilities from each groupwere selected by simple random sampling. Facilities were visited by surveying groupsand specific data about collection and disposal of waste were collected by askingmanagement personnels of hospitals, doctors and staff.RESULT- 90% of single speciality hospitals and 80% of multispeciality hospitals arefollowing proper storage and segregations of BMW.90% of super speciality hospitalshave transportation facilities.60% of super speciality hospitals , 30% of multispecialityand 20% of single speciality hospitals have incinerators. All super speciality hospitalshave autoclave machines, while 70% of single and 50% of multispeciality hospitalshave that. While only 2 out of 10 clinics have an autoclave machine.60% of both clinicsand Superspeciality hospitals are using land disposal as a method of BMWmanagement. 80% of small clinics and 70% of multispeciality hospitals are having dryand wet thermal management.CONCLUSION- Superspeciality hospitals and Single specialty hospitals are usingcostly methods like incineration and autoclave also following guidelines for storage ,segregation and transportation of BMW properly while amongst all most small clinicscan’t afford costly methods so uses cheaper techniques like chemical treatment and dryand wet thermal methods.

Mumbai metropolitan region eye care facility survey: Mumbai Eye Disease Study (MEDiS) report #1

Purpose: To examine the eye care practice in the Mumbai Metropolitan Region (MMR). Methods: This study consisted of primary and secondary research conducted in five zones of MMR. The primary research included interviews with the patients, eye care providers, and key opinion leaders. The secondary research included analyzing data from the professional ophthalmology societies, public health domain, and health insurance providers. We divided people into three economic classes by annual income – low (<INR 0.3 m), middle (INR 0.31–1.8 m), and high (>1.8 m). We analyzed the collected data to estimate the eye care demand– supply, quality of eye care, health?seeking behavior, gap in eye care delivery, and eye care expenditure. Results: We examined 473 key eye care facilities and interviewed 513 people. The ophthalmologist density in MMR was 80/million, and it was the highest in North MMR. Most ophthalmologists visited several facilities. Cataract surgery and glaucoma care coverage were better than other specialties; it was poor for oncology and oculoplastic services. Annual eye examination practice was poor in the low? and middle?income groups than in the high?income group (48%–50% vs. 85%). Most people preferred visiting eye care facilities within 5 km of their residence. Out?of?pocket spending was between 60% and 83%. Lower?income group people preferred public facilities. Conclusion: MMR eye care needs further improvement in affordable and accessible eye care, health literacy, public health surveillance, research into the application of newer technologies to provide less?expensive home care for the elderly and minimize their hospital visits, and collection and analysis of big data to address city?specific eye health issues.

A STUDY OF PERIPARTUM CARDIOMYOPATHY AMONG CASES OF PREECLAMPSIA AND ECLAMPSIA.

Peripartum cardiomyopathy is a rare complication in pregnancy but is more commonly found in the patients of preeclampsia and eclampsia. The purpose of study is to evaluate incidence of peripartum cardiomyopathy among cases of preeclampsia and eclampsia. This is a prospective observational study. A total of 190 cases of preeclampsia and eclampsia were studied for features of PPCM and subjected to echocardiography. Out of 190 subjects, 3.7% had ?ndings suggestive of PPCM. Incidence of PPCM was 0.009 per year among cases of pre-eclampsia and eclampsia and the incidence of PPCM among 6028 deliveries was 0.001 per year.

Microbiological Profile and Antibiogram of Uropathogens Isolate in Tertiary Care Hospital

Introduction: Urinary tract infections (UTIs) are one of the most common bacterial infections in humans, both in the community and the hospital settings. The distribution of antimicrobial susceptibility data of UTI-causing microorganisms changes from time to time and from place to place. The susceptibility data provided by regional microbiology laboratories helps to choose the empirical antimicrobials to treat UTI. Materials and methods: Total 1381 urine were received in Bacteriology section of microbiology department from January 2022 to August 2022. Urine was processed for culture according to standard operating procedures at Microbiology laboratory, tertiary care hospital. Identification and antibiotic sensitivity testing was performed by automated VITEK-2 compact system. Results: In total, 1381 urine were received during the study period, 433(31.35%) cultures yielded significant pathogens and no organisms were isolated in 941 cultures and some sample was contaminate. The most commonly isolated organism were Escherichia coli (38.8%), followed by Candida spp. 88(20.32%), Klebsiellaspp (13.40%), Pseudomonas aeruginosa (12.24%), Gram positive organisms 12(2%) isolated. E. coli were most susceptible to Amikacin (87%), Fosfomycin (83%), colistin (82%), and tigecycline (78.39%). Klebsiella spp were most susceptible to colistin (72%). Nearly, 75% strains of Klebsiella spp were showing resistance to Carbapenems due to Carbapenemase production. Conclusion: Over enthusiastic use of the antibiotic has resulted in the emergence of drug-resistant bacterial strains in patients. The study of antimicrobial susceptibility patterns of uropathogens in a particular area can guide the clinicians in the rational choice of empirical treatment to prevent the misuse of antibiotics.

Identification and antibiotic susceptibility pattern of Staphylococcus aureus with special reference to methicillin resistant Staphylococcus aureus in tertiary care hospital

Background: The emergence of Methicillin-resistant Staphylococcus aureus (MRSA) has posed a serious therapeutic challenge. It is responsible for a wide range of infections including superficial skin infections, food poisoning, osteomyelitis and septicemia. Aim of this study was to identify and to determine antibiotic susceptibility pattern of Staphylococcus aureus from various clinical samples. Materials and methods: Different clinical specimens were collected and processed for routine culture and antibiotic sensitivity test by standard microbiology techniques. Results: A total of 129 S. aureus strains were isolated from various clinical specimens out of which 84 (65.12%) were Methicillin Resistance Staphylococcus aureus (MRSA). 66(51.16%) S. aureus were obtained from indoor (IPD) patients. S. aureus was found higher in male than female. S. aureus was found highly resistant to Benzylpenicillin (94.57%) followed by ciprofloxacin (77.51%), Erythromycin (61.24%), and Cotrimoxazole (51.94%), Clindamycin (44.19%), and Gentamicin (17.05%). 1 (0.78%) of the isolates were resistance to Vancomycin and Linezolid. For urine isolates Nitrofurantoin was drug of choice. Conclusion: Methicillin resistant Staphylococcus aureus was found 65.12% of Staphylococcus aureus isolates. It was most common in males and hospitalized patients. Teicoplanin or Tigecyline seems to be drug of choice followed by Vancomycin, Linezolid, Tetracycline and Gentamicin. It would be helpful to formulating and monitoring the antibiotic policy and ensure proper empiric treatment.

Perception of Indian citizens regarding lockdown during COVID-19 pandemic in the Indian context

Background: In response to coronavirus disease 2019 (COVID-19), the government of India declared a lockdown on March 24, 2020. This affected the daily life of citizens, influencing the availability of daily needs. There was a diverse opinion among public health experts regarding the implementation of the lockdown. Therefore, this study was planned to assess the perceptions and to study the effects of lockdown and challenges faced by Indian citizens during the lockdown imposed during the COVID-19 pandemic. Materials and Methods: A cross-sectional study was carried out among Indian citizens above 18 years old using the snowball sampling method. Data were collected through Google forms containing a semistructured questionnaire. Results: Of 464 participants, 61.85% of them reported that lockdown is necessary to contain the spread of the coronavirus infection; 50.43% had a negative effect on their job; and felt mental health problems like anxiety, lack of sleep, stress due to increased workload, and the feeling of separated from family. Conclusion: According to the majority of participants, the lockdown was necessary to contain the spread of the pandemic. Participants who faced different problems also found ways to overcome them in a positive way.

Unusual Involvement of Basal Ganglia and Dentate Nucleus in Children with Acute Encephalopathy with COVID-19

Children account for 1% to 5% of diagnosed COVID-19 infection with relatively mild presentation compared to adults. The frequency of neurological involvement in acute COVID-19 infection in children is unclear. COVID-19 is also considered to be a neurotropic virus, but so far, in the pediatric age group, very few cases with involvement of basal ganglia and no case of dentate nucleus involvement have been reported in the literature. The present paper reports two cases of acute encephalopathy with COVID-19, the frst case with basal ganglia involvement and the second with dentate nucleus involvement. Both cases required aggressive management and had complete neurological recovery on follow-up. Hence, these cases are reported to make everyone aware of the neurological presentation with atypical neuroimaging fnding of acute COVID-19 infection in the pediatric age group; timely management improves the outcome.

Stroke – A Rare Initial Presentation of Takayasu Arteritis

Introduction: Now-a-days, young people below age of 40 years without known risk factors are presenting with stroke. The cause of stroke should be found so that recurrence and other complications can be prevented. Case description: An 18-year-old female presented with holocranial headache, focal seizures with impaired awareness and left hemiparesis. The upper limb pulses were absent on both sides, while pulses in lower limbs were present. MRI scan of brain revealed infarct in right middle cerebral artery territory. CT angiography brain showed luminal narrowing in upper limb arteries, carotid artery and vertebral artery. She was treated with antiplatelet drug, tablet carbamazepine, tablet methotrexate with folinic acid and she improved. Discussion: Takayasu arteritis is an inflammatory vasculitis disease causing stenosis in medium and large sized arteries. It can present as stroke, myocardial infarction, aortic insufficiency, retinal ischemia, renal failure and hypertension. Conclusion: Takayasu arteritis is one of the rare causes of stroke, which when detected should be promptly treated to prevent further episodes of stroke and other system complications.

“CLINICAL PRESENTATION OF HYPERTENSIVE EMERGENCY AND URGENCY PATIENTS”

Arterial hypertension affects approximately a billion people worldwide and approximately 30 % of them remain undiagnosed.1% - 2% of known hypertensive patients will have hypertensive emergency at some time in their life Though hypertensive crisis contributes one fourth of all emergency visits and trend is increasing in last few years still there is lack of data over the actual incidence of hypertensive crisis The present study aims to know the incidence and clinical presentation of the hypertensive crisis ( hypertensive emergency and urgency ) in a tertiary hospital and will help us to know the incidence and pattern of clinical presentation with respect to different aspects. This is a prospective Methods; observational study of 100 cases of hypertensive crisis (hypertensive emergency and hypertensive urgency) presenting to the emergency department. Study conduct during 2016 to 2018. The incidence of hypertensive crisis was found to be Results; 20%.Most of the patients were belonged to the 5th and 6th decades of life and Male patients were more than female patients Majority of the patients were known hypertensives for 6 to 10 years and 22% of the known hypertensive patients has discontinued their anti hypertensive medications Cardiovascular symptoms in the form of dyspnoea & chest pain were the most common accompanying symptoms Acute coronary syndrome was the most common clinical manifestation followed by neurological de?cit. As the trend of hypertensive crisis is increasing efforts should be made to reduce the Conclusion; occurrence of hypertension Preventive measures should be taken in the form of community education for dietary modi?cation and routine exercise Routine blood pressure check ups compliance to the anti hypertensive treatment and control of associated comorbidities is essential to reduce the risk of hypertensive crisis.

Predictors of toxicity after neoadjuvant chemoradiotherapy for locally advanced gall bladder cancer

Background: The present study evaluated the correlation of hepatobiliary toxicity and radiation dose received in patients undergoing neoadjuvant chemoradiotherapy (NACRT) for locally advanced unresectable gall bladder cancers (LAGBC). Methods: Twenty-six patients with LAGBC, treated with NACRT (55–57 Gy/25 fractions/5 weeks and weekly gemcitabine 300 mg/m2) within a phase II study, were included. Whenever feasible, surgery was performed after NACRT. Acute and late hepatobiliary toxicity was recorded. Treatment scans were retrieved to delineate central porto-hepatobiliary system (CPHBS), resected liver surface, segment IV B and V, and duodenum. The doses received by these structures were recorded and correlated with toxicity. Results: Of 26 patients, 20 (77%) had partial or complete response and 12 (46%) had R0 resection. At the median follow-up of 38 months, overall survival was 38%. Eight (30%) patients had post-treatment toxicity, of which most common was biliary toxicity (30%). A correlation was observed between the biliary leak and V45Gy CPHBS >50 cm3 (P = 0.070). Higher toxicity was observed in those with metallic stents (P = 0.072). Conclusion: The incidence of the biliary leak was 46%. CPHBS dose was found to correlate with biliary leaks. Restricting V45Gy CPHBS <50 cm3 and using plastic stent may facilitate a reduction in hepatobiliary toxicity in patients undergoing NACRT and surgery.

A REVIEW ON DIGITALIZATION OF HEALTHCARE WITH SWOC ANALYSIS OF DIGITAL PATHOLOGY IN THE BACKDROP OF COVID-19

This is an era where digitalization has creeped into every single task that we perform; be it transaction of money online or consulting doctors over online platforms. Although digitalization in healthcare was slightly slow in its progress, the recent pandemic of COVID that hit the world forced everyone in the healthcare industry to adopt digitalization to its maximum potential. Healthcare digitalization has touched upon various aspects viz. medical education, clinical consultations, radiological and pathological diagnosis, and also medical research. However, in spite of its positive impact on the overall healthcare scenario, there are some challenges which need to be overcome. This review discusses the various domains of healthcare where digitalization could be implemented with an additional analysis of the strengths, weaknesses, opportunities and challenges of digitalization in pathology especially in times of the recent pandemic of COVID

Hepatocellular Carcinoma Evaluation and Management for Physicians: Joint Gastroenterology Research Society and Association of Physicians of India Guidelines

Hepatocellular carcinoma (HCC) is the most common cause of, and accounts for almost 90% of all liver cancers. Data from India is limited especially due to cancer not being a reportable disease and in view of wide variation in diagnostic modalities. This document is a result of a consensus meeting comprising Hepatologists, Interventional Radiologists, Hepatobiliary surgeons, medical and surgical Oncologists nominated by the Association of Physicians of India and Gastroenterology Research Society of Mumbai. The following Clinical Practice Guidelines for practicing physicians is intended to act as an up to date protocol for clinical management of patients with hepatocellular carcinoma. The document comprises seven sections with statements and sub-statements with strength of evidence and recommendation.

Correlation of caries occurrence in primary teeth using human leukocyte antigen typing and maternal and physiochemical factors

Background: Dental caries being the leading health issue worldwide has no specific cure due to its multifactorial etiology and genetic susceptibility. Hence, this paper attempted to correlate the clinical and hereditary factors between mother and child, to predict the caries occurrence in child in future, and thereby implement early preventive measures. Aim: The aim of the study was to look for an association between maternal and child's human leukocyte antigen (HLA)-DR4 levels and relate it with other physiochemical factors to assess caries susceptibility in children. Methodology: Saliva samples were collected from children who were in the age group of 0–6 years and their mothers by spitting method and swab method. The clinical indicators such as Decayed, Missing, and Filled Teeth, decayed, extraction needed, and filled teeth, salivary flow rate, and pH were recorded by clinical evaluation. The Streptococcus mutans count was measured by culture plate followed by colony count method, and the HLA-DR4 factor was assessed using ELISA. Results: The results revealed a statistically significant correlation between the physiochemical factors of the mother and the child. The genetic factor in which the HLA-DR4 caries indicator was checked also has a strong association between the mother and the offspring. Thus, a strong caries prediction formula was derived through which probability of caries occurrence in the child could be determined prematurely. Conclusion: Thus, it can be concluded that using the clinical and genetic factors, the caries prediction can be done for the child and preventive protocol can be started before disease occurrence.

Management of video?assisted thoracoscopic (VATs) bilateral cardiac sympathectomy in refractory ventricular storm: A case report

A 65?year?old male post?CABG surgery presented with history of ventricular storm refractory to antiarrhythmics and requiring multiple DC shocks. He got posted for VATs bilateral cardiac denervation for sympathetic remodulation. Patient was induced with high dose opioids and Etomidate and intubated with 37Fr left double lumen tube. A multidisciplinary approach was planned to tackle peri?operative cardiac event along with the placement of invasive monitors. Events that might lead to sympathetic overactivation because of laryngoscopy, pain, capnothorax, and surgical handling were kept in mind and avoided with optimum depth of anesthesia, analgesia, and pharmacological sympatholysis. There was no major cardiac event intraoperatively as well as in postoperative period.

Schizophyllum commune maxillary sinusitis in an immunocompromised patient: A case report

Schizophyllum commune is a basidiomycotic fungus that grows ubiquitously on trees and rotting wood. Human infections caused by it are of diverse presentation but are very rare. We present a case of sinusitis caused by S. commune in a 58-year-old female patient with post-COVID-19 infection along with a history of allergic rhinitis and diabetes mellitus type 2. Computed tomography scan findings established the clinical diagnosis of fungal maxillary sinusitis which was confirmed with culture report and polymerase chain reaction followed by sequencing. The patient underwent functional endoscopic sinus surgery. She was treated empirically with itraconazole after surgical excision

Impact of hematologic toxicities during concurrent chemoradiation for cervical cancer

Objective@#To evaluate the prognostic significance of hematological toxicities during cervical cancer treatment. @*Methods@#Patients treated for cervical carcinoma with definitive chemoradiation were identified. Toxicities were assessed during weeks 1 to 6 of concurrent external beam radiation and chemotherapy. Outcomes were analyzed using Cox regression analysis. @*Results@#One hundred twenty-one patients with Federation of Gynecology and Obstetrics stage I-III disease were eligible for analysis. Median age at diagnosis was 45 years (interquartile range, 40-52) with median follow-up time of 34 months (95% confidence interval, 30.8-37.2). All patients experienced some grade of hematologic toxicity. The most common grade 3+ toxicities were low absolute lymphocyte count (n=115, 95%), low white blood cell count (n=21, 17%), and anemia (n=11, 9%). The most common grade 4 toxicity was lymphopenia, experienced by 36% of patients (n=44). Grade 4 lymphopenia was associated with reduced overall survival (hazard ratio [HR], 4.5; P=0.005), progression-free survival (HR, 3.4; P=0.001), and local control (HR, 4.1; P=0.047). Anemia grade 3, 4 was also associated with reduced overall survival (HR, 4.1; P=0.014). After controlling for disease and treatment variables, grade 4 lymphopenia remained significantly associated with reduced overall survival (HR, 9.85; P=0.007). The association with grade 4 lymphopenia only remained significant in women of Hispanic ethnicity. @*Conclusion@#Severe lymphopenia was associated with reduced overall survival and progression-free survival in Hispanic women undergoing definitive chemoradiation for cervical cancer, but not associated with outcomes in non-Hispanic women.