Clinical outcome and course of Tenon’s patch graft in corneal perforation and descemetocele

Purpose: To assess the efficacy and clinical outcome of Tenon’s patch graft (TPG) in corneal perforation and descemetocele. Methods: In this retrospective study, medical records of 83 patients (85 eyes) who underwent TPG for corneal perforation (58, 68%) or descemetocele (27, 32%) between July 2018 and October 2021 were reviewed. Clinical examination and anterior segment optical coherence tomography (AS?OCT) were performed on every follow?up visit. Anatomical success was considered as the restoration of the structural integrity with the formation of scar and anterior chamber (AC). Results: The mean size of the corneal lesions (corneal perforation or descemetocele) was 4.20 ± 1.01 mm. The mean follow?up period was 9.2 ± 5.48 months. The common underlying etiologies were infectious keratitis in 48% and autoimmune disorders in 35% of cases. TPG successfully restored the globe integrity in 74 (87%) eyes (83% in perforation and 96% in descemetocele). Anatomical failure occurred in 11 eyes (13%). The failures were due to graft dehiscence (8 eyes), graft ectasia (1 eye), and scarring with flat AC (2 eyes). The median time to epithelialization and scar formation were 3 and 15 weeks, respectively. Logistic regression analysis showed few predictors for a successful outcome: descemetoceles, noninfective causes, viral keratitis in infectious etiology, and paracentral or peripheral lesions. Conclusion: TPG can be considered an effective and inexpensive treatment for restoring the structural integrity in the eyes with perforations and descemetoceles, particularly when the donor tissue is unavailable. AS?OCT is a valuable noninvasive tool for monitoring the graft status

An insight into the altered ophthalmic dynamics during the COVID-19 pandemic

Purpose: The objective of this survey?based study was to examine the effects of personal protective measures taken at the level of instrument and surgeon during the pandemic on the optics in ophthalmology. Methods: The study involved an online questionnaire of 24 questions which was distributed to ophthalmologists practicing in several hospitals, including residents and fellows undergoing training in ophthalmology in India. The responses were collected through an online data collection tool (Google forms). The participants could choose from multiple options provided to them in each question. Results: A total of 285 participants out of 296 had used modified methods for examining and performing surgical procedures during the pandemic, while 78.7% (265) of the participants acknowledged having encountered difficulty in interpreting the ocular findings of patients while examining in personal protective equipment. Moreover, 58.7% (198) of our study respondents also reported that there was significant worsening of the quality of ophthalmological examination with pandemic?appropriate measures and 84.8% (286) of our study participants also felt that these measures have significantly added to the time of examination, hence increasing the risk of exposure to both patient and doctor. Conclusion: The workplace study has highlighted the crucial aspects of optics in ophthalmology during the pandemic. The protective measures taken during the pandemic have significantly worsened the quality of ophthalmological examination and increased the time taken to perform outpatient department?based and surgical procedures in ophthalmology

Effect of COVID-19 in geriatric individuals and role of a prosthodontist in clinical setup in Indian populations: a literature review

Medical professionals including dentists are one of those high-risk professionals who can easily get affected by COVID-19 due to its highly contagious nature.Evaluating the molecular pathogenesis and the role of immune system in modulating symptoms it can be assumed that susceptibility of COVID-19 to older adults is more.This review aimed to summarize all the information available on electronic databases PubMed, PubMedcentral, Cochranedatabase related to the effect of COVID-19 ingeriatric individuals and guidelines for a prosthodontist during treatment of geriatric individuals in Indian population during this pandemic period.This review will focus on the characteristic symptoms and signs of COVID-19 in geriatric individuals and how the prosthodontists during treatment of geriatric individuals in Indian populations can better equip themselves to prevent the spread of COVID-19 in a clinical setup.

Comparison of pregnancy outcome between clomiphene citrate and sequential clomiphene citrate+human menopausal gonadotropin in intrauterine insemination

Background: Intrauterine insemination (IUI) has been widely used as a common treatment for infertile couples. This study compares the sequential clomiphene citrate (CC) treatment with CC and human menopausal gonadotropin (hMG) treatment in women undergoing IUI. Therefore, this study was designed to determine the effects of addition of gonadotropin (CC+hMG) would improve the pregnancy rate in women undergoing IUI. And also compare the sequential CC+hMG treatment with CC treatment in women undergoing IUI. Methods: A cross-sectional study design was conducted at D. Y. Patil Fertility Centre, D.Y Patil Hospital, Navi Mumbai from September 2018 to August 2019. Source populations were all patients who live in Mumbai, Maharashtra, India. A total of 67 patients were enrolled in this study. (It consisted of 67 sub fertile couples undergoing ovarian stimulation for IUI cycles). Results: There was no significant difference between the two studied groups regarding endometrial thickness (8.3±2.1 versus 9.7±2.8, respectively), number of mature follicles on the day of hCG injection (3.3±1.2 versus 3.5±1.1, respectively) and, but there was significant difference between the CC+hMG group and CC group regarding the total dose of gonadotropins used in ovulation induction (305±23.8 versus 655±192; total IU, respectively) p<0.05. Conclusions: Women undergoing IUI, ovarian stimulation CC combined with hMG, significantly improved the pregnancy and live birth rates as compared to that of CC group. In women undergoing ovarian stimulation and IUI, there are no significant differences in pregnancy and live birth rates among the various stimulation protocols.

Ocular doppler imaging: opening a new window in decoding glaucoma

Background: In the aetiopathogenesis of multifactorial glaucoma autoregulation of ocular blood flow plays an important role as failure of autoregulation may lead to progression of disease. Aim of this study to understand this better this study was designed to investigate the quantum of these abnormalities and their likely role in pathogenesis and prognosis of primary open angle glaucoma(POAG).Methods: This is a case control study design which involved 67 POAG patients and 67 matched controls. The parameters assessed includes peak systolic velocity(PSV), end diastolic velocity(EDV) and resistive index(RI) of ophthalmic artery(OA) and central retinal artery(CRA) of patients having POAG with age and sex matched healthy subjects. The data obtained was statistically analysed using IBM SPSS 21.Results: The study showed decreased PSV of 31.7 cm/s vs 42.7 cm/s(p=0.0001) and EDV11.7 cm/s vs 19.8 cm/s(p=0.002) with increased RI 0.63 vs 0.53(p=0.000) in  OA and PSV of 15.2 cm/s vs 21.4 cm/s(p=0.001) and EDV4.7 cm/s vs 11.7 cm/s(p=0.003) with increased RI 0.69 vs 0.45(p=0.000) in CRA in both eyes in POAG patients as compared to healthy controls.Conclusion: The study has shown the promising application of ocular Doppler in evaluating POAG patients. However, more such studies are needed with larger study sample and on follow up basis for better understanding glaucoma hemodynamics and applicability of ocular Doppler in management of glaucoma.

Unrecognized hyperlucent lesion on lateral film of chest X-Ray

We report an interesting case of bulla right lung, incidently found during CABG surgery.

Atypical recurrence of rheumatic chorea.

Syndenhams Chorea in acute rheumatic fever is reported to occur in 20-30% of patients. It is usually late onset, occurring upto 6 months after acute infection but may occasionally be present as presenting symptom of rheumatic fever. It is a self-limiting condition with spontaneous remission lasting from 1 week to 6 months. The risk of recurrence is present in 1st 1-2 years in about 20% of cases. Most of children (two thirds) with rheumatic fever are of school age (5-15 years of age). It is common in India and the incidence has not shown the declining trends seen in the developing countries. We report the clinical findings, investigations and the course of clinical development of a 14-year-old girl, who presented with Rheumatic chorea which recurred 3 years after the initial episode.

Circulating nucleic acids damage DNA of healthy cells by integrating into their genomes.

Whether nucleic acids that circulate in blood have any patho-physiological functions in the host have not been explored. We report here that far from being inert molecules, circulating nucleic acids have significant biological activities of their own that are deleterious to healthy cells of the body. Fragmented DNA and chromatin (DNAfs and Cfs) isolated from blood of cancer patients and healthy volunteers are readily taken up by a variety of cells in culture to be localized in their nuclei within a few minutes. The intra-nuclear DNAfs and Cfs associate themselves with host cell chromosomes to evoke a cellular DNAdamage- repair-response (DDR) followed by their incorporation into the host cell genomes. Whole genome sequencing detected the presence of tens of thousands of human sequence reads in the recipient mouse cells. Genomic incorporation of DNAfs and Cfs leads to dsDNA breaks and activation of apoptotic pathways in the treated cells. When injected intravenously into Balb/C mice, DNAfs and Cfs undergo genomic integration into cells of their vital organs resulting in activation of DDR and apoptotic proteins in the recipient cells. Cfs have significantly greater activity than DNAfs with respect to all parameters examined, while both DNAfs and Cfs isolated from cancer patients are more active than those from normal volunteers. All the above pathological actions of DNAfs and Cfs described above can be abrogated by concurrent treatment with DNase I and/or anti-histone antibody complexed nanoparticles both in vitro and in vivo. Taken together, our results suggest that circulating DNAfs and Cfs are physiological, continuously arising, endogenous DNA damaging agents with implications for ageing and a multitude of human pathologies including initiation of cancer.

A Conservative Approach Towards Prosthetic Rehabilitation of The Young Female Patient With Amelogenesis Imperfecta- A Case Report.

Amelogenesis imperfecta (AI) is a hereditary disorder expressing a group of conditions that cause developmental alterations in the structure of enamel. This clinical case report describes the oral rehabilitation of a young adult female patient diagnosed with hypoplastic amelogenesis imperfecta with mutilated dentition. The main objective for the selected treatment was to enhance the esthetics, restoring masticatory function and eliminate the teeth sensitivity. Toothsupported overdenture is used as treatment due to patient’s financial constraints. Patient was satisfied with the esthetic and functional expectations.